Ask Proactive – I have recently been directed, when completing the PHQ-2 to 9, that if a resident acknowledges a symptom, but is unable to give a frequency, I should dash both questions (column 1 and 2). Is this correct?

by | Oct 1, 2025 | Coding, Compliance, Depression, MDS, Medicaid, Medicare, Nursing, PDPM, Reimbursement

Q: I have recently been directed, when completing the PHQ-2 to 9, that if a resident acknowledges a symptom, but is unable to give a frequency, I should dash both questions (column 1 and 2). Is this correct?   A: No, this is incorrect. If a resident answers “yes”...

Ask Proactive – Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents?

by | Aug 4, 2025 | Billing, Compliance, MDS, Reimbursement, Survey

Q: Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents?   A: A Denial of Payment for new admissions (DPNA) is a CMS enforcement remedy that...

Ask Proactive – Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria?

by | Jul 16, 2025 | ADR, Appeals, Audits, Documentation, Medical Review, Medicare, Reimbursement, SNF

Q: Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria?   A: Unfortunately, yes — at least for now. Most managed care plans (including Medicare Advantage) still require prior...