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...