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...

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?

by | Jun 18, 2024 | Documentation, MDS, Nursing, PDPM, Q&A, Reimbursement

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...

Ask Proactive – I had a resident admitted to our SNF under skilled care who has been diagnosed with HIV/AIDS, but the NTA points are not generating in the HIPPS code. Can you please explain why this is happening and what corrective action should be taken to ensure reimbursement is accurate?

by | Apr 3, 2024 | ICD.10, Nursing, PDPM, Q&A, Reimbursement

Q: I had a resident admitted to our SNF under skilled care who has been diagnosed with HIV/AIDS, but the NTA points are not generating in the HIPPS code. Can you please explain why this is happening and what corrective action should be taken to ensure reimbursement is...