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Setting Priorities for 5-Star Improvement
2020 was anything but normal in terms of survey processes and 5-Star rating system updates. All three of the 5-Star rating system domains were temporarily held constant at some point during 2020. On Jan. 27, 2021, CMS resumed calculating nursing home 5-Star ratings...
Taking Your Nursing Documentation to Court
“No matter how skilled or experienced you are, inaccurate or incomplete nursing documentation can mean serious trouble for your patients – and for you if you’re ever involved in a lawsuit.” Austin, Nursing2021. Many nurses who have had to testify in a deposition or...
Ask Proactive – How are reviewers determining PDPM payment accuracy from Section GG coding?
Q: How are reviewers determining PDPM payment accuracy from Section GG coding? A: The Function Score calculated from coding responses to certain Section GG items impacts your PDPM rate in the nursing component and the OT/PT component. Not surprisingly,...
Post-Pandemic Considerations – Moving Forward Instead of Just ‘Back to Normal’
There’s nothing quite like a National Public Health Emergency to shake things up and force an altered perspective. Most providers are doing well to keep up with near-daily changes relative to managing the pandemic in its current form and, in a whirlwind of Infection...
Ask Proactive – I am seeking assistance for accurate coding of CVA at item I4500 of the MDS. The physician acknowledges history of stroke in his progress note during the look-back period. The patient also receives daily aspirin and requires ongoing medication management for stroke prevention, nurses monitor for potential side effects from medication including signs & symptoms of bleeding and bruising. Would this meet the criteria to code active condition CVA at I4500?
Q: I am seeking assistance for accurate coding of CVA at item I4500 of the MDS. The physician acknowledges history of stroke in his progress note during the look-back period. The patient also receives daily aspirin and requires ongoing medication management for stroke...
Restorative Nursing Program-Overcoming the Barriers and Obstacles
Last week we reviewed Restorative Nursing and its relationship with COVID in part 1 of this 2-part series. It’s been a tumultuous time in long-term care and restorative programs may have had to be put on the back burner temporarily. How do we rebuild and possibly even...
Ask Proactive – I would like to code isolation for a resident who has COVID and was in single room isolation for 4 days in the look-back period. However, the therapy documentation reports 2 episodes of the resident walking in the hallway. Can we still code isolation?
Q: I would like to code isolation for a resident who has COVID and was in single room isolation for 4 days in the look-back period. However, the therapy documentation reports 2 episodes of the resident walking in the hallway. Can we still code isolation? A:...
Rebuilding: Restorative Nursing Programming After COVID-19
In the heat of the pandemic battle, staffing shortages and emergency prioritization of tasks left many facilities with no choice but to triage programming. Functional decline is not unusual as residents already prone to decline faced pandemic driven activity...
Ask Proactive – Do you recommend including concurrent therapy in your POC & rationale? For group tx, there is a separate CPT code. Many therapists may provide concurrent tx later in the plan of care when patient is safer.
Q: Do you recommend including concurrent therapy in your POC & rationale? For group tx, there is a separate CPT code. Many therapists may provide concurrent tx later in the plan of care when patient is safer. A: Modes of Therapy are outlined in Chapter 3...
SNF QRP Update: Infections & Staff COVID-19 Vaccination Measures Proposed
In Dec 2020, CMS issued its 2020 measures under consideration (MUC) list that included two proposed new SNF QRP quality measures (QMs). The measures under consideration are: Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (outcome...
Ask Proactive – What are the ARD, completion and transmission requirements for the IPA?
Q: What are the ARD, completion, and transmission requirements for the IPA? A: The ARD may be set for any day of the SF PPS stay, beyond the ARD of the 5-day assessment. The IPA must be completed within 14 days after the ARD (ARD+14 days). The IPA must be...
Clinical Foundations: Person-Centered Care for the Resident with Dementia
There are 47 million people worldwide diagnosed with dementia and 9.9 million new cases each year (World Health Organization Media Center, 2017). It is well known that residents living with dementia have complex care needs that should be taken into account by...
Ask Proactive – I have a resident with an active diagnosis of hyperglycemia who is receiving blood glucose monitoring and scheduled and sliding scale insulin during the 5-day assessment look-back period. Why is the NTA Case-mix Group NF (0 points)?
Q: I have a resident with an active diagnosis of hyperglycemia who is receiving blood glucose monitoring and scheduled and sliding scale insulin during the 5-day assessment look-back period. Why is the NTA Case-mix Group NF (0 points)? A: Hyperglycemia alone is...
PDPM Top 10 Can’t Miss Success Strategies: Driving Quality Care & Reimbursement in 2021
They say hindsight is 20/20. Most are glad to see 2020 go; it’s certainly been a challenging year. After the first full calendar year of the Patient-Driven Payment Model (PDPM), several key takeaways in terms of successful implementation strategies have become clear....
Ask Proactive – What time periods are reflected in the current 5-Star Rating that was updated Jan. 2021?
Q: What time periods are reflected in the current 5-Star Rating that was updated Jan. 2021? A: The Jan. 2021 refresh includes data for the following: Health Inspections – Your current health inspection rating includes data from your last 3 recertification...