Ask Proactive – When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?

by | Sep 17, 2025 | Admissions, Coding, Documentation, Education, MDS, Medicare, SNF, Webinars

Q: When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?   A: This question comes up often in SNFs. The primary diagnosis should be...

New SNF Audits Coming—How to be Ready

by | Aug 5, 2025 | SNF

The Minimum Data Set (MDS) plays a vital role in driving resident care through the resident-centered care plan process, regulatory compliance, Medicare and Medicaid reimbursement, quality outcomes, and reporting programs. MDS data accuracy has been under increased...

Ask Proactive – A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the SNF. Would we use the respiratory failure or presence of tracheostomy as the primary diagnosis?

by | Jul 30, 2025 | Coding, ICD.10, MDS, Medicare, Nursing, SNF

Q: A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the...

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...