by Proactive Medical Review | Dec 15, 2020 | blog, ICD.10, PDPM
Diagnosis coding accuracy is paramount to appropriate payment under PDPM, as ICD-10 Diagnosis codes & other patient characteristics are used as the basis for classification in determining Medicare (MCR) payment. The 5-day/Initial MDS establishes the PDPM payment...
by Proactive Medical Review | Dec 15, 2020 | COVID-19, PDPM Coding Questions
Q: We have a patient nearing the end of their 100 Part A days, but now he is COVID+. Will we need to have 1 non-skilled day in order to elect the benefit period waiver? A: In November, CMS released an update to the MLN Matters Number (SE20011 Revised) for...
by Proactive Medical Review | Dec 9, 2020 | COVID-19, PDPM Coding Questions
Q: What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey? A: One of the best ways to prepare for a COVID-19 focused Infection Control Survey is to complete a facility QA review utilizing the CMS COVID-19 Focused...
by Proactive Medical Review | Dec 2, 2020 | COVID-19, PDPM Coding Questions
Q: If the BIMS nor the CPS Staff Assessment is completed, how is the resident’s cognitive level determined under PDPM? A: If BIMS nor the CPS Staff Assessment is not completed the resident would be classified under PDPM as cognitively intact. If the resident...
by Proactive Medical Review | Nov 23, 2020 | COVID-19, PDPM Coding Questions
Q: Do we have to place new admissions in transmission-based precautions for 14 days after admission if we have a negative COVID-19 test at the time of admission? A: Yes, Per the CDC, new admissions should be placed in a single-person room or in a separate...
by Proactive Medical Review | Nov 17, 2020 | COVID-19, PDPM Coding Questions
Q: What MDS assessments need to be completed when newly skilling a current resident who develops COVID? Is a Significant Change required? A: Presuming skilled care requirements outlined in Chapter 8 of the Medicare Benefit Policy Manual have been met, a PPS...
