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Ask Proactive – A resident was admitted with a pressure injury (PI) that was unstageable because it was covered with slough and eschar. I coded it on the admission MDS under M0300F(Unstageable Pressure Ulcers Related to Slough and/or Eschar). I’m now doing a quarterly and the slough has been debrided, but there is still a lot of eschar. Do I still code it as unstageable on the MDS?
Q: A resident was admitted with a pressure injury (PI) that was unstageable because it was covered with slough and eschar. I coded it on the admission MDS under M0300F(Unstageable Pressure Ulcers Related to Slough and/or Eschar). I’m now doing a quarterly and the...
Avoiding the #2 Survey Tag: F812 Food Procurement
Based on 2021 Survey Data, F-Tag 812: Food Procurement was the second most cited deficiency on annual surveys and the 5th most cited overall. So far, in 2022, it has been the #1 deficiency cited on annual survey and the 4th most cited overall. (Source: S&C's...
Guidance on Precautions for Unvaccinated Staff
According to CMS, facilities are required to “ensure that staff who are not yet fully vaccinated, or who have a pending or been granted an exemption, or who have a temporary delay as recommended by the CDC, adhere to additional precautions that are intended to...
Care Planning for Fall Prevention
Falls in nursing homes are an unfortunate, yet common occurrence. Studies show that approximately half of nursing home residents in the United States fall each year, and a 2014 report by the Office of the Inspector General found that nearly 10% of adverse events...
Ask Proactive – Under the NHSN Data Reporting, who is included in contracted and vendor HCP (healthcare personnel) for vaccination reporting?
Q: Under the NHSN Data Reporting, who is included in contracted and vendor HCP (healthcare personnel) for vaccination reporting? A: After the NHSN COVID-19 Vaccination Team held webinars in November 2021 that reviewed frequently asked questions (FAQs) and data entry...
Top Vulnerabilities in SNF Infection Prevention and Control Programs
Is your facility at risk for one of the top vulnerabilities in SNF IPC programs? With the ongoing COVID-19 public health emergency, CMS has made Infection Prevention and Control programs (IPC) a significant focus of survey efforts. Surveys are bringing to light many...
Ask Proactive – Are the resident quarantine requirements the same for residents who are unvaccinated and those who are vaccinated, but have not received a booster?
Q: Are the resident quarantine requirements the same for residents who are unvaccinated and those who are vaccinated, but have not received a booster? A: Yes, Based on updated guidance released by the CDC on Feb. 2, 2022: CDC now recommends quarantining residents who...
Ask Proactive – What happens if a patient receives more than 25% of therapy in a concurrent/group setting?
Q: What happens if a patient receives more than 25% of therapy in a concurrent/group setting? A: The provider will receive a warning edit on the validation report that will inform them that they have exceeded the 25% limit. The edit will state: “The total number of...
Understanding the CMS Vaccine Mandate and Compliance with F888
BACKGROUND On November 5, 2021, CMS published an interim final rule with comment period, entitled “Medicare and Medicaid Programs; Omnibus COVID-19 health Care Staff Vaccination.” This IFC revised the infection control requirements, adding a staff vaccination mandate...
Vaccine Mandate To-Do List with Compliance Dates
With the Supreme Court vaccine mandate decision, state surveyors (and/or CMS) will soon begin enforcing COVID-19 vaccine requirements under F888. The mandate covers all Medicare certified health care facilities under the Medicare & Medicaid requirements of...
The Primary Diagnoses Under PDPM: How to Avoid Common Mistakes
Since the inception of PDPM, selecting the Primary Diagnosis has been a challenge for MDS/RAI coordinators. Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B largely determines reimbursement for the entire Medicare stay...
Ask Proactive – Since the Discharge MDS does not have a HIPPS code, do we have to do the BIMS/PHQ-9 interviews at DC?
Q: Since the Discharge MDS does not have a HIPPS code, do we have to do the BIMS/PHQ-9 interviews at DC? A: Although the discharge assessment is not required for reimbursement purposes, it is required for regulatory compliance. RAI guidelines (pp. C-1-2) state that...
A Fresh Look at Fall Prevention
It probably comes as no surprise that falls are the number one cause of injury for seniors, the leading cause of hospital admissions for nursing home residents, and the top issue prompting facility lawsuits. The average facility fall-related cost is $17,000.00. Half...
Ask Proactive – I’ve just received an old findings letter from our recent RAC audit. Unfortunately, it looks like our time for open discussion has expired. What should we do next?
Q: I’ve just received an old findings letter from our recent RAC audit. Unfortunately, it looks like our time for open discussion has expired. What should we do next? A: A phone call to the customer service number listed on the letter may prove successful. If not, the...
Ask Proactive – Should discontinued and/or revised policies still be maintained by the facility?
Q: Should discontinued and/or revised policies still be maintained by the facility? A: It is always best to check with your facility legal counsel for their guidance on what documents, other than resident care records, should be maintained, where to maintain them and...