by Proactive LTC Consulting | 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... by Proactive LTC Consulting | Jul 2, 2025 | Compliance, MDS, Medical Review, Quality, Reimbursement
Top Nursing Home Missed Reimbursement Opportunities Practical Strategies to Capture What You’ve Rightfully Earned In today’s long-term care environment, nursing homes are under more pressure than ever to deliver high-quality care while navigating increasingly... by Proactive LTC Consulting | Apr 9, 2025 | Audits, Coding, Compliance, Documentation, ICD.10, MDS, Reimbursement
Crack the Code to Payment Accuracy: Why ICD-10 Coding Proficiency Matters Now More Than Ever In today’s reimbursement-driven healthcare environment, one thing is clear: accurate coding isn’t optional—it’s essential. For Skilled Nursing Facilities, ICD-10 coding... by Proactive LTC Consulting | Apr 2, 2025 | Compliance, MDS, Reimbursement
Q: What is the time frame in which a 5-day assessment should be completed? A: The answer depends on whether the 5-day MDS is combined with the OBRA admission assessment or completed as a stand-alone Medicare 5-day MDS. When combined with the OBRA admission... by Proactive LTC Consulting | Apr 2, 2025 | Compliance, MDS, Quality Measure, Reimbursement, Survey
F641 Accuracy of MDS Assessments – Revised LTC Surveyor Guidance CMS and the Department of Health & Human Services released an updated version of the LTC Surveyor Guidance on March 10, 2025. This update, which revises the earlier January 16th release, takes... by Proactive LTC Consulting | Apr 2, 2025 | Compliance, MDS, Medical Review, Medicare, PDPM, Reimbursement, Therapy
The State of SNF Medical Review in 2025: Trends, Challenges, and Key Findings Medical review of Skilled Nursing Facilities (SNFs) continues to be a focus of Medicare and Medicare Advantage oversight activities in 2025. With increased scrutiny from Medicare...