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Long Term Care Mock Survey Considerations: A Study in Survey Readiness
Is your nursing facility survey ready? Are you up to date with all of the upcoming regulatory changes effective in October 2022? Preparation for the annual recertification survey should be ongoing, with a formal mock survey process several months prior to the...
Medicare A PPS and MDS Essentials for the DON
If you are currently a Director of Nursing or are considering taking on that role, you understand that clinical knowledge is only one ingredient in the recipe that makes an effective nurse leader. Among numerous responsibilities, the challenging role of DON includes...
Ask Proactive – I understand SNFs will be transitioning from using QIES to IQIES for transmission of assessment data in early 2023. What steps should providers take to prepare for this transition?
Q: I understand SNFs will be transitioning from using QIES to IQIES for transmission of assessment data in early 2023. What steps should providers take to prepare for this transition? A: Although the MDS submission and reporting functionality in IQIES will not be...
Will the FY 2023 SNF final rule change how CMS defines the COVID-19 population?
Q: Will the FY 2023 SNF final rule change how CMS defines the COVID-19 population? A: For the FY 2023 SNF final rule, CMS defines the COVID-19 population to include the following: Stays that have the interim COVID-19 code B97.29 from January 1, 2020 to March 31, 2020...
Revised LTC Surveyor Guidance—Prepare for Oct. 24th Survey Updates
On June 29, 2022, CMS issued QSO-22-19-NH, announcing the release of new Interpretive Guidance for Phase 3 requirements, which went into effect November 28, 2019, as well as revisions to Phase 2 guidance. Surveyors will begin using this guidance to identify...
Ask Proactive – Claim Denial Based on ICD10 Coding
Q: We have a claim denial from a commercial insurance plan that references their policy related to Excludes 1 Notes based on the ICD10 Official Guidelines for Coding & Reporting. OT and PT used codes R26.2 (difficulty in walking) and R26.81 (unsteadiness on feet)...
Avoiding F695 Respiratory/Trach Care and Suctioning Tags
F695 Respiratory care, including tracheostomy care and tracheal suctioning, is one of the top 10 areas cited most often in nursing homes. This regulation states that the facility must ensure that a resident who needs respiratory care, including tracheostomy care and...
Ready for Survey?
Now that annual surveys have resumed, long-term care facilities should be prepared for the first Annual survey they may have had in a very long time. Consider completing a survey readiness checklist as part of your facility’s self-evaluation. Use this sample checklist...
MDS to Transition to iQIES – Action Required!
CMS will be migrating MDS submission and reporting to the internet Quality Improvement and Evaluation System (iQIES) in early 2023. The iQIES portal is available at https://iqies.cms.gov/ and will soon be the new interface for MDS submission and reporting, replacing...
Ask Proactive – Can a resident requiring the CDC updated “Enhanced Barrier Precautions” be coded in Section O0100M for Isolation or Quarantine?
Q: Can a resident requiring the CDC updated “Enhanced Barrier Precautions” be coded in Section O0100M for Isolation or Quarantine? A: No. The CDC updated Enhanced Barrier Precautions (EBP) do not meet the RAI requirements for coding Isolation or Quarantine on the MDS...
Proactive Summary – FY 2023 SNF Final Payment Rule
On July 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY)...
QAPI Efficacy: From Plan to Sustained Improvement
Nursing homes are required to develop, implement, and maintain an effective, comprehensive, and data-driven Quality Assurance & Performance Improvement (QAPI) program to improve the quality of life and quality of care delivered to residents. Establishing an...
Ask Proactive – I have a resident who was discharged (unplanned) and remained in the hospital for 15 days before returning to my facility. A Quarterly MDS assessment fell due during the time they were out of the facility and my software is showing it as late or missed. What should I do?
Q: I have a resident who was discharged (unplanned) and remained in the hospital for 15 days before returning to my facility. A Quarterly MDS assessment fell due during the time they were out of the facility and my software is showing it as late or missed. What should...
Risk Management Strategies for the DON
The word “Risk” is referenced in the CMS State Operations Manual - Appendix PP 524 times. Clearly Risk Management is a critical area of focus for the Director of Nursing and the nursing department. According to the article Clinical Areas of Liability: Risk Management...
Update: SNF Qualifying Hospital Stay (QHS), Benefit Period Waivers and Medical Review Preparedness
Effective July 15, 2022, HHS Secretary extended the PHE, the new expiration date being October 13, 2022. CMS continues to recognize that disruptions arising from a PHE can affect coverage under the SNF benefit: Prevent a patient from having the 3-day inpatient QHS...