News / Blog
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Q & A – Are we still restricted from utilizing telehealth therapy services for our Medicare Part A beneficiaries?
Q: I understand that CMS has approved telehealth services for outpatient therapy as billable on institutional claims (UB-04). Are we still restricted from utilizing telehealth therapy services for our Medicare Part A beneficiaries? A: The Centers for Medicare...
CMS Releases Memo Regarding COVID-19 Survey Activities and Enhanced Enforcement for Infection Control Deficiencies
Focused Infection Control Surveys and CARES Act Funding On June 1, 2020, CMS released a memo to State Survey Agency Directors calling on states to ensure that all Medicare and Medicaid certified nursing homes receive an on-site infection control focused survey and...
Q & A – When can Podiatrists, Optometrists and Dentists return to Nursing Facilities?
Q: When can Podiatrists, Optometrists and Dentists return to Nursing Facilities? A: This should be determined on a case-by-case basis based on resident specific needs for the specialized service in consultation with the resident's attending physician. These...
Q & A – How should SNF facilities handle employee requests off related to traveling out of state? Should we look at a mandatory negative test or a quarantine?
Q: How should SNF facilities handle employee requests off related to traveling out of state? Should we look at a mandatory negative test or a quarantine? A: Since every contact increases the risk of transmission to residents, it is recommended to continue to...
CDC Guidance on Contact Tracing for Healthcare Personnel
This week, multiple states across the nation announced increased funding to be used to help provide COVID-19 testing and contact tracing. Contact tracing involves retracing movements of an individual with COVID-19 to locate, test, and isolate anyone who has come in...
Q & A – What is the #1 ICD.10 coding error that you find in your audits?
Q: What is the #1 ICD.10 coding error that you find in your audits? A: Answer: The coding error seen most often is using acute conditions/diagnoses. The RAI Manual states while certain conditions represent acute diagnoses, SNFs should not use acute diagnosis...
Q & A – Should presumptive positive COVID-19 test results be coded as confirmed?
Q: Should presumptive positive COVID-19 test results be coded as confirmed? A: Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or...
COVID-19 Medical Review Preparedness and Reimbursement Compliance Risks
Throughout the COVID-19 pandemic, regulatory guidance, reimbursement waivers, and state requirements evolved quickly. Tracking these changes and implementing or updating facility processes to comply was a challenge on the best day. Add to the mix weeks of prolonged...
Safely Reopening Nursing Homes: Quick Summary of New CMS Guidance
As part of President Trump’s Guidelines for Opening Up America Again, the Centers for Medicare and Medicaid Services (CMS) announced new nursing home reopening recommendations for state and local officials. These recommendations detail criteria for relaxing certain...
Reimbursement Pitfalls When Coding the Primary Diagnosis: Tips from an MDS Auditor
After 1000 PDPM coding audits completed since the PDPM transition, there are many trends our audit team has identified. This week’s blog highlights specific tips for selecting the primary diagnosis in Section I0020B based on common missed opportunities and errors...
Q & A – I have a resident who was discharged from Medicare A services, but then had a renewed skilled need and will receive skilled speech therapy services. How do I code section GG if we are not addressing ADL needs (no PT or OT services)?
Q: I have a resident who was discharged from Medicare A services, but then had a renewed skilled need and will receive skilled speech therapy services. How do I code section GG if we are not addressing ADL needs (no PT or OT services)? A: All column 1 –...
Q & A – Can you use a “Z” code as a primary diagnosis under PDPM and map to a Clinical Category?
Q: Can you use a "Z" code as a primary diagnosis under PDPM and map to a Clinical Category? A: The ICD-10-CM Coding Guidelines state that some Z-codes can be primary. There are many Z-codes that would not be appropriate to use as primary diagnoses such as...
New Reporting Process Rules Released for Long Term Care Facilities
CMS released an Interim Final Rule May 1, 2020, which will require all Medicare and/or Medicaid-certified nursing homes to report information about COVID-19 at least weekly to the CDC Long-Term Care Facility Module in the National Healthcare Safety Network (NHSN). The...
Now that CMS approved OT, PT, and SLPs for telehealth service delivery, can we start utilizing this distant service option for treatment delivery with appropriate patients?
Q: Now that CMS approved OT, PT, and SLPs for telehealth service delivery, can we start utilizing this distant service option for treatment delivery with appropriate patients? A: New guidance issued by CMS issued on April 30th acknowledges OT, PT, SLP...
Coronavirus Commission for Safety and Quality in Nursing Homes
On April 30, 2020 President Trump announced the formation of the Centers for Medicare & Medicaid Services (CMS) independent commission, or nursing home task force, officially known as the Coronavirus Commission for Safety and Quality in Nursing Homes [1]. This...