by Proactive LTC Consulting | Nov 5, 2024 | Compliance, Documentation, MDS, Medical Review, Medicare, Nursing, PDPM, Quality, Regulatory, Reimbursement, SNF, Therapy
Skilled Service Justification in SNFs In the ever-evolving landscape of skilled nursing facilities (SNFs), the stakes have never been higher. With constant advancements in data analytics, regulatory bodies are sharpening their focus on compliance and accountability... by Proactive LTC Consulting | Oct 22, 2024 | Compliance, Documentation, Medical Review, Medicare, SNF
Mandatory update to SNF ABN (CMS-10055) – 10/31/2024 The Centers for Medicare & Medicaid Services (CMS) released an update to the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN)—Form CMS-10055 in August. The revised form and updated... by Proactive LTC Consulting | May 1, 2024 | Compliance, Documentation, Medical Review, Nursing, SNF, Therapy
Audits are on the rise! Skilled nursing facilities (SNFs) are at an all-time high when it comes to active medical review. From the SNF 5 Claim Probe and Educate and individual Medicare Advantage reviews, to recovery audit contractors (RACs) and Supplemental Medical... by Proactive LTC Consulting | Nov 21, 2023 | Blog, Compliance, Documentation, Medical Review, Medicare, Nursing, PDPM, SNF
SNF Meetings– UR & Triple Check Essentials According to a recent Agency Financial Report released by the Department of Health and Human Services (HHS), the primary reasons for SNF payment error include (1) missing or insufficient documentation to support the... by Proactive LTC Consulting | Aug 9, 2023 | Appeals, Medical Review, Medicare, Q&A
Q: My facility is going through a Medicare UPIC review and received a significant number of denials followed by a demand letter requiring repayment. What are our options for appealing the decision and what is the interest rate that will apply if we aren’t able to... by Proactive LTC Consulting | May 9, 2023 | Blog, Compliance, Medical Review, Medicare, PDPM
On May 4th, CMS issued Transmittal 12015 instructing MACs to perform a 5 claim probe and educate medical review on every SNF in their jurisdiction. A 15.1% SNF error rate in 2022 based on the Comprehensive Error Rate Testing (CERT) program is the catalyst for this...