Ask Proactive – Fall with major injury has triggered under my SNF QRP reports but no fall with major injury was coded on the 5-Day assessment or the PPS Discharge assessment that were submitted. Where did the information pull from?

by | Dec 22, 2024 | Compliance, Falls, MDS, PDPM, Quality, Reimbursement

Q: Fall with major injury has triggered under my SNF QRP reports but no fall with major injury was coded on the 5-Day assessment or the PPS Discharge assessment that were submitted. Where did the information pull from?   A: The SNF QRP measure for falls with...

The Landscape of Skilled Service Justification in Skilled Nursing Facilities

by | Nov 5, 2024 | Compliance, Documentation, MDS, Medical Review, Medicare, Nursing, PDPM, Quality, Regulatory, Reimbursement, SNF, Therapy

Skilled Service Justification in SNFs In the ever-evolving landscape of skilled nursing facilities (SNFs), the stakes have never been higher. With constant advancements in data analytics, regulatory bodies are sharpening their focus on compliance and accountability...

Ask Proactive – Our facility is triggering the UTI QM, and we have identified that many of these are the result of the hospital diagnosing a UTI that does not meet our infection criteria. Do we have to code those on the MDS if they occur during the look-back period?

by | Sep 18, 2024 | Coding, Q&A, Quality Measure, RAI Manual, Reimbursement

Q: Our facility is triggering the UTI QM, and we have identified that many of these are the result of the hospital diagnosing a UTI that does not meet our infection criteria. Do we have to code those on the MDS if they occur during the look-back period?    ...

Ask Proactive – My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify.

by | Sep 4, 2024 | Coding, Medicare, Q&A, Reimbursement

Q: My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify.     A: Generally, the day of...