by Proactive Medical Review | Aug 17, 2022 | ICD.10, Q&A
Q: We have a claim denial from a commercial insurance plan that references their policy related to Excludes 1 Notes based on the ICD10 Official Guidelines for Coding & Reporting. OT and PT used codes R26.2 (difficulty in walking) and R26.81 (unsteadiness on feet)...
by Proactive Medical Review | Aug 8, 2022 | COVID-19, MDS, Q&A
Q: Can a resident requiring the CDC updated “Enhanced Barrier Precautions” be coded in Section O0100M for Isolation or Quarantine? A: No. The CDC updated Enhanced Barrier Precautions (EBP) do not meet the RAI requirements for coding Isolation or Quarantine on the MDS...
by Proactive Medical Review | Aug 3, 2022 | blog, CMS, ICD.10, PDPM
On July 29, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY)...
by Proactive Medical Review | Aug 1, 2022 | MDS, Q&A
Q: I have a resident who was discharged (unplanned) and remained in the hospital for 15 days before returning to my facility. A Quarterly MDS assessment fell due during the time they were out of the facility and my software is showing it as late or missed. What should...
by Proactive Medical Review | Jul 19, 2022 | Q&A
Q: What happens in the MDS department when a building is being purchased by a new company? A colleague mentioned that since it’s a new NPI number, we may need to complete a discharge and entry on every patient. Is this true? A: There are two types of change in...
by Proactive Medical Review | Jul 6, 2022 | Q&A
Q: We have had multiple outbreaks of COVID in recent weeks. There has been confusion when coding isolation. Can we code isolation if we have two positive residents sharing a room? A: Coding isolation requires specific criteria. One of these characteristics is if the...