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…
Ask Proactive – I know the PHE is set to expire in July. As we continue to admit new patients using the SNF waivers, what will happen if the PHE ends during the patient’s benefit period?
Q: I know the PHE is set to expire in July. As we continue to admit new patients using the SNF waivers, what will happen if the PHE ends during the patient’s benefit period? A: Effective April 21, 2021, HHS Secretary extended the PHE, the new expiration date...
How Hot is Your SNF PEPPER?
As part of CMS’ goal of preventing Medicare fraud, waste and abuse, PEPPER (Program for Evaluating Payment Patterns Electronic Report) analyzes billing patterns to determine the level of risk for improper payments in key target areas. PEPPER compares your SNF’s...
Updated CDC & CMS Guidance for Fully Vaccinated Individuals
On April 27, 2021, the CDC provided updated Healthcare Infection Prevention & Control Recommendations in Response to COVID-10 Vaccination and CMS updated guidance related to COVID-19 testing and visitation. Revisions to QSO-20-38-NH related to facility testing...
Ask Proactive – Is this a Fall with Major Injury? A resident had an unwitnessed fall and self-reported that she hit her head. No injuries or concerns were noted upon post-fall evaluations. Three days later, the resident was transferred to the hospital due to chest pain and non-reactive pupils. Diagnostic imaging showed a subdural hematoma. Should this be reported on the MDS as a fall with major injury?
Q: Is this a Fall with Major Injury? A resident had an unwitnessed fall and self-reported that she hit her head. No injuries or concerns were noted upon post-fall evaluations. Three days later, the resident was transferred to the hospital due to chest pain and...
2021 Audit Forecast: Cloudy with a Chance of Storms
Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive...
Ask Proactive – In addition to the 6 feet spacing guidance, handwashing and the use of masks, what other things should be considered when opening up for communal dining?
Q: In addition to the 6 feet spacing guidance, handwashing and the use of masks, what other things should be considered when opening up for communal dining? A: On April 6, 2021, AHCA/NCAL provided a summary of the CMS guidance with the following recommendations...
Proactive to Partner with McKnight’s LTC News
Proactive Medical Review (PMR) is proud to announce that Eleisha Wilkes, RN, RAC-CTA, DNS-CT will join McKnight’s Long-Term Care News (McKnight’s) as the new monthly columnist for the Ask the Payment Expert News Column. This column features responses to frequently...
Ask Proactive – Is it required that the SNF primary diagnosis and the primary diagnosis for the qualifying hospital stay match?
Q: Is it required that the SNF primary diagnosis and the primary diagnosis for the qualifying hospital stay match? A: No, the SNF primary diagnosis and the primary diagnosis from the qualifying hospital stay do not need to match. We want to be sure we are...
FY 2022 SNF PPS Proposed Rule Released
On April 8, 2021, the Centers for Medicare and Medicaid Services (CMS) released the FY 2022 SNF PPS Proposed Rule which will take effect October 1, 2021. As anticipated, changes to the Patient Driven Payment Model (PDPM) rates and Case Mix Indexes (CMI) are proposed....
Care of the SNF Dialysis Recipient
Per the CDC, the prevalence of CKD in adults aged 30 years or older is expected to increase from 14.4% in 2020 to 16.7% in 2030. For those progressing to End-Stage Renal Disease (ESRD), dialysis is a crucial intervention to prolong life. While you may already be...
Ask Proactive – We had a resident that was discharged home with family, return not anticipated. He suffered a fall after returning home, the family decided they could not care for him and readmitted him to our facility 8 hours after discharge. Since he wasn’t out after midnight, do we have to complete discharge/entry MDS assessments?
Q: We had a resident that was discharged home with family, return not anticipated. He suffered a fall after returning home, the family decided they could not care for him and readmitted him to our facility 8 hours after discharge. Since he wasn’t out after midnight,...
COVID-19 Litigation
Nursing homes have seen a wave of complaints alleging negligence and wrongful death as a result of purportedly failing to protect residents from contracting the COVID-19 virus. As of March 23, 2021, over 9,500 complaints related to COVID-19 have already been filed in...
Medication Management: Best Practices for Regulatory Compliance
Are you ready for the annual survey and the Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review task that is part of that process? Surveyors select 5 residents to conduct this review on following the Critical Element Pathway. Consider...
Ask Proactive – Now that standard surveys are beginning to resume, will surveyors still conduct the annual survey if we have active COVID-19 cases in the facility and will it trigger them to combine a Focused Infection Control (FIC) Survey with the annual survey?
Q: Now that standard surveys are beginning to resume, will surveyors still conduct the annual survey if we have active COVID-19 cases in the facility and will it trigger them to combine a Focused Infection Control (FIC) Survey with the annual survey? A: Yes,...
Ask Proactive – If we have a resident who has a bed that is lowered very close to the floor, and we have a mat beside the bed, and the resident rolls or moves off of the bed onto the mat, is that considered a fall?
Q: If we have a resident who has a bed that is lowered very close to the floor, and we have a mat beside the bed, and the resident rolls or moves off of the bed onto the mat, is that considered a fall? A: Unfortunately, as you will see in this section from the...