by Proactive Medical Review | Nov 24, 2020 | blog, Compliance, Physicians
The Department of Health and Human Services (HHS) and The Centers for Medicare and Medicaid Services (CMS) published two final rules last week, targeting the reduction of regulatory barriers to care coordination and increased flexibility for provider participation in...
by Proactive Medical Review | Nov 18, 2020 | blog, Compliance, COVID-19, Medicare
As most providers are aware, the Centers for Medicare & Medicaid Services (CMS) suspended most Medicare fee-for-service medical reviews because of the COVID-19 pandemic on March 30, 2020. This included pre-payment medical reviews conducted by Medicare...
by Proactive Medical Review | Nov 12, 2020 | blog, Compliance, Education, QAPI
Under regulation §483.35 Nursing Services we find the regulatory requirement for sufficient and competent nursing staff at section §483.35(a)(3) which states “The facility must ensure that licensed nurses have the specific competencies and skill sets necessary to care...
by Proactive Medical Review | Nov 4, 2020 | 5 Star, Antipsychotics, blog, QAPI, Quality Measure
There are two antipsychotic quality measures, the percent of short stay residents who newly received an antipsychotic medication and the percent of long-stay residents who received an antipsychotic medication. Significantly, both of these quality measures impact the...
by Proactive Medical Review | Oct 28, 2020 | 5 Star, blog, Coding, QAPI, Quality Measure
Since the COVID-19 pandemic began, guidance from CDC, CMS, and states on effective preparedness and outbreak management is being updated frequently. It is essential that LTC providers have strong processes in place for updating facility policies and procedures and...
by Proactive Medical Review | Oct 28, 2020 | 5 Star, blog, Coding, QAPI, Quality Measure
Use of an indwelling catheter can place a resident at a higher risk for conditions such as Urinary Tract Infections (UTIs), sepsis, trauma, and hospitalization. Indwelling catheters should only be used when medically necessary and periodically re-evaluated for the...
