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 – Is the monoclonal antibody infusion considered an IV med for MDS coding purposes?
Q: Is the monoclonal antibody infusion considered an IV med for MDS coding purposes? A: There has been a lot of confusion surrounding this. So far, what we know is monoclonal antibodies are considered IV medications and should be coded as such in O0100H....
F689 Accident Hazards/Supervision/Devices
F689 Free of Accident Hazards/Supervision/Devices has been the third most frequently cited F tag so far in the 2021 fiscal year per Casper data (9/5/21). 3,466 citations have been issued nationally for the 16.6% of providers surveyed. Scope and Severity has ranged...
SNF Waiver Clarification Issued & Medical Review Anticipated
On Sept. 8, 2021, CMS updated SE20011 (see p. 13) regarding Emergency SNF QHS and benefit period requirements under Section 1812(f) of the Social Security Act which were implemented to help restore SNF coverage for patients affected by the emergency. The update...
Addressing Pain – The “Fifth Vital Sign”
The prevalence of pain in long-term care residents is estimated to range from 49% to 83%” (Fox, Raina, & Jadad, 1999). Chronic pain is the top cause of long-term disability in the US, and advanced age a key indicator of chronic pain risk (Ljubica Cvetkovska)....
Ask Proactive – What changes are being made to ICD-10-CM guidelines or codes for FY2022 that impact nursing facilities?
Q: What changes are being made to ICD-10-CM guidelines or codes for FY2022 that impact nursing facilities? A: The code change that will have the greatest impact on nursing facilities is the new code for unspecified depression, which is F32.A. Prior to 10/01/21,...
Ask Proactive – Our facility would like to start a process for assessing post-COVID patients to determine if they would benefit from restorative nursing program(s). This will be for those patients who are not appropriate for skilled therapy services. I know our licensed nurse can complete the assessment and implement the program, but how do you suggest we go about developing specific programs without therapy recommendations?
Q: Our facility would like to start a process for assessing post-COVID patients to determine if they would benefit from restorative nursing program(s). This will be for those patients who are not appropriate for skilled therapy services. I know our licensed nurse can...
Targeted Probe and Educate (TPE) Medical Review Restarting
CMS announced on August 12, 2021 that the MAC’s Targeted Probe and Educate (TPE) Program is restarting after a temporary pause during the Public Health Emergency. TPE involves a process of selecting providers identified based on data analysis as being at high risk for...
Predicting PDPM Reimbursement
Strategies for timely estimation of potential care needs and costs are essential to SNF success, as well as systems for identifying clinical conditions and services that impact reimbursement under PDPM. Follow these steps to drive payment accuracy. Prior to Admission...
Guest Blog: Strategies Nurse Leaders Can Take Regarding the New Vaccination Mandate
NOTE: This article was written and posted by AAPACN on August 19, 2021. Proactive Medical Review has received permission to repost this article in full. Yesterday, President Biden announced that nursing homes must vaccinate their staff or lose Medicare and...
Simplifying Interpretive Guidance for F656 Comprehensive Care Plans
Care planning is an essential part of quality patient care as it offers an organized structure of identification of needs via the comprehensive assessment. This structure then drives the individualized type of services and care the resident receives by the development...
Ask Proactive – Do Items V0200C1 and V0200C2. Signature of Person Completing Care Plan Decision and Date Signed have to be signed by an RN?
Q: Do Items V0200C1 and V0200C2. Signature of Person Completing Care Plan Decision and Date Signed have to be signed by an RN? A: No, unlike items Z0400 A and B, V0200B1 and V0200B2, items V0200C1 and V0200C2 can be signed by the staff person facilitating the...
F761 Label/Store Drugs and Biologicals
F761 Label/Store Drugs and Biologicals is currently the 8th most frequently cited deficiency throughout the nation thus far in FY2021. Source: CASPER 08/08/2021 REGULATION The F761 regulation includes three requirements: Labeling – (1) Drugs and biologicals...
Ask Proactive – Should therapists conduct initial evaluations upon readmission of a patient in an interrupted stay under the Interrupted Stay Policy?
Q: Should therapists conduct initial evaluations upon readmission of a patient in an interrupted stay under the Interrupted Stay Policy? A: A new 5-day PPS assessment is not required after the interruption in the case of an interrupted stay that meets the...
Ask Proactive – Is a wound that has a JP drain considered a surgical wound and is changing the dressing to the drain considered surgical wound care?
Q: Is a wound that has a JP drain considered a surgical wound and is changing the dressing to the drain considered surgical wound care? A: Yes, the RAI Manual states that a surgical wound includes, “any healing and non-healing, open or closed surgical...
Unpacking the FY22 SNF PPS Medicare Final Rule
July 29th, 2021, the Skilled Nursing Facility (SNF) prospective payment system (PPS) final rule was released. The rule, which goes into effect October 1, 2021, contained several updates, including factors affecting the usual payment rates, changes to diagnosis code...
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