News / Blog
Need to brush up on the latest industry news? Look no further! Proactive Medical Review consultants provide up-to-date blog postings to keep you in the know.
The latest news, events, blogs and more…
CY2022 Medicare Part B Proposed Rule Impact to LTC Therapy Departments
Last month, CMS released the “Medicare Part B” CY 2022 Medicare Physician Fee Schedule (PFS) Proposed Rule outlining proposed changes which would take effect January 1, 2022. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. The...
Ask Proactive – Are there going to be any MDS Updates in October?
Q: Are there going to be any MDS Updates in October? A: Updates are not expected. The CMS PHE Tip Sheet provides the following: The Center for Medicare and Medicaid Services (CMS) posted an update on May 8, 2020 announcing the delayed release of updated...
CMS Returns to Per-Day CMPs
On July 28, 2021, CMS issued a memo stating that they are removing the guidance they issued in 2017 that instructed CMS Locations to impose civil monetary penalties (CMPs) for prior noncompliance solely on a per-instance basis. CMS states they will now retain the...
Census Development 101: First Impression Focused Tours
It takes 27 seconds to make a first impression.[i] How is your facility fostering a positive impression as visitors enter the property, open your front door and wait in the lobby before a tour? The front entrance and lobby should be one of the most appealing areas of...
Ask Proactive – With most facilities awaiting their annual survey after waiting 15 months to 2 years without one, what are some tips for things to double check to make sure they are prepared?
Q: With most facilities awaiting their annual survey after waiting 15 months to 2 years without one, what are some tips for things to double-check to make sure they are prepared? A: Answer: One of the most important things to do is to make sure you have all of...
Ask Proactive – How is the patient classified under PDPM if neither the BIMS nor the CPS staff assessment is completed to determine cognitive level?
Q: How is the patient classified under PDPM if neither the BIMS nor the CPS staff assessment is completed to determine cognitive level? A: If neither the BIMS nor the staff assessment is completed, a patient will be classified under PDPM as if the patient were...
Telehealth’s Impact on Short Stay Emergency Department Visit QMs
Nationally, telehealth appears to have had a positive impact on the CMS Quality Measures regarding Emergency Department (ED) Visits—has your facility shown improvement in this area? In March 2020, following the declaration of the COVID-19 public health emergency, CMS...
Ask Proactive – We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare Part A for this while she remains on Hospice?
Q: We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare...
The Current State of Recertification Surveys Across the Nation
Wondering when surveyors will be at your facility for your annual survey? You’re not alone. This past year has been anything but normal in terms of survey activities. Let’s take a look at the current state of recertification surveys occurring across the nation and...
Start Here for PDPM Reimbursement Accuracy
Even though SNFs have collectively seen higher reimbursement rates under the Patient-Driven Payment Model compared to the previous RUG IV payment model, data shows that there is still room for improvement for most facilities in terms of ensuring accurate revenue under...
Ask Proactive – Do citations received during Focused Infection Control Surveys impact my Five-Star rating?
Q: Do citations received during Focused Infection Control Surveys impact my Five-Star rating? A: Yes, focused infection control surveys are included in the rating calculation, with citations from these surveys counting towards the total weighted health...
Ask Proactive – How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code?
Q: How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code? A: Fractures result from trauma or injury or a pathological condition. With a periprosthetic fracture, two ICD-10 codes would be utilized. One code would include the...
Internal Investigations
When you became a long-term care Administrator or Director of Nursing you probably didn’t envision that you would also wear the hat of a detective. In today’s long-term care environment, being able to conduct a thorough internal investigation is a critical strength...
Part 2: Ready, Set, Medical Review-Preparing for PDPM Audits
The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020 this past August, but according to a June 3, 2021 announcement may now officially begin conducting post-payment medical reviews for later dates of...
Ask Proactive – Our facility is seeing an influx of Medicare Advantage Medical Review. Unfortunately, there have been a few denials based on the PDPM HIPPS code billed versus the HIPPS code generated from the MDS assessment. For example, the MA plan predetermined a score without comorbidity conditions COPD and Pulmonary Fibrosis. Now they have denied at the medical review because our MDS HIPPS code (KAPD1) did not match the plan’s approved HIPPS code (KAPF1). We billed as was approved, not what was MDS generated. Is there any way to overturn these decisions? We haven’t had luck so far.
Q: Our facility is seeing an influx of Medicare Advantage Medical Review. Unfortunately, there have been a few denials based on the PDPM HIPPS code billed versus the HIPPS code generated from the MDS assessment. For example, the MA plan predetermined a score without...