by Proactive Medical Review | May 11, 2022 | blog, SNF
According to the most recent Comprehensive Error Rate Testing (CERT) report released by the Centers for Medicare & Medicaid Services (CMS), $2.7 billion in improper payments were projected for Skilled Nursing Facility (SNF) services for 2021. Inadequate...
by Proactive Medical Review | Apr 6, 2022 | blog, Compliance, SNF
The Q4FY21 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2021 is now available for download. Follow these steps to access your PEPPER and analyze any outlier billing...
by Proactive Medical Review | Mar 16, 2022 | CMS, Medicare, Q&A, SNF
Q: What should be done if a PPS 5-Day assessment completed for Managed Care is submitted to CMS? A: Assessments that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted, e.g., private insurance, including but not limited to...
by Proactive Medical Review | Sep 22, 2021 | blog, SNF
“Calm seas never made a good sailor” Franklin D. Roosevelt was quoted as saying, and if that’s true, I expect the storms weathered by nursing home leaders over the past two years have seasoned many into veteran skippers. While we certainly would not have chosen this...
by Proactive Medical Review | Sep 13, 2021 | 5 Star, blog, Compliance, Falls, Nursing, QAPI, Quality, Regulatory, SNF, Survey
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...
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...
