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…
PDPM Operations: Selecting Primary Diagnosis
Driving PDPM Operations: Selecting the Primary Diagnosis Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B (primary reason for skilled stay) largely determines reimbursement for the entire Medicare stay, unless an Interim...
New in 2020! 3 Targeted Webinar Series Coming Soon
PDPM Master Class with Optional Certification January through December 2020 This 12 month webinar series focuses on developing mastery of the skills required to successfully lead clinical reimbursement excellence under PDPM. Participants may register for each session...
PDPM Coding Question – Indiana Medicaid: QMs for Quality Score
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Indiana Medicaid: QMs for Quality Score Q: With recent and future quality measure changes to 5-star / Nursing Home Compare, will the Quality Measure Score used to...
How you may be missing the mark in the Nursing CMG under PDPM.
How well did you identify, document, and report conditions and services under RUG-IV? With all the changes the Patient-Driven Payment Model (PDPM) brought in October, it was comforting to think that, at least, determinations for the Nursing Case-Mix Group (CMG)...
Medicare Final 2020 Physician Fee Schedule
Medicare Final 2020 Physician Fee Schedule (PFS) Released & Rule Includes Challenges for Part B Therapy Providers CMS released the final 2020 Medicare Physician Fee Schedule on November 1, 2019 which includes updates to payment policies, rates and quality...
PDPM Coding Question – NTA Conditions Parenteral / IV Feeding Level?
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: What is the difference between the NTA conditions parenteral / IV Feeding level high and low? A: In order to qualify for high intensity parental / IV feeding and...
PDPM Coding Question – I69 Code Timeline?
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Is there a "timeline" to using I69 codes? For example: My new patient had cognitive deficits and Dysphagia and had CVA in 2016. Do I use I69 codes or R codes? A:...
PDPM Coding Question – Interrupted Stay MDS Error Code?
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Why am I getting an error message when trying to complete an Interrupted Stay MDS Assessment? A: CMS has reported that providers are receiving “error” messages...
Don’t let documentation HAUNT you under PDPM!
Have you been SPOOKED by the recent implementation of PDPM? The recent implementation of PDPM has been a scary time for all and while the focus seems to be back on nursing, so are the challenges. One such challenge is enhancing the quality of supportive documentation....
SNF QAPI Program: What to Know for November Phase 3 Readiness
Possible one year delay of the SNF QAPI Program requirements While CMS published a proposed rule to delay for one year the Phase 3 SNF QAPI Program requirements, providers have good reason to move forward in implementing a comprehensive QAPI Program with the original...
SNF Compliance & Ethics Programs: What to Know for November Phase 3 Readiness
Delay for one year the SNF Compliance and Ethics Program requirements While CMS published a proposed rule to delay for one year the SNF Compliance and Ethics Program requirements, providers have good reason to move forward in implementing the Compliance and Ethics...
Medicaid and the Optional State Assessment (OSA)
CMS Will Continue to Report RUG-III and RUG-IV HIPPS Codes, as Requested by the State, Until September 30, 2020 As of October 1, 2019, all scheduled PPS assessments (except the 5-day) and all unscheduled PPS assessments were retired. If you’re in a Medicaid case-mix...
PDPM Coding Questions – E66 Morbid Obesity Code?
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Can the E66 morbid obesity codes be assigned if the BMI is less than 40 when there is physician documentation of morbid obesity diagnosis? A: You can assign the...
PDPM Coding Questions – BIMS on the ARD date?
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: We are completing the BIMS on the ARD date. Should it be done earlier? A: BIMS is to be conducted “within the look-back period” and “preferably” on or one day...
PDPM Coding Questions – GG coding clinical judgement?
PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: For section GG, we understand that unless the professional-nurse or therapist-views the resident doing the task we would fill out 88. Instead, the therapy...
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