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The Ins and Outs of Immediate Jeopardy
There are few things that raise the alarm quicker during a facility survey than the mention of possible Immediate Jeopardy. This level of deficiency scope and severity has a significant impact on the facility staff and residents in the present and going into the...
Ask Proactive – A nursing home resident rose out of his wheelchair, walked 2 steps, and stated “I am too weak to move any further” as staff noticed his knees beginning to buckle. Two aides assisted him onto his roommate’s bed. Is this considered a fall?
Q: A nursing home resident rose out of his wheelchair, walked 2 steps, and stated “I am too weak to move any further" as staff noticed his knees beginning to buckle. Two aides assisted him onto his roommate’s bed. Is this considered a fall? A: Yes, this is an...
Infection Preventionist Essentials: Infectious Diseases Common in Post-Acute Care Setting
Long Term Care facilities present unique infection prevention risks. Communal living environments, in general, provide an excellent breeding ground for bacteria and viruses with closed ventilation systems, regular use of common bathing facilities and shared dining...
SNF PEPPER Available: Do you have outliers that may trigger medical review?
The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2021 is now available for download. Follow these steps to access your PEPPER and analyze any outlier billing...
Ask Proactive – My facility considers October through March as “flu season.” Does this mean flu season is officially over for MDS Section O coding purposes?
Q: My facility considers October through March as “flu season.” Does this mean flu season is officially over for MDS Section O coding purposes? A: It’s best not to restrict yourself to specific date ranges for influenza vaccination seasons and reporting...
Ask Proactive – A resident went out to the ER, and while he was there, he received IV medication. Can I count that as ‘IV Medication while a resident’ under O0100H2?
Q: A resident went out to the ER, and while he was there, he received IV medication. Can I count that as ‘IV Medication while a resident’ under O0100H2? A: If the resident was not admitted to the hospital, then he would be considered a resident of the facility...
If I Were Your Compliance Officer
Our office regularly receives urgent calls from providers in crisis. We are in the business of coming alongside nursing facilities to shoulder a portion of the burden, drive corrective actions and assist to remedy problem situations. Given the choice and resources,...
MDS 3.0 Refresh: Mastering the Art of Coding Accuracy
Compliance, Accuracy, Quality. These are words we’ve heard over and over in long-term care. They are part of our everyday regulatory landscape and are essential to MDS data integrity. Despite two years under our belts operating under the PDPM payment model, data shows...
Ask Proactive – What are some best practices for residents who refuse care?
Q: What are some best practices for residents who refuse care? A: In the CMS State Operations Manual – Appendix PP in F 578 §483.10(c)(6), (c)(8), (g)(12) CMS has provided guidance regarding resident refusals: While the resident also has the right to refuse any...
2022 Medical Review in Full Swing
While nursing homes across the nation are seeing a significant decline in COVID-19 cases, providers are reporting a sharp increase in medical review. The most prominent activity includes RAC (Recovery Auditors Contractor) reviews and TPE (Targeted Probe &...
Ask Proactive – What should be done if a PPS 5-Day assessment completed for Managed Care is submitted to CMS?
Q: What should be done if a PPS 5-Day assessment completed for Managed Care is submitted to CMS? A: Assessments that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted, e.g., private insurance, including but not limited to...
Ask Proactive – I’ve assumed a new role that requires me to audit our compliance with reporting to NHSN. The instructions for completion of the LTCF COVID-19 module are not clear in some areas. For example, we are the designated COVID-19 unit amongst two sister facilities. If the patient acquires COVID in my sister facility, then transfers to my facility, and passes away due to the infection, do I have to count this as a resident COVID death in my facility?
Q: I’ve assumed a new role that requires me to audit our compliance with reporting to NHSN. The instructions for completion of the LTCF COVID-19 module are not clear in some areas. For example, we are the designated COVID-19 unit amongst two sister facilities. If the...
F761 Label/Store Drugs & Biologicals
F 761 Label/Store Drugs & Biologicals is consistently a “Top 10” deficiency. Compliance with F761 is complicated by the vast number of medications and related supplies that facilities must utilize each day, along with the multiple places they must be stored,...
Biden Announces Nursing Home Reforms
Biden’s March 1st State of the Union speech included a promise to bring Nursing Home Industry Reforms including minimum staffing requirements, enhanced nursing home oversight, and greater transparency of facility ownership with a focus on private equity firms. The...
Ask Proactive – We have a patient who received a skilled stay (34 days) using the spell of illness waiver (related to positive COVID condition and clinical needs). She just returned from the hospital outside her 30-day window, but still has 38 days remaining in the benefit period. Can we skill her again? How many times can we use the waiver for a patient?
Q: We have a patient who received a skilled stay (34 days) using the spell of illness waiver (related to positive COVID condition and clinical needs). She just returned from the hospital outside her 30-day window, but still has 38 days remaining in the benefit period....