by Proactive Medical Review | Dec 22, 2021 | blog, Documentation
Quite often, we receive questions related to whether or not a patient can be “skilled.” Perhaps a resident has a new onset cardiac condition, is receiving wound care, or is not making progress in therapy and will be transitioning to a restorative nursing program. In...
by Proactive Medical Review | Sep 13, 2021 | blog, Compliance, COVID-19, Documentation, Medical Review, Medicare, SNF
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...
by Proactive Medical Review | Jun 17, 2021 | COVID-19, Documentation, Q&A
Q: Our facility is seeing an influx of Medicare Advantage Medical Review. Unfortunately, there have been a few denials based on the PDPM HIPPS code billed versus the HIPPS code generated from the MDS assessment. For example, the MA plan predetermined a score without...
by Proactive Medical Review | Jun 16, 2021 | COVID-19, Documentation, Q&A
Q: Default or Provider Liable? I mistakenly thought a resident qualified for the interrupted stay when in actuality they readmitted beyond the 3-day interruption window (on day 4). I failed to schedule a new PPS 5-day assessment within the required timeframe. Can I...
by Proactive Medical Review | Jun 7, 2021 | COVID-19, Documentation, Q&A
Q: Is it a “disability-related inquiry” under the ADA to ask about or request documentation that an employee obtained the COVID-19 vaccine from a third party in the community, such as a pharmacy, primary physician, or public clinic? A: According to the EEOC,...
by Proactive Medical Review | Mar 15, 2021 | blog, Documentation, Legal, Medicaid, Medical Review, Medicare
“No matter how skilled or experienced you are, inaccurate or incomplete nursing documentation can mean serious trouble for your patients – and for you if you’re ever involved in a lawsuit.” Austin, Nursing2021. Many nurses who have had to testify in a deposition or...