Ask Proactive – When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?

by | Sep 17, 2025 | Admissions, Coding, Documentation, Education, MDS, Medicare, SNF, Webinars

Q: When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?   A: This question comes up often in SNFs. The primary diagnosis should be...

Ask Proactive – Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria?

by | 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...