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Ask Proactive – Why is nursing documentation one of the biggest risks in medical reviews?

by | Feb 18, 2026 | Coding, Compliance, Documentation, MDS, Medical Review, Medicare, Nursing Home Consultant, PDPM, Reimbursement

Q: Why is nursing documentation one of the biggest risks in medical reviews?   A: Nursing documentation is one of the biggest medical review risk areas because it supports Medicare coverage and directly affects the nursing component, Non-Therapy Ancillaries...

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...