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…
Q & A – A resident had a UTI in the hospital but their antibiotics were finished before admitting to the facility. The DC Summary notes “UTI-Resolved”. Should UTI be coded?
Q: A resident had a UTI in the hospital but their antibiotics were finished before admitting to the facility. The DC Summary notes “UTI-Resolved”. Should UTI be coded? A: Yes, UTI must be coded in I2300 if occurred in the last 30 days. The RAI Manual (page...
Updated CDC guidance blog- Symptom-based strategy for DC isolation and return to work
On July 17, 2020, CDC updated the guidance related to Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance) and the Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2...
PDPM Interrupted Stay Issue – You may need to modify claims
Per the MLN Connects news issued July 23, 2020, a new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a...
SNF PEPPER Now Available: Is Your Facility an Outlier?
PEPPER summarizes Medicare claims data statistics for billed claims in target areas that may be at risk for improper payments. Your facility data is compared to all SNFs in the nation, in your state, and in your jurisdiction to assess how your past billing practices...
Q & A – Do I have to restart the Medicare physician certification process when a resident qualifies for an interrupted stay?
Q: Do I have to restart the Medicare physician certification process when a resident qualifies for an interrupted stay? A: The requirements for physician certifications and recertifications for the SNF PPS stay did not change with the implementation of PDPM....
COVID-19 Point of Care Testing, CLIA Waivers, Tracking & Reporting
Recently, CMS held a stakeholder call for nursing home providers with additional information regarding the White House announcement of distribution of COVID-19 point-of-care rapid results testing instruments and supplies to all skilled nursing facilities across the...
CLIA Waiver Required for COVID-19 Point of Care Testing
Is your facility CLIA certified? Beginning this week, COVID-19 point of care (POC) testing instruments and supplies will start to be provided to skilled nursing facilities, prioritizing “hot spots” first. Only facilities with a Clinical Laboratory Improvement...
Medicare Medical Review Activity Expected to Resume in August
CMS suspended most Medicare Fee-For-Service (FFS) medical review in late March due to the public health emergency (PHE). However, CMS has recently updated the COVID-19 Provider Burden Relief FAQ related to claim audit waivers. This update states that Medical Review...
Q & A – How often do restorative progress notes need to be written?
Q: How often do restorative progress notes need to be written? A: The RAI Manual, p. O-43 states, “Evidence of periodic evaluation by the licensed nurse must be present in the resident’s medical record.” Facility policy should determine the frequency of the...
All In! Interdisciplinary Supportive Documentation to Succeed Under PDPM
Working together for the best clinical outcomes and for reimbursement accuracy requires good systems for communication – both verbally and in our documentation. The fundamental expectations for documentation to support skilled level of care, medical necessity, and...
Q & A – Can we query the MD AFTER the MDS assessment is completed for documentation of an active diagnosis, or does it have to be prior to the ARD?
Q: Can we query the MD AFTER the MDS assessment is completed for documentation of an active diagnosis, or does it have to be prior to the ARD? A: Unfortunately, the documentation needs to be present during the appropriate assessment reference period (which ends...
Safe Strategies for Visitation
Nursing facilities are moving toward safe reopening while adhering to guidance described in the CMS reopening recommendations, CDC guidance and state and local directives. While recognizing the potential psychosocial effects of resident separation from family and...
Returning to Work After Suspected or Confirmed COVID-19
Healthcare personnel (HCP) who are suspected or confirmed to have COVID-19 should meet the Centers for Disease Control and Prevention (CDC) Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance)[i]. Decisions about...
Current State of the 5-Star Rating System
As of mid-June, the only announcement that CMS has made regarding the 5-Star Rating system is that the Health Inspection rating is being held constant to include only data from surveys that occurred on or before March 3, 2020. Health inspections conducted after March...
Q & A – Can I code TIA if a resident is receiving Eliquis routinely to prevent further TIAs
Q: Can I code TIA if a resident is receiving Eliquis routinely to prevent further TIAs A: In order for TIA to be considered an active diagnosis, the physician would need to specifically document that the diagnosis is active (and not by listing TIA on the...
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