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…
Q & A – How do you pull the 5-Star Report?
Q: How do you pull the 5-Star Report? A: Select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting system, select the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where...
Restorative Nursing Under PDPM – Part 1
The QM, Functional Outcome & Reimbursement Perks of Restorative Nursing Restorative & PDPM Several months into the swing of PDPM, some facilities are taking a second look at the benefits of restorative nursing programs. In many cases, facilities may need to...
PDPM Coding Questions – If a physician diagnoses “sepsis” but no mention of septicemia, and blood cultures come back negative, can you still code “Septicemia” in I2100?
Q: If a physician diagnoses “sepsis” but no mention of septicemia, and blood cultures come back negative, can you still code “Septicemia” in I2100? A: When you search for septicemia in the ICD-10 coding guidelines, you are cross-referenced to see sepsis &...
Person-Centered Care Planning
“Person-centered”, “Individualized”, “Resident-focused”; whatever you may call it, it’s past time to evolve from the institutionalized, staff-focused care planning we’ve become accustomed to and embrace the requirement that the individual has control over their life...
CMS Decides to Retain the CCI Edits That Were in Effect Prior to January 1, 2020
The therapy industry recently received some good news in terms of hard edits that were previously applied effective January 1, 2020 without warning. Our blog posted on 1/16/2020 shared that therapeutic activities (97530) and group therapy (97150) could no longer be...
Nursing Home Compliance: HIPAA Privacy & Security Essentials
As you prepare the SNF Compliance and Ethics Program work plan for 2020, consider planning a review of the facility HIPAA privacy and security program and take steps to manage risk. Consider these 12 tips to get started: Designate a privacy officer, security...
PDPM Coding Questions – Can you continue to skill with a resolved diagnosis? We have been discharging resident from skilled services once the active diagnosis is resolved example: UTI, E. coli, and pneumonia. Are we correctly doing this?
Q: Can you continue to skill with a resolved diagnosis? We have been discharging resident from skilled services once the active diagnosis is resolved example: UTI, E. coli, and pneumonia. Are we correctly doing this? A: Providers should assess the resident’s...
Infection Preventionist Work Plan Considerations
Infection control is a crucial, though sometimes overlooked, component of health care. It’s been suggested that nursing home residents are at greater risk of developing infections than the general population. This can be tied to the congregative setting of the nursing...
PDPM Coding Questions – If a resident is cut from skilled services but a new skilled need arises during the interrupted stay window, would the facility be allowed to re-skill the resident?
Q: If a resident is cut from skilled services but a new skilled need arises during the interrupted stay window, would the facility be allowed to re-skill the resident? A: The Medicare Benefit Policy Manual, Chapter 8 states that “Another qualifying hospital...
PDPM Coding Questions – What would happen if the interrupted stay criteria was met, but the resident came back from the hospital with a new diagnosis?
Q: What would happen if the interrupted stay criteria was met, but the resident came back from the hospital with a new diagnosis? A: In order to utilize Medicare benefits, even if the criteria of the Interrupted Stay Policy have been met, the resident must...
Ohio CMP Funded Grant Project Awarded to Proactive: Seeking Participants for Ohio Nursing Home Competency Training
CMS has approved funds for an Ohio Medicaid Grant Project in partnership with Proactive Medical Review & Consulting, LLC to administer a targeted Nursing Home Competency Certification Program that will include access to regional workshops, webinars, support from a...
Top 3 Survey Tags of 2019 and How to Avoid Them
As we begin a new year, there is benefit in evaluating lessons learned in 2019 to establish improvement goals for 2020. As you know, both annual surveys and complaint surveys can have a significant impact on the overall 5-Star Rating. To help guide action planning,...
PDPM Coding Questions – I have NPO resident on tube feeding. He coughed during trials of nectar thick liquids per speech therapy. Should the MDS be coded for swallow problems?
Q: I have NPO resident on tube feeding. He coughed during trials of nectar thick liquids per speech therapy. Should the MDS be coded for swallow problems? The RD says directions on the MDS RAI manual say “do not code if interventions are successful in treating...
Have you updated your Facility Assessment for 2020?
Nursing facilities are required to complete a comprehensive Facility Assessment as part of the Requirements of Participation (RoP.) The assessment must be presented to surveyors during each annual survey within four hours of entrance. Surveyors will review the...
PDPM Coding Questions – With section GG replacing Section G in October, will CNA ADL charting go away?
Q: With section GG replacing Section G in October, will CNA ADL charting go away? A: CMS posted a new DRAFT version of the 2020 MDS item sets (v1.18.0) on December 20, 2019 in which Section G has been removed from all Federal item sets. This will help eliminate the...