by Proactive Medical Review | Jun 15, 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, but may now officially begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will...
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 15, 2021 | blog, Documentation, Legal, Medicaid, Medical Review, Medicare
“No matter how skilled or experienced you are, inaccurate or incomplete nursing documentation can mean serious trouble for your patients – and for you if you’re ever involved in a lawsuit.” Austin, Nursing2021. Many nurses who have had to testify in a deposition or...
by Proactive Medical Review | Feb 3, 2021 | blog, Documentation, MDS, Medical Review, Medicare, PDPM, Reimbursement
They say hindsight is 20/20. Most are glad to see 2020 go; it’s certainly been a challenging year. After the first full calendar year of the Patient-Driven Payment Model (PDPM), several key takeaways in terms of successful implementation strategies have become clear....
by Proactive Medical Review | Oct 19, 2020 | blog, Coding, Compliance, Documentation, MDS, Medical Review, Medicare, PDPM, Reimbursement
Has nursing documentation and internal auditing suffered due to COVID-19 prevention or outbreak efforts? Many facilities have had to prioritize staff and resources in order to meet the challenge of the public health emergency and the many additional responsibilities...
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...
