News / Blog
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Ask Proactive – What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey?
Q: What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey? A: One of the best ways to prepare for a COVID-19 focused Infection Control Survey is to complete a facility QA review utilizing the CMS COVID-19 Focused...
Losing the War on Weight?
Approximately 50-60% of elders in nursing homes experience unintentional weight loss (Dodd, 2020). Weight loss and malnutrition is associated with delayed wound healing, decline in functional and cognitive status, immunodeficiency, impaired muscle function, anemia,...
Ask Proactive – If BIMS nor the CPS Staff Assessment is completed, how is the resident’s cognitive level determined under PDPM?
Q: If the BIMS nor the CPS Staff Assessment is completed, how is the resident’s cognitive level determined under PDPM? A: If BIMS nor the CPS Staff Assessment is not completed the resident would be classified under PDPM as cognitively intact. If the resident...
Updating Your Emergency Preparedness Plan in the Wake of COVID-19
CMS defines “emergency/disaster” as an event that can affect the facility internally as well as the overall target population or the community at large or community or a geographic area(1). COVID-19 certainly meets that definition. Even if your facility has not...
Stark Law and Anti-Kickback Statute (AKS) Final Rules Published
The Department of Health and Human Services (HHS) and The Centers for Medicare and Medicaid Services (CMS) published two final rules last week, targeting the reduction of regulatory barriers to care coordination and increased flexibility for provider participation in...
Ask Proactive – Do we have to place new admissions in transmission based precautions for 14 days after admission if we have a negative COVID-19 test at the time of admission?
Q: Do we have to place new admissions in transmission-based precautions for 14 days after admission if we have a negative COVID-19 test at the time of admission? A: Yes, Per the CDC, new admissions should be placed in a single-person room or in a separate...
Supporting Skilled Level of Care for the COVID Positive Resident
As most providers are aware, the Centers for Medicare & Medicaid Services (CMS) suspended most Medicare fee-for-service medical reviews because of the COVID-19 pandemic on March 30, 2020. This included pre-payment medical reviews conducted by Medicare...
PDPM Coding Question – What MDS assessments need to be completed when newly skilling a current resident who develops COVID? Is a Significant Change required?
Q: What MDS assessments need to be completed when newly skilling a current resident who develops COVID? Is a Significant Change required? A: Presuming skilled care requirements outlined in Chapter 8 of the Medicare Benefit Policy Manual have been met, a PPS...
PDPM Coding Question – Can we code morbid obesity for resident with Dx on DC Summary but BMI is not 40 or above?
Q: Can we code morbid obesity for resident with Dx on DC Summary but BMI is not 40 or above? A: You can assign the E66 morbid obesity code if it is specifically documented by the provider & some sort of intervention/treatment due to obesity (i.e. reduced...
Compliance in Action: Yearly Licensed Nurse Competency Evaluations
Under regulation §483.35 Nursing Services we find the regulatory requirement for sufficient and competent nursing staff at section §483.35(a)(3) which states “The facility must ensure that licensed nurses have the specific competencies and skill sets necessary to care...
PDPM Coding Question – What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey?
Q: What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey? A: One of the best ways to prepare for a COVID-19 focused Infection Control Survey is to complete a facility QA review utilizing the CMS COVID-19 Focused...
Quality Measure Coding Deep Dive: Antipsychotics
There are two antipsychotic quality measures, the percent of short stay residents who newly received an antipsychotic medication and the percent of long-stay residents who received an antipsychotic medication. Significantly, both of these quality measures impact the...
PDPM Coding Question – What happens if someone leaves prior to being assessed?
Q: What happens if someone leaves prior to being assessed? A: When the Part A resident dies or is discharged prior to the end of the look-back period for a required assessment, the ARD must be adjusted to equal the discharge date. The provider should prepare a...
COVID-19 Preparedness and Response Policy Quick List
Since the COVID-19 pandemic began, guidance from CDC, CMS, and states on effective preparedness and outbreak management is being updated frequently. It is essential that LTC providers have strong processes in place for updating facility policies and procedures and...
Quality Measure Coding Deep Dive: UTI & Indwelling Catheters
Use of an indwelling catheter can place a resident at a higher risk for conditions such as Urinary Tract Infections (UTIs), sepsis, trauma, and hospitalization. Indwelling catheters should only be used when medically necessary and periodically re-evaluated for the...