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.
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Ask Proactive – Immediate Jeopardy cited –now what?
Q: Immediate Jeopardy cited – now what? A: When a skilled nursing facility is cited with immediate jeopardy, it means that the facility is in violation of regulations to an extent that it poses a serious threat to the health and safety of its residents....
Ask Proactive – We are questioning the MDS/Care planning meeting schedule. When adding an extra OBRA to capture rehab or other clinical conditions for Case Mix, do we need a care plan review even though we may have had one recently?
Q: We are questioning the MDS/Care planning meeting schedule. When adding an extra OBRA to capture rehab or other clinical conditions for Case Mix, do we need a care plan review even though we may have had one recently? A: Per the State operations...
Long-Term Care Federal Monitoring Surveys
On November 20, 2023, CMS released Guidance for Federal Monitoring Surveys (FMS) which identifies the FY2024 and FY2025 focus concerns and guidance on how CMS staff will conduct FMS and communicates estimated FY2024-FY2025 required number of long-term care (LTC) FMS...
SNF Meetings– UR & Triple Check Essentials
SNF Meetings– UR & Triple Check Essentials According to a recent Agency Financial Report released by the Department of Health and Human Services (HHS), the primary reasons for SNF payment error include (1) missing or insufficient documentation to support the...
Ask Proactive – For PBJ, where do we allocate NP hours?
Q: For PBJ, where do we allocate NP hours? A: If performing MD delegated duties report Job code 13 (see definitions below) Per the PBJ manual, Job Code 7 Registered Nurse hours include: Those persons licensed to practice as registered nurses in the...
Ask Proactive – We have a resident who receives Haldol decanoate injections every 3 weeks. How is this coded in section N of the MDS?
Q: We have a resident who receives Haldol decanoate injections every 3 weeks. How is this coded in section N of the MDS? A: Haldol decanoate is a long-acting antipsychotic medication and the MDS 3.0 RAI User Manual provide the following guidance related...
F565: Implementing Resident and Family Councils
While residents and families are not required to organize a resident or family group in their facility, the F 565 regulation does stipulate the obligations of the facility when residents/families choose to exercise this right. F565 states “The resident has a right to...
Ask Proactive – How will the 10/1/23 changes to the MDS impact the 5-Star Quality Measure rating for nursing facilities?
Q: How will the 10/1/23 changes to the MDS impact the 5-Star Quality Measure rating for nursing facilities? A: On 9/20/23, CMS issued QSO-23-21-NH, which announced that CMS will replace some of the Quality Measures (QMs) used on Nursing Home Care...
10/1 Update to the Coding of Parkinson’s Disease
As of October 1, 2023, the code G20 is now obsolete and will likely reject on any billing to Medicaid, Medicare, or insurance companies. Prior to your November billing, you will want to update to the appropriate new codes to avoid delayed billing processes. This...
Outside the Box Staffing: Remote MDS
On any given day, there are more than 1500 open MDS positions across the United States. With MDS staff feeling the ongoing pressure of staffing shortages, combined with the added stress of the October 1st MDS changes, many facilities are at significant risk of MDS...
LTC Best Practices: F770-779 Labs & Other Diagnostic Services
Consistent adherence to nursing home regulations is crucial for ensuring resident safety and well-being. In this blog, we overview of CMS Nursing Home Regulations F770-779, which cover laboratory and diagnostic services. We'll delve into the key compliance elements...
Ask Proactive – What do I need to know about the changes to Depression Screening in MDS Section D that were effective October 1, 2023?
Q: What do I need to know about the changes to Depression Screening in MDS Section D that were effective October 1, 2023? A: MDS Section D, “Resident Mood Interview,” which captures depression screening, changed from the full PHQ-9 (which includes 9...
Ask Proactive – What can a Director of Nursing (DON) do to ensure an effective antibiotic stewardship program is in place?
Q: What can a Director of Nursing (DON) do to ensure an effective antibiotic stewardship program is in place? A: The DON plays a significant role in establishing and maintaining an effective antibiotic stewardship program. Here are key strategies the DON...
IQIES and CASPER Reports
Earlier this year CMS transitioned from QIES to IQIES for MDS submission and CASPER reporting access. This transition left some MDS coordinators confused about how to access reports that were previously made available through QIES. Available report types for each user...
Ask Proactive – How can I ensure my care plan meetings are meeting the needs of the resident, responsible party and the IDT while being efficient and mindful of everyone’s time?
Q: How can I ensure my care plan meetings are meeting the needs of the resident, responsible party and the IDT while being efficient and mindful of everyone’s time? A: Care planning is a critical aspect of patient-centered care and plays a pivotal role...