Ask Proactive – I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A?

by | Oct 30, 2024 | Clinical, Coding, Compliance, MDS, Nursing, RAI Manual

Q: I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A?     A: Page N-9 of...

Ask Proactive – Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because the resident’s previous BIMS scores have been 14 or15. When I interact with the resident, I don’t observe any cognitive decline, and the staff report no concerns either. Is this BIMS coding correct?

by | Oct 14, 2024 | Coding, Compliance, Dementia Care, Documentation, MDS

Q: Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because...

Ask Proactive – My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening?

by | Oct 9, 2024 | Coding, Documentation, MDS, Quality Measure, RAI Manual

Q: My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening?     A: This measure may trigger if the most recent MDS is coded...

Ask Proactive – Our facility is triggering the UTI QM, and we have identified that many of these are the result of the hospital diagnosing a UTI that does not meet our infection criteria. Do we have to code those on the MDS if they occur during the look-back period?

by | Sep 18, 2024 | Coding, Q&A, Quality Measure, RAI Manual, Reimbursement

Q: Our facility is triggering the UTI QM, and we have identified that many of these are the result of the hospital diagnosing a UTI that does not meet our infection criteria. Do we have to code those on the MDS if they occur during the look-back period?    ...

Ask Proactive – My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify.

by | Sep 4, 2024 | Coding, Medicare, Q&A, Reimbursement

Q: My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify.     A: Generally, the day of...