by Proactive LTC Consulting | Sep 12, 2023 | Blog, Compliance, Medicare, Physicians
MACs have begun rolling out the mandated 5-Claim Probe and Educate audit and will eventually review claims for every eligible SNF in their jurisdiction. SNF certifications and recertifications are important elements of SNF Medicare stay compliance and will be...
by Proactive LTC Consulting | Aug 30, 2023 | Blog, Medicare, Nursing, Quality, SNF
How much of your time is spent in meetings? Depending on your role, time in meetings may take more time than any other task or responsibility you have. Do you sometimes wonder if all these meetings are even necessary (“Could this have been an email?”) Days are busy...
by Proactive LTC Consulting | Aug 23, 2023 | Blog, ICD.10, Medicare, PDPM, Reimbursement
PDPM has been in place for nearly four years, and with it came the shift from payment based on resource utilization to payment driven by patient characteristics and service provision. PDPM presents with many nuances and complexities that open the door to sinking...
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 31, 2023 | Blog, Compliance, Education, MDS, Medicare, Nursing, PDPM
You’ve likely heard that significant changes are coming to the MDS in October 2023. Here’s what you need to know in a nutshell and our recommended action steps to be prepared. An updated version of the MDS 3.0 (version 1.18.11) will be implemented effective October 1,...
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...
