by Proactive Medical Review | Apr 21, 2021 | Audits, Compliance, Legal, Medicaid, Medical Review, Medicare
Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive...
by Proactive Medical Review | Mar 31, 2021 | Antipsychotics/Psychotropics, blog, Compliance, Nursing, Quality Measure, Regulatory, SNF
Are you ready for the annual survey and the Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review task that is part of that process? Surveyors select 5 residents to conduct this review on following the Critical Element Pathway. Consider...
by Proactive Medical Review | Dec 2, 2020 | blog, Compliance, Physicians
CMS defines “emergency/disaster” as an event that can affect the facility internally as well as the overall target population or the community at large or community or a geographic area(1). COVID-19 certainly meets that definition. Even if your facility has not...
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...
