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 – What is the #1 ICD.10 coding error that you find in your audits?
Q: What is the #1 ICD.10 coding error that you find in your audits? A: Answer: The coding error seen most often is using acute conditions/diagnoses. The RAI Manual states while certain conditions represent acute diagnoses, SNFs should not use acute diagnosis...
Q & A – Should presumptive positive COVID-19 test results be coded as confirmed?
Q: Should presumptive positive COVID-19 test results be coded as confirmed? A: Yes, Presumptive positive COVID-19 test results should be coded as confirmed. A presumptive positive test result means an individual has tested positive for the virus at a local or...
COVID-19 Medical Review Preparedness and Reimbursement Compliance Risks
Throughout the COVID-19 pandemic, regulatory guidance, reimbursement waivers, and state requirements evolved quickly. Tracking these changes and implementing or updating facility processes to comply was a challenge on the best day. Add to the mix weeks of prolonged...
Safely Reopening Nursing Homes: Quick Summary of New CMS Guidance
As part of President Trump’s Guidelines for Opening Up America Again, the Centers for Medicare and Medicaid Services (CMS) announced new nursing home reopening recommendations for state and local officials. These recommendations detail criteria for relaxing certain...
Reimbursement Pitfalls When Coding the Primary Diagnosis: Tips from an MDS Auditor
After 1000 PDPM coding audits completed since the PDPM transition, there are many trends our audit team has identified. This week’s blog highlights specific tips for selecting the primary diagnosis in Section I0020B based on common missed opportunities and errors...
Q & A – I have a resident who was discharged from Medicare A services, but then had a renewed skilled need and will receive skilled speech therapy services. How do I code section GG if we are not addressing ADL needs (no PT or OT services)?
Q: I have a resident who was discharged from Medicare A services, but then had a renewed skilled need and will receive skilled speech therapy services. How do I code section GG if we are not addressing ADL needs (no PT or OT services)? A: All column 1 –...
Q & A – Can you use a “Z” code as a primary diagnosis under PDPM and map to a Clinical Category?
Q: Can you use a "Z" code as a primary diagnosis under PDPM and map to a Clinical Category? A: The ICD-10-CM Coding Guidelines state that some Z-codes can be primary. There are many Z-codes that would not be appropriate to use as primary diagnoses such as...
New Reporting Process Rules Released for Long Term Care Facilities
CMS released an Interim Final Rule May 1, 2020, which will require all Medicare and/or Medicaid-certified nursing homes to report information about COVID-19 at least weekly to the CDC Long-Term Care Facility Module in the National Healthcare Safety Network (NHSN). The...
Now that CMS approved OT, PT, and SLPs for telehealth service delivery, can we start utilizing this distant service option for treatment delivery with appropriate patients?
Q: Now that CMS approved OT, PT, and SLPs for telehealth service delivery, can we start utilizing this distant service option for treatment delivery with appropriate patients? A: New guidance issued by CMS issued on April 30th acknowledges OT, PT, SLP...
Coronavirus Commission for Safety and Quality in Nursing Homes
On April 30, 2020 President Trump announced the formation of the Centers for Medicare & Medicaid Services (CMS) independent commission, or nursing home task force, officially known as the Coronavirus Commission for Safety and Quality in Nursing Homes [1]. This...
OSHA Releases Enforcement Guidance for Recording Cases of COVID-19
On April 10, 2020 the Occupational Safety and Health Administration released a memorandum detailing enforcement guidance for recording cases of Coronavirus disease 2019 (COVID-19). The memo provides interim guidance to Compliance Safety and Health Officers (CSHOs) for...
Reducing Liability Risk Related to COVID-19
In recent months, providers have been faced with the challenge of caring for those patients diagnosed with COVID-19. It has greatly affected the long-term care community and several states have taken steps to protect providers from lawsuits related to the care...
Q & A – If the resident continues to have a dry cough after hospitalization, do I still use the RO5 for cough–he had one positive test for COVID-19 and 2 negatives?
Q: If the resident continues to have a dry cough after hospitalization, do I still use the RO5 for cough--he had one positive test for COVID-19 and 2 negatives? A: You should only code the signs and symptoms (i.e. R05 cough) if the patient has s/s associated...
Q & A – Is PNA related to COVID-19 an opportunistic infection?
Q: Is PNA related to COVID-19 an opportunistic infection? A: Pneumonia related to COVID-19 does not map to the NTA item Opportunistic Infection. Blog by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Proactive Medical Review Click here to learn more about Shelly...
Q & A – Is COVID19 coded as a MDRO?
Q: Is COVID19 coded as a MDRO? A: COVID-19 is not considered a Multi-drug resistant organism (MDRO) and should not be coded at I1700 on the MDS. Blog by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Proactive Medical Review Click here to learn more about Shelly...
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