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... by Proactive LTC Consulting | Oct 6, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare
Wrongful death claims pose a significant concern for healthcare facilities. In a 2019 review of claims, roughly half of fall-related claims involved a death and 62% of closed claims involved death related to pressure injury with total payments related to pressure... by Proactive LTC Consulting | Sep 29, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare
The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health... by Proactive LTC Consulting | Jul 7, 2021 | Audits, Blog, Coding, Compliance, ICD.10, MDS, Reimbursement
Even though SNFs have collectively seen higher reimbursement rates under the Patient-Driven Payment Model compared to the previous RUG IV payment model, data shows that there is still room for improvement for most facilities in terms of ensuring accurate revenue under...