by Proactive LTC Consulting | Jun 17, 2021 | Audits, Blog, Compliance, Medical Review, Regulatory, Reimbursement
The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020 this past August, but according to a June 3, 2021 announcement may now officially begin conducting post-payment medical reviews for later dates of... by Proactive LTC Consulting | Jun 15, 2021 | Audits, Blog, Compliance, Medical Review, Regulatory, Reimbursement
The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020, but may now officially begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will... by Proactive LTC Consulting | Apr 21, 2021 | Audits, Compliance, Legal, Medicaid, Medical Review, Medicare
Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive... by Proactive LTC Consulting | Sep 23, 2020 | Audits, Blog, Coding, MDS, Medical Review, Medicare, PDPM
As we began discussing in part 1 of this article last week, the accuracy of coding, documentation and data monitoring is vital as we prepare for the inevitable start of PDPM medical review audit activity. Provider data outliers will trigger audits, and any coding... by Proactive LTC Consulting | May 21, 2020 | Audits, Blog, Coding, COVID-19, Education, ICD.10, MDS
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... 
by Proactive LTC Consulting | Jan 6, 2020 | Audits, Compliance, Education, MDS, Medical Review, PDPM
When reviewing the CMI components driving PDPM reimbursement it’s important to consider the critical role of the Non-Therapy Ancillary (NTA) score. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. CMS...