by Proactive Medical Review | Oct 18, 2021 | ADR, Appeals, Audits, blog, Medical Review, Medicare
Are your processes achieving accurate CMI reimbursement for the care that your staff delivers? The case mix index is intended to reflect the type of residents being treated and the level of care required. Therefore, it is important to ensure that procedures are in...
by Proactive Medical Review | Oct 6, 2021 | ADR, Appeals, Audits, blog, Medical Review, Medicare
Wrongful death claims pose a significant concern for healthcare facilities. In a 2019 review of claims, roughly half of fall-related claims involved a death and 62% of closed claims involved death related to pressure injury with total payments related to pressure...
by Proactive Medical Review | Sep 29, 2021 | ADR, Appeals, Audits, blog, Medical Review, Medicare
The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health...
by Proactive Medical Review | Sep 13, 2021 | blog, Compliance, COVID-19, Documentation, Medical Review, Medicare, SNF
On Sept. 8, 2021, CMS updated SE20011 (see p. 13) regarding Emergency SNF QHS and benefit period requirements under Section 1812(f) of the Social Security Act which were implemented to help restore SNF coverage for patients affected by the emergency. The update...
by Proactive Medical Review | Aug 31, 2021 | blog, CMS, Medical Review
CMS announced on August 12, 2021 that the MAC’s Targeted Probe and Educate (TPE) Program is restarting after a temporary pause during the Public Health Emergency. TPE involves a process of selecting providers identified based on data analysis as being at high risk for...
by Proactive Medical Review | Jun 17, 2021 | Audits, blog, Compliance, Medical Review, Regulatory, Reimbursement
The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020 this past August, but according to a June 3, 2021 announcement may now officially begin conducting post-payment medical reviews for later dates of...
