News / Blog

Need to brush up on the latest industry news? Look no further! Proactive Medical Review consultants provide up-to-date blog postings to keep you in the know.

The latest news, events, blogs and more…

Ask Proactive – We recently received a letter from our MAC informing us of findings on the Comparative Billing Report (CBR) of SNF Short-Stays for PT / PT and NTA services. Our facility triggered greater than the 90th percentile as compared to our state and jurisdiction related to claims with PT/OT Short-Stays (0-20 days LOS). Wondering if we need to complete a self-audit? Have you seen this? What should be our next steps?

Q: We recently received a letter from our MAC informing us of findings on the Comparative Billing Report (CBR) of SNF Short-Stays for PT / PT and NTA services. Our facility triggered greater than the 90th percentile as compared to our state and jurisdiction related to...

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Becoming a Dynamic DON

Fulfilling the role of Director of Nursing (DON) in a skilled nursing facility is not an easy challenge. In addition to an extensive list of formal responsibilities and job duties, those who are truly successful in the role have tremendous grit, a sense of purpose,...

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Ask Proactive – I’m a new DON at a skilled nursing facility and the team meeting procedures don’t appear to help the facility manage the resident or team’s needs. What items should I be sure we cover to make these meetings both efficient and effective for the team?

Q: I’m a new DON at a skilled nursing facility and the team meeting procedures don’t appear to help the facility manage the resident or team’s needs. What items should I be sure we cover to make these meetings both efficient and effective for the team?I A: Ensuring...

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Ask Proactive – Under F761, what needs to be included on the label of multi-dose products that are pulled from the E-kit, brought from home or brought from the hospital?

Q: Under F761, what needs to be included on the label of multi-dose products that are pulled from the E-kit, brought from home or brought from the hospital? A: Multi-use products should be labeled with: The original manufacturer’s or pharmacy-applied label indicating...

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Ask Proactive – I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation?

Q: I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation? A: Possibly, but timing matters.  An...

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Ask Proactive – Let’s say I have a resident fall with injury on January 1st. How many days have to pass before it will drop off and not count against us as far as our 5-star rating?

Q: Let's say I have a resident fall with injury on January 1st. How many days have to pass before it will drop off and not count against us as far as our 5-star rating? A: The fall with major injury will be included in the QM % for the quarter if it was coded on a MDS...

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Ask Proactive – I conducted the pain interview with a resident recently and they stated that they have ‘almost constant’ pain and rated it as ‘moderate’. I reviewed the chart and the resident has PRN analgesic available, but never requests it, and the Q shift Pain monitoring on the MAR indicates no pain during the look back period. How should I address this on the MDS?

Q: I conducted the pain interview with a resident recently and they stated that they have ‘almost constant’ pain and rated it as ‘moderate’. I reviewed the chart and the resident has PRN analgesic available, but never requests it, and the Q shift Pain monitoring on...

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