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... by Proactive LTC Consulting | Sep 29, 2021 | ADR, Appeals, Audits, Blog, Medical Review, Medicare
The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health... by Proactive LTC Consulting | Sep 13, 2021 | Blog, Compliance, COVID-19, Documentation, Medical Review, Medicare, SNF
On Sept. 8, 2021, CMS updated SE20011 (see p. 13) regarding Emergency SNF QHS and benefit period requirements under Section 1812(f) of the Social Security Act which were implemented to help restore SNF coverage for patients affected by the emergency. The update... by Proactive LTC Consulting | Aug 31, 2021 | Blog, Compliance, MDS, Medicare, PDPM, QAPI, Reimbursement
Strategies for timely estimation of potential care needs and costs are essential to SNF success, as well as systems for identifying clinical conditions and services that impact reimbursement under PDPM. Follow these steps to drive payment accuracy. Prior to Admission...