by Proactive Medical Review | Sep 23, 2020 | Audits, blog, Coding, MDS, Medical Review, Medicare, PDPM
As we began discussing in part 1 of this article last week, the accuracy of coding, documentation and data monitoring is vital as we prepare for the inevitable start of PDPM medical review audit activity. Provider data outliers will trigger audits, and any coding...
by Proactive Medical Review | Sep 23, 2020 | blog, COVID-19, Reimbursement
CARES Act Provider Relief Fund The U.S. Department of Health and Human Services (HHS) Provider Relief Fund has made $50 billion available for distribution to Medicare fee-for-service providers as financial relief during the coronavirus (COVID-19) pandemic. Phases of...
by Proactive Medical Review | Sep 22, 2020 | blog, MDS, PDPM, PDPM Coding Questions
Q: Can I use M codes as primary diagnosis? A: M codes can be used as long as they are not “return to provider” codes. Recommend utilizing the CMS ICD-10 Mapping Tool listed under the resources below to determine if diagnosis can be considered as...
by Proactive Medical Review | Sep 16, 2020 | blog, COVID-19
CMS announced that Medicare Fee for Service medical review (which was temporarily suspended due to the public health emergency,) may now resume beginning August 3, 2020. CMS has expressed their intent to examine provider behavior, patterns of therapy provision and...
by Proactive Medical Review | Sep 15, 2020 | blog, MDS, PDPM, PDPM Coding Questions
Q: If MDS Section GG documentation information is not filled out, can we use section G documentation to code Section GG? A: The difference between Section G & Section GG is more than one letter. Key variances include the steps for assessment,...
by Proactive Medical Review | Sep 9, 2020 | blog, MDS, PDPM, PDPM Coding Questions, Therapy
Q: What procedure should we follow if a staff member refuses to participate in our facility’s mandatory routine COVID-19 testing? A: It is recommended that your facility policy and procedure regarding COVID-19 testing is consistent with your policies for other...
