Ask Proactive – My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating?

by | Sep 6, 2023 | 5-Star, Audits, Q&A, Quality Measure, Regulatory

Q: My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating?     A: Inaccuracies identified through these audits impact QM ratings as follows: The overall QM and long-stay QM...

Ask Proactive – We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission assessment, he indicated that he did not want to be resuscitated in the event of cardiac/respiratory arrest. Would staff still be required to perform CPR since there is no signed Advance Directive and Physician’s Order?

by | Aug 30, 2023 | Nursing, Q&A, Regulatory

Q: We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission...

Ask Proactive – 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 immediately issue repayment?

by | 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...