The Landscape of Skilled Service Justification in Skilled Nursing Facilities

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?

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.

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...

Ask Proactive – We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives an inhaler to help with symptom management. Is it okay to mark at I6200 on his 5-day PPS assessment?

Q: We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives...