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Update: SNF Qualifying Hospital Stay (QHS), Benefit Period Waivers and Medical Review Preparedness

by Proactive LTC Consulting | Jul 20, 2022 | Blog, Medical Review

Effective July 15, 2022, HHS Secretary extended the PHE, the new expiration date being October 13, 2022. CMS continues to recognize that disruptions arising from a PHE can affect coverage under the SNF benefit: Prevent a patient from having the 3-day inpatient QHS...

Ensuring CMI Accuracy: Don’t Miss Out on These Easy Fixes

by Proactive LTC Consulting | Oct 18, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare

Are your processes achieving accurate CMI reimbursement for the care that your staff delivers? The case mix index is intended to reflect the type of residents being treated and the level of care required. Therefore, it is important to ensure that procedures are in...

The Relationship Between the Standards of Care (SoC) and a Wrongful Death

by Proactive LTC Consulting | Oct 6, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare

Wrongful death claims pose a significant concern for healthcare facilities. In a 2019 review of claims, roughly half of fall-related claims involved a death and 62% of closed claims involved death related to pressure injury with total payments related to pressure...

Medical Review: Preparing for TPE Audits

by Proactive LTC Consulting | Sep 29, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare

The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health...

SNF Waiver Clarification Issued & Medical Review Anticipated

by Proactive LTC Consulting | Sep 13, 2021 | Blog, Compliance, COVID-19, Documentation, Medical Review, Medicare, SNF

On Sept. 8, 2021, CMS updated SE20011 (see p. 13)  regarding Emergency SNF QHS and benefit period requirements under Section 1812(f) of the Social Security Act which were implemented to help restore SNF coverage for patients affected by the emergency. The update...

Targeted Probe and Educate (TPE) Medical Review Restarting

by Proactive LTC Consulting | Aug 31, 2021 | Blog, CMS, Medical Review

CMS announced on August 12, 2021 that the MAC’s Targeted Probe and Educate (TPE) Program is restarting after a temporary pause during the Public Health Emergency. TPE involves a process of selecting providers identified based on data analysis as being at high risk for...
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Proactive Medical Review Consulting, LLC

2207 Morgan Ave, Suite D
Evansville, IN 47711

Phone: (812) 471-7777
Fax: (812) 471-7802
info@proactivemedicalreview.com