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?

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.

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...

Ask Proactive – One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint replacement surgery but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?

Q: One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint...

Minimum Staffing Final Rule

*Content in this post was corrected on 4/24/2024 at 11:11 Central Time. The HPRD of direct nurse aide care was changed from .45 to 2.45* On Monday, April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a comprehensive 329-page final rule...