by Proactive LTC Consulting | Jul 16, 2025 | ADR, Appeals, Audits, Documentation, Medical Review, Medicare, Reimbursement, SNF
Q: Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria? A: Unfortunately, yes — at least for now. Most managed care plans (including Medicare Advantage) still require prior... by Proactive LTC Consulting | May 7, 2025 | Audits, Compliance, Quality, Regulatory
Q: Is the nursing home required to have Compliance and Ethics Program meetings with a certain frequency? A: While there is no requirement related to a specific meeting frequency at 483.85, the General Compliance Program Guidance states that “The Compliance... by Proactive LTC Consulting | Apr 9, 2025 | Audits, Coding, Compliance, Documentation, ICD.10, MDS, Reimbursement
Crack the Code to Payment Accuracy: Why ICD-10 Coding Proficiency Matters Now More Than Ever In today’s reimbursement-driven healthcare environment, one thing is clear: accurate coding isn’t optional—it’s essential. For Skilled Nursing Facilities, ICD-10 coding... by Proactive LTC Consulting | Sep 6, 2023 | 5-Star, Audits, Q&A, Quality Measure, Regulatory
Q: My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating? A: Inaccuracies identified through these audits impact QM ratings as follows: The overall QM and long-stay QM... by Proactive LTC Consulting | Jan 4, 2023 | Audits
The New Year calls for new beginnings and fresh starts! With increasingly sophisticated data analytics, regulatory enforcement of required Compliance and Ethics Programs (CEP) effective October 2022, and President Biden’s nursing home reform, providers must focus... by Proactive LTC Consulting | Oct 18, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare
Are your processes achieving accurate CMI reimbursement for the care that your staff delivers? The case mix index is intended to reflect the type of residents being treated and the level of care required. Therefore, it is important to ensure that procedures are in...