by Proactive LTC Consulting | Feb 22, 2023 | Blog, F-Tag, Medicaid, Medicare, Regulatory, Reimbursement
Medicare beneficiaries in a SNF have rights and safeguards with regard to financial liability and appeal of the denial of Medicare services. Providers are required to inform beneficiaries of their financial liability and their appeal rights in writing by issuing... by Proactive LTC Consulting | Jun 21, 2022 | Coding, Medicare, Q&A
Q: Our Medicare Part A claim was rejected due to “principal diagnosis is an unacceptable diagnosis. Correct and resubmit/rekey”. The principal diagnosis coded on the Medicare claim and in section I0020B of the Medicare 5-day MDS is B95.62 (MRSA infection as the cause... by Proactive LTC Consulting | May 4, 2022 | MDS, Medicare, Q&A
Q: A Medicare patient was admitted to our SNF in the morning and went home AMA later that same afternoon. What MDS assessments need to be completed? A: The Entry record and the unplanned discharge return not anticipated are required to be completed. In addition,... by Proactive LTC Consulting | Mar 16, 2022 | CMS, Medicare, Q&A, SNF
Q: What should be done if a PPS 5-Day assessment completed for Managed Care is submitted to CMS? A: Assessments that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted, e.g., private insurance, including but not limited to... 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... 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...