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Ask Proactive – In order for us to capture in room isolation for our COVID positive residents, what is needed for supportive documentation? Also, is there a length of time this resident has to be in isolation in order to capture it?
Q: In order for us to capture in room isolation for our COVID positive residents, what is needed for supportive documentation? Also, is there a length of time this resident has to be in isolation in order to capture it? A: The resident must have an “active”...
Does your Falls Management Program Have Room for Improvement?
Did you know that of the 1.6 million residents in U.S. nursing facilities, approximately half fall annually? (CDC) About 1 in 3 of those who fall will fall two or more times in a year. The CDC also indicates that one in every 10 residents who fall has a serious...
Ask Proactive – With the extension of the PHE effective January 21st, can we expect the 5-star rating related to Quality Measures to remain “frozen”?
Q: With the extension of the PHE effective January 21st, can we expect the 5-star rating related to Quality Measures to remain “frozen”? A: No. In December, CMS announced quality measures posted to the Care Compare website and used in the Five Star Quality...
Focused QAPI Programming During All-Time Census Low
With occupancy in senior living communities at an all-time low of 80.7% during the fourth quarter, planning to capture accurate payments, safeguarding revenue to withstand the scrutiny of Medical Review and securing 5 star status is more important than ever as we...
Ask Proactive – During the COVID-19 Pandemic, some states have been allowing facilities to temporarily certify beds during the declared pandemic emergency for Medicare/Medicaid that were not already certified. Do MDS Assessments have to be completed for residents in these beds, that are only certified temporarily?
Q: During the COVID-19 Pandemic, some states have been allowing facilities to temporarily certify beds during the declared pandemic emergency for Medicare/Medicaid that were not already certified. Do MDS Assessments have to be completed for residents in these beds,...
Best Practices with Skilled Nursing Documentation for COVID-19+ Patients
Through the challenges of the pandemic, charting quality may have taken a backseat to other priorities during times of staffing shortages and outbreaks. However, claims for services related to COVID-19 care are vulnerable to medical review. Consider these best...
Driving Clinical Quality – Identifying Changes in Condition
Early identification of a change in a resident’s condition can lead to timely and effective intervention to minimize risk, avoid hospitalization, and increase the likelihood of positive patient outcomes. To identify changes in condition and be confident in reporting,...
Revised Criteria for Conducting Focused Infection Control Surveys
On 01/04/2021 CMS issued revised QSO-20-31-All. In this memo, CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the...
Ask Proactive – What effect does the IPA have on the variable per diem rate?
Q: What effect does the IPA have on the variable per diem rate? A: The IPA does not affect the variable per diem. When an IPA is completed and payment changes, it continues the variable per diem schedule that was established by the 5-day PPS assessment. The IPA...
Ask Proactive – After completing the PPS 5-day assessment, a Medicare resident developed symptoms and tested positive for COVID-19 later in their stay. The resident was subsequently moved to the COVID (RED) unit in single room isolation. Should I complete an IPA?
Q: After completing the PPS 5-day assessment, a Medicare resident developed symptoms and tested positive for COVID-19 later in their stay. The resident was subsequently moved to the COVID (RED) unit in single room isolation. Should I complete an IPA? A: Once...
Did you miss any of Proactive’s Top 10 Most Read Blogs of 2020?
Medicaid Case Mix Index (CMI): Common Errors and Opportunities Kristen Walden & Jessica Cairns OSHA Compliant COVID-19 Reporting Janine Lehman Restorative Nursing Under PDPM Part 1 and Part 2 Kristen Walden Reducing PDPM Non-Therapy Ancillary...
Plan to be Deficiency Free: Strategies for 2021 Survey Success
With the challenges of 2020 dictating the priority focus for most, the New Year presents the opportunity for goal setting and strategic planning that includes 5-Star Improvement and positive survey outcomes. What should your 2021 strategic plan for survey success...
Ask Proactive – Would I be able to capture isolation for a resident with the documentation that the resident had periods of wandering out of her room?
Q: Would I be able to capture isolation for a resident with the documentation that the resident had periods of wandering out of her room? A: No. The resident must remain in her room and alone because of active infection. Reference Center for Medicare and...
The Impact of Diagnosis Coding Under PDPM Reimbursement
Diagnosis coding accuracy is paramount to appropriate payment under PDPM, as ICD-10 Diagnosis codes & other patient characteristics are used as the basis for classification in determining Medicare (MCR) payment. The 5-day/Initial MDS establishes the PDPM payment...
Ask Proactive – We have a patient nearing the end of their 100 Part A days, but now he is COVID+. Will we need to have 1 non-skilled day in order to elect the benefit period waiver?
Q: We have a patient nearing the end of their 100 Part A days, but now he is COVID+. Will we need to have 1 non-skilled day in order to elect the benefit period waiver? A: In November, CMS released an update to the MLN Matters Number (SE20011 Revised) for...