Ask Proactive – A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the SNF. Would we use the respiratory failure or presence of tracheostomy as the primary diagnosis?

by | Jul 30, 2025 | Coding, ICD.10, MDS, Medicare, Nursing, SNF

Q: A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the...

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...

Ask Proactive – I recently started working as the MDS coordinator at a facility. MDS assessments have been scheduled, but no one completed them. What should I do to get back in compliance?

by | Jun 18, 2025 | Compliance, MDS, Medicare, Staffing

Q: I recently started working as the MDS coordinator at a facility. MDS assessments have been scheduled, but no one completed them. What should I do to get back in compliance?   A: 1. Assess the Extent of the Delay Identify how many assessments are overdue and...