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# Proactive LTC Consulting

Your patients depend on you, you can depend on us.

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## Posts

- [Blogs](https://proactiveltcexperts.com/blogs/) - The latest news, events, blogs and more… SNF PDPM Fraud and Abuse Risk Update: What Providers Need to Know by Proactive LTC Consulting | Jul 29, 2026 | Abuse, Coding, Compliance, Fraud, Medicaid, Medicare, PDPM, Reimbursement, SNF SNF PDPM Fraud and Abuse Risk Update: What Providers Need to Know The Patient-Driven Payment Model (PDPM) significantly
- [SNF PDPM Fraud and Abuse Risk Update: What Providers Need to Know](https://proactiveltcexperts.com/snf-pdpm-fraud-and-abuse-risk-update-what-providers-need-to-know/) - SNF PDPM Fraud and Abuse Risk Update: What Providers Need to Know The Patient-Driven Payment Model (PDPM) significantly changed skilled nursing facility (SNF) reimbursement under Medicare by shifting reimbursement from therapy service volume to residents’ clinical characteristics, While CMS achieved the goal of reducing incentives tied to therapy minutes, this payment model introduced new compliance,
- [Ask Proactive - Medical marijuana is legal in our state, and a new resident has a physician's certification for its use. Are we required to allow the resident to use medical marijuana in our facility?](https://proactiveltcexperts.com/ask-proactive-medical-marijuana-is-legal-in-our-state-and-a-new-resident-has-a-physicians-certification-for-its-use-are-we-required-to-allow-the-resident-to-use-medical-marijuana-in-our-facility/) - Q: Medical marijuana is legal in our state, and a new resident has a physician's certification for its use. Are we required to allow the resident to use medical marijuana in our facility? A: This is a common question long-term care providers face as more states legalize medical marijuana. The answer is not necessarily. While
- [Is Your PBJ Data Telling the Right Story?](https://proactiveltcexperts.com/is-your-pbj-data-telling-the-right-story/) - Is Your PBJ Data Telling the Right Story? Payroll-Based Journal reporting is often viewed as a quarterly payroll task. Submit the file, confirm it was accepted, and move on. But PBJ tells a much bigger story—reflecting the staffing your residents received, the accuracy of your facility’s data, the strength of your internal processes, and your
- [The Landscape of Skilled Service Justification in Skilled Nursing Facilities](https://proactiveltcexperts.com/the-landscape-of-skilled-service-justification-in-skilled-nursing-facilities/) - Skilled Service Justification in SNFs In the ever-evolving landscape of skilled nursing facilities (SNFs), the stakes have never been higher. With constant advancements in data analytics, regulatory bodies are sharpening their focus on compliance and accountability for payment accuracy, leading to an uptick in audits. This shift underscores the critical importance of robust skilled service
- [Ask Proactive - How does the activities CAA influence care planning?](https://proactiveltcexperts.com/ask-proactive-how-does-the-activities-caa-influence-care-planning-2/) - Q: How does the activities CAA influence care planning? A: The Activities Critical Assessment Area (CAA) triggers when the MDS identifies that an individual’s activity preferences or needs require further evaluation. This process ensures that the care plan is personalized to the resident's unique preferences, abilities, and barriers, enhancing their quality of life through
- [The Impact of Accurate Depression Screening](https://proactiveltcexperts.com/understanding-the-practical-impact-of-accurate-depression-screening/) - The Minimum Data Set (MDS) plays a crucial role in influencing facility reimbursement, quality measures, and overall care quality. The accuracy of MDS coding is paramount, relying heavily on precise assessments and interviews. Accuracy in assessing and screening for depression symptoms is critical for care quality and reimbursement outcomes. The MDS uses the PHQ-2 to
- [Ask Proactive – MDS Section I—ICD.10 Diagnosis Code Error](https://proactiveltcexperts.com/ask-proactive-ive-noticed-when-reviewing-resident-diagnoses-for-mds-section-i-that-several-of-the-diagnoses-are-suddenly-showing-an-error-message-how-do-i-correct-this/) - Q: I’ve noticed when reviewing resident diagnoses for MDS Section I that several of the diagnoses are suddenly showing an error message. How do I correct this? A: CMS has revised several ICD-10 codes for the 2023 fiscal year. These codes became effective October 1, 2022. Check with your clinical software provider to determine how
- [Ask Proactive – What are some of the most significant changes to the new RoP Interpretive Guidance for Abuse, Neglect & Exploitation?](https://proactiveltcexperts.com/ask-proactive-what-are-some-of-the-most-significant-changes-to-the-new-rop-interpretive-guidance-for-abuse-neglect-exploitation/) - Q: What are some of the most significant changes to the new RoP Interpretive Guidance for Abuse, Neglect & Exploitation? A: Some of the most significant changes to the new RoP Interpretive Guidance (IG) for Abuse, Neglect & Exploitation include the following: The IG now states that surveyors should not automatically determine that every resident-to-resident
- [2022 Survey Trends to Guide 2023 Survey Success](https://proactiveltcexperts.com/2022-survey-trends-to-guide-2023-survey-success/) - As we begin a new year, many of us are reflecting back on 2022 to help us set goals for positive change in 2023. Do your goals include prioritizing 5-Star Improvement or better survey outcomes? As you know, both annual surveys and complaint surveys can have a significant impact on the overall 5-Star Rating. To
- [If I Were Your Compliance Officer](https://proactiveltcexperts.com/if-i-were-your-compliance-officer/) - Our office regularly receives urgent calls from providers in crisis. We are in the business of coming alongside nursing facilities to shoulder a portion of the burden, drive corrective actions and assist to remedy problem situations. Given the choice and resources, our clients and consulting team would agree that preemptively addressing potential risks is preferred
- [Detecting the Root Cause of Infection Events](https://proactiveltcexperts.com/update-snf-qualifying-hospital-stay-qhs-benefit-period-waivers-and-medical-review-preparedness/) - Federal regulations require the facility Infection Preventionist (IP) to be a participant on the facility’s Quality Assessment and Assurance (QAA) committee and report on the Infection Prevention and Control Program (IPCP) and on incidents (e.g., healthcare-associated infections (HAIs)) identified under the program on a regular basis. Reporting may include, but is not limited to, facility
- [Does Your MDS Office Need an Ally?](https://proactiveltcexperts.com/does-your-mds-office-need-an-ally/) - Does Your MDS Office Need an Ally? Our MDS experts offer the support your team needs to achieve your clinical assessment, coding, & reimbursement goals.
- [Ask Proactive - What should be included in the note for periodic review of restorative nursing programs?](https://proactiveltcexperts.com/ask-proactive-what-should-be-included-in-the-note-for-periodic-review-of-restorative-nursing-programs/) - Q: What should be included in the note for periodic review of restorative nursing programs? A: As the nurse overseeing restorative nursing, when reviewing restorative documentation, ensure the note answers these questions: Was the restorative intervention actually performed? Did it match the care plan and physician order? How much assistance was required? How did the
- [Ask Proactive - Family Communication Challenges](https://proactiveltcexperts.com/ask-proactive-family-communication-challenges/) - Family Communication Challenges: What should you do? Strong communication with families is essential to providing quality resident-centered care. Challenging conversations often occur during times of stress, unexpected changes, or misunderstandings. Effective communication techniques promote trust, empathy, and collaboration. Below are some scenarios and suggested responses. Q: Mrs. Smith’s daughter arrives at the facility upset
- [Common Reasons Plans of Correction (PoCs) Are Rejected](https://proactiveltcexperts.com/common-reasons-plans-of-correction-pocs-are-rejected/) - Common Reasons Plans of Correction (PoCs) Are Rejected Receiving a Statement of Deficiencies (CMS-2567) is stressful enough. Writing a Plan of Correction (PoC) that satisfies your state survey agency can be equally intimidating. Under CMS regulations (42 CFR §488.401), a Plan of Correction is a written plan developed by the facility, and approved by CMS
- [F671 Compliance: Medication and Treatment Cart Oversight](https://proactiveltcexperts.com/f671-compliance-medication-and-treatment-cart-oversight/) - F671 Compliance: Medication and Treatment Cart Oversight F 761 Labeling and Storage of Drugs and Biologicals has been cited in over 12% of all surveys through June 2026 with 1,850 deficiencies and currently ranks 5th in the overall deficiencies cited. This is a clear indication of the ongoing need for frequent education for medication
- [Ask Proactive - How do I determine if a diagnosis is active and can be coded on the MDS?](https://proactiveltcexperts.com/ask-proactive-how-do-i-determine-if-a-diagnosis-is-active-and-can-be-coded-on-the-mds/) - Q: How do I determine if a diagnosis is active and can be coded on the MDS? A: Determining whether a diagnosis can be coded on the MDS involves a two-step process. A diagnosis must meet both criteria to be coded as an active diagnosis. Step 1: Was the diagnosis documented within the
- [Top Nursing Documentation Mistakes Impacting Survey Outcomes—And How to Avoid Them](https://proactiveltcexperts.com/top-nursing-documentation-mistakes-impacting-survey-outcomes-and-how-to-avoid-them/) - Top Nursing Documentation Mistakes Impacting Survey Outcomes—And How to Avoid Them Documentation has always been an essential part of resident care, but in today's regulatory environment, it has become one of the most powerful pieces of evidence surveyors use to determine compliance. Surveyors don't simply evaluate whether care was provided—they evaluate whether the medical
- [Ask Proactive - Our facility was selected for a second round of a Medicare TPE. Should we be worried that Medicare is targeting us?](https://proactiveltcexperts.com/ask-proactive-our-facility-was-selected-for-a-second-round-of-a-medicare-tpe-should-we-be-worried-that-medicare-is-targeting-us/) - Q: Our facility was selected for a second round of a Medicare TPE. Should we be worried that Medicare is targeting us? A: No. While receiving a second round of a TPE can certainly be unsettling, it is important to know that you are not alone. Over the past year, we’ve seen a
- [The Importance of an Individualized Plan of Care in Home Health](https://proactiveltcexperts.com/the-importance-of-an-individualized-plan-of-care-in-home-health/) - In home health care, every patient’s journey is unique — and their care should be too. That’s where an Individualized Plan of Care (POC) becomes essential. The POC serves as the foundation for all care provided, ensuring that every intervention, medication, and visit is designed to meet the specific needs of the patient. What Is
- [Ask Proactive - We are in our survey window and some staff are nervous about surveyors observing care and asking them questions during survey. Do you have any tips to share for interacting with surveyors?](https://proactiveltcexperts.com/ask-proactive-we-are-in-our-survey-window-and-some-staff-are-nervous-about-surveyors-observing-care-and-asking-them-questions-during-survey-do-you-have-any-tips-to-share-for-interacting-with-survey/) - Q: We are in our survey window and some staff are nervous about surveyors observing care and asking them questions during survey. Do you have any tips to share for interacting with surveyors? A: Communicating with state surveyors can feel stressful and at times intimidating, but it doesn't have to be. The key is
- [Top 5 Nursing Documentation Misses Impacting QMs and How to Avoid Them](https://proactiveltcexperts.com/top-5-nursing-documentation-misses-impacting-qms-and-how-to-avoid-them/) - Top 5 Nursing Documentation Misses Impacting QMs and How to Avoid Them Nursing documentation is the backbone of the care provided to long term care residents and supports many of the critical components used to measure facility performance, including: Survey outcomes PDPM and Case Mix Reimbursement The Five-Star Rating System The Quality Reporting Program (QRP)
- [Why AI Should Support the MDS Coordinator — Not Replace Them](https://proactiveltcexperts.com/why-ai-should-support-the-mds-coordinator-not-replace-them/) - Why AI Should Support the MDS Coordinator — Not Replace Them Artificial intelligence is rapidly reshaping healthcare and long-term care operations. Facilities are already using it to review documentation, identify trends, streamline workflows, summarize records, and flag potential reimbursement opportunities. But as the conversation around automation accelerates, healthcare leaders need to recognize an important truth:
- [Ask Proactive - One of the residents at my facility was recently put onto a fluid restriction for ESRD, what should I be concerned about for documentation and care planning?](https://proactiveltcexperts.com/ask-proactive-one-of-the-residents-at-my-facility-was-recently-put-onto-a-fluid-restriction-for-esrd-what-should-i-be-concerned-about-for-documentation-and-care-planning/) - Q: One of the residents at my facility was recently put onto a fluid restriction for ESRD, what should I be concerned about for documentation and care planning? A: Fluid restrictions, and any dietary restrictions, are not uncommon, but can present some potential documentation pitfalls. First, the restriction itself should be documented including the
- [Survey Updates: Scheduling, Revisits, Exit Conferences & More](https://proactiveltcexperts.com/survey-updates-scheduling-revisits-exit-conferences-more/) - Survey Updates: Scheduling, Revisits, Exit Conferences & More CMS recently issued updates that impact the survey process including new guidance regarding scheduling procedures, acceptable plans of correction, revisits, exit conferences and other areas. Let’s review what you need to know from QSO-26-03-NH Revised and summarize the most recent updates to the State Operations Manual
- [Ask Proactive - We have a resident with dementia who becomes restless and repeatedly attempts to leave the unit during the late afternoon. As part of care planning, what non-pharmacological interventions should we consider?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-with-dementia-who-becomes-restless-and-repeatedly-attempts-to-leave-the-unit-during-the-late-afternoon-as-part-of-care-planning-what-non-pharmacological-interventi/) - Q: We have a resident with dementia who becomes restless and repeatedly attempts to leave the unit during the late afternoon. As part of care planning, what non-pharmacological interventions should we consider? A: Effective person-centered care focuses on understanding the reason behind a behavior. The interdisciplinary team should first assess the resident's individual preferences,
- [Ask Proactive - We have an employee who has had multiple attendance issues and performance concerns. We've documented counseling sessions, provided coaching, and issued written warnings, but the employee has not improved. What steps should we take before terminating employment?](https://proactiveltcexperts.com/ask-proactive-we-have-an-employee-who-has-had-multiple-attendance-issues-and-performance-concerns-weve-documented-counseling-sessions-provided-coaching-and-issued-written-warnings-but-the-empl/) - Q: We have an employee who has had multiple attendance issues and performance concerns. We've documented counseling sessions, provided coaching, and issued written warnings, but the employee has not improved. What steps should we take before terminating employment? A: Before making a termination decision, leaders should ensure they have followed their organization's personnel policies
- [F692 Nutrition Risk Blueprint: Documentation that Drives Results](https://proactiveltcexperts.com/f692-nutrition-risk-blueprint-documentation-that-drives-results/) - F692 Nutrition Risk Blueprint: Documentation that Drives Results Few clinical issues draw more focus and attention during surveys than unintended weight loss and altered nutritional status. These issues impact resident well-being and quality of life and are linked to regulatory requirements under F-tags, such as F692 (Nutrition/hydration Status) and F693 (Feeding Tube Management). Nursing facilities
- [Ask Proactive - We recently had a resident who experienced a choking episode during lunch. Staff performed the Heimlich maneuver successfully, and a swallowing evaluation later showed they had difficulty managing regular-texture foods and thin liquids. What should be included in the care plan for a resident who has experienced a choking event or is at risk of choking?](https://proactiveltcexperts.com/ask-proactive-we-recently-had-a-resident-who-experienced-a-choking-episode-during-lunch-staff-performed-the-heimlich-maneuver-successfully-and-a-swallowing-evaluation-later-showed-they-had-difficu/) - Q: We recently had a resident who experienced a choking episode during lunch. Staff performed the Heimlich maneuver successfully, and a swallowing evaluation later showed they had difficulty managing regular-texture foods and thin liquids. What should be included in the care plan for a resident who has experienced a choking event or is at risk of choking?
- [Are We Delivering Care… or Creating a Resident Experience?](https://proactiveltcexperts.com/are-we-delivering-care-or-creating-a-resident-experience/) - Are We Delivering Care… or Creating a Resident Experience? In long-term care, most teams come to work wanting to provide compassionate care. But between staffing challenges, admissions, med passes, documentation, call lights, treatments, and survey readiness, it’s easy for daily routines to become task-driven instead of resident-driven. This can be the slippery slope where quality
- [Top Home Health Survey Deficiencies and How to Avoid Them](https://proactiveltcexperts.com/home-health-news-top-home-health-survey-deficiencies-and-how-to-avoid-them/) - Top Home Health Survey Deficiencies and How to Avoid Them When it comes to home health agency compliance, survey readiness requires year-round attention. Let’s breakdown of the top home health survey deficiencies and actionable tips to prevent them. 1. Patient Rights and Informed Consent Deficiency: Failure to properly inform patients of their rights
- [Emergency Preparedness Plan Drills & Tabletop Exercises](https://proactiveltcexperts.com/emergency-preparedness-plan-drills-tabletop-exercises/) - Emergency Preparedness Plan Drills & Tabletop Exercises Emergency preparedness can no longer be treated as a “binder on the shelf” requirement. Surveyors increasingly expect Skilled Nursing Facilities to demonstrate that emergency preparedness programs are active, interdisciplinary, operational, and capable of protecting residents during real-world emergencies. One of the most effective ways to show compliance is
- [Ask Proactive - Does a triggered CAA always require a care plan intervention?](https://proactiveltcexperts.com/ask-proactive-does-a-triggered-caa-always-require-a-care-plan-intervention/) - Q: Does a triggered CAA always require a care plan intervention? A: No. A triggered CAA does not automatically mean the resident must have a new or revised care plan intervention. The purpose of the CAA process is to help the interdisciplinary team analyze the resident’s condition and determine whether care planning is clinically
- [Major CMS Change for Home Health and Hospice](https://proactiveltcexperts.com/major-cms-change-for-home-health-and-hospice-take-action-today/) - The major Medicare change announced on May 13, 2026, is a nationwide temporary freeze on new Medicare enrollments for home health agencies and hospice providers. The action was announced by the U.S. Centers for Medicare & Medicaid Services (CMS) as part of a broad anti-fraud crackdown focused on home health and hospice services. Here is
- [Ask Proactive - Can IV fluids be coded in K0520A (Parenteral/IV Feeding) on the MDS?](https://proactiveltcexperts.com/ask-proactive-can-iv-fluids-be-coded-in-k0520a-parenteral-iv-feeding-on-the-mds/) - Q: Can IV fluids be coded in K0520A (Parenteral/IV Feeding) on the MDS? A: Yes — but only when the IV fluids are administered specifically to address a nutrition or hydration need and there is supporting documentation in the medical record. CMS clarifies that K0520A includes nutrition or hydration received during the observation period
- [Fresh Take on Repetitive Falls](https://proactiveltcexperts.com/fresh-take-on-repetitive-falls/) - Fresh Take on Repetitive Falls Falls remain one of the most challenging quality and safety concerns in skilled nursing facilities with one in three residents experiencing recurrent falls each year[i]. While many falls do not result in major injury, repetitive falls often lead to other issues including fear of falling, restriction of physical activity, declines
- [F880 Citations: Infection Preventionist Oversight of Laundry](https://proactiveltcexperts.com/f880-citations-infection-preventionist-oversight-of-laundry/) - F880 Citations: Infection Preventionist Oversight of Laundry Laundry services in long-term care are often viewed as a support function, but from an infection prevention standpoint, they represent a critical control point for preventing healthcare- associated infections. Oversight of Linen Systems When proper processes are followed, transmission risk is generally low; however, failure to handle
- [Ask Proactive - I have a resident that was originally admitted to our facility with a stage 2 pressure ulcer who went out to the hospital for three days and returned with a stage 2 pressure ulcer in the same location.  How would this be coded on the MDS?](https://proactiveltcexperts.com/ask-proactive-i-have-a-resident-that-was-originally-admitted-to-our-facility-with-a-stage-2-pressure-ulcer-who-went-out-to-the-hospital-for-three-days-and-returned-with-a-stage-2-pressure-ulcer-in-t/) - Q: I have a resident that was originally admitted to our facility with a stage 2 pressure ulcer who went out to the hospital for three days and returned with a stage 2 pressure ulcer in the same location. How would this be coded on the MDS? A: Completing a head-to-toe physical examination of
- [Medical Necessity: The Key to Successful Home Health Documentation](https://proactiveltcexperts.com/medical-necessity-the-key-to-successful-home-health-documentation-2/) - One of the top denial reasons for home health claims is “services were not medically necessary”. Many home health agencies face challenges related to documenting medical necessity for both nursing and therapy services. Clinicians must “paint the picture” each visit to ensure that the visit stands alone. Failure for each note to individually support medical
- [Ask Proactive - What should be considered when assessing a resident’s safety with hot liquids?](https://proactiveltcexperts.com/ask-proactive-what-should-be-considered-when-assessing-a-residents-safety-with-hot-liquids/) - Q: What should be considered when assessing a resident’s safety with hot liquids? A: Several factors that should be considered for all residents in determining safe ingestion of hot liquids including: Is there any history of spills or injuries related to hot liquids? Does the resident’s dexterity assessment indicate any risks for ingesting hot
- [Behavior Tracking & Trending to Drive Better Care Management](https://proactiveltcexperts.com/behavior-tracking-trending-to-drive-better-care-management/) - In long-term care, behaviors are often one of the earliest signs that something has changed with a resident. Agitation, wandering, refusal of care, exit-seeking, verbal outbursts, sleep disruption, repetitive questioning, or sudden withdrawal are rarely “just behaviors.” They are usually communication. When facilities consistently track and trend behaviors, they gain valuable insight that can lead
- [Ask Proactive - My facility Long-Stay antipsychotic percentage increased on my 2026 Quality Measures. What are some best practices for reviewing Psychotropic medications?](https://proactiveltcexperts.com/ask-proactive-my-facility-long-stay-antipsychotic-percentage-increased-on-my-2026-quality-measures-what-are-some-best-practices-for-reviewing-psychotropic-medications/) - Q: My facility Long-Stay antipsychotic percentage increased on my 2026 Quality Measures. What are some best practices for reviewing Psychotropic medications? A: It is possible the increase in your QM percentage is not due to a true increase in antipsychotic medication use in your facility. An increase in this measure was anticipated in 2026
- [The Engine Behind Outcomes: QM Systems](https://proactiveltcexperts.com/the-engine-behind-outcomes-qm-systems/) - The Engine Behind Outcomes: Quality Measure Systems Many facilities focus on Quality Measure scores after they decline. High-performing facilities build systems that prevent decline before it happens. Improving Quality Measures (QMs) in skilled nursing facilities is not simply about chasing numbers—it is about building systems that consistently lead to better resident outcomes. Facilities that
- [Top Survey Deficiencies Q1-2026](https://proactiveltcexperts.com/top-survey-deficiencies-q1-2026/) - Top Survey Deficiencies Q1-2026 The top survey tag for Quarter 1 of 2026 was F880 Infection Prevention and Control, followed by F689 Free of Accident Hazards/Supervision/Devices. Read on for details on the most commonly cited issues in these tags…. Top Survey Deficiencies for Quarter 1 2026 included: Tag # Tag Description #
- [Ask Proactive - What is a Good Way to Gauge the Current Competency Level of My Staff?](https://proactiveltcexperts.com/ask-proactive-what-is-a-good-way-to-gauge-the-current-competency-level-of-my-staff/) - Q: What is a good way to gauge the current competency level of my staff? A: A practical and effective way to gauge the current competency level of your staff is to combine your Facility Assessment with hands-on skills validation. Start by ensuring your Facility Assessment accurately reflects your current resident population, acuity, and
- [Risk Management in Action: Effective Meeting Strategies for Long-Term Care Leaders](https://proactiveltcexperts.com/risk-management-in-action-effective-meeting-strategies-for-long-term-care-leaders/) - Risk Management in Action: Effective Meeting Strategies for Long-Term Care Leaders Risk management meetings area a cornerstone of safe, high-quality care in long-term care facilities. They provide a structured forum to identify trends, reduce harm, and strengthen regulatory compliance. Below are some frequently asked questions to guide leaders in running effective, risk-focused meetings. Q:
- [FY 2027 SNF Proposed Payment Rule: What SNFs Need to Know](https://proactiveltcexperts.com/fy-2027-snf-proposed-payment-rule-what-snfs-need-to-know/) - FY 2027 SNF Proposed Payment Rule: What SNFs Need to Know On April 2, 2026, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for updates to Medicare payment policies and rates for skilled nursing facilities under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for fiscal year (FY) 2027. Let’s
- [From Risk to Results: Pressure Ulcer QM Improvement](https://proactiveltcexperts.com/from-risk-to-results-pressure-ulcer-qm-improvement/) - From Risk to Results: Pressure Ulcer QM Improvement Pressure Ulcer and injury Quality Measures (QMs) are no longer just indicators of care; they are performance drivers that directly impact your Five-Star rating, public reporting, and reimbursement. Yet many facilities struggle to achieve targets in this measure because they lack a structured approach to QM improvement.
- [Ask Proactive - I am a Director of Nursing Services (DNS) juggling many responsibilities. What is the best way to support and oversee the MDS department?](https://proactiveltcexperts.com/ask-proactive-i-am-a-director-of-nursing-services-dns-juggling-many-responsibilities-what-is-the-best-way-to-support-and-oversee-the-mds-department/) - Q: I am a Director of Nursing Services (DNS) juggling many responsibilities. What is the best way to support and oversee the MDS department? A: The most effective approach to overseeing MDS is to balance support, accountability, and clinical involvement with a focus on consistent accuracy, compliance, and reimbursement outcomes. I suggest starting with
- [Turning Fall Data into Action: Driving Meaningful Prevention Strategies](https://proactiveltcexperts.com/turning-fall-data-into-action-driving-meaningful-prevention-strategies/) - Turning Fall Data into Action: Driving Meaningful Prevention Strategies Falls remain one of the most persistent and costly challenges in skilled nursing facilities. Yet despite ongoing prevention efforts, many facilities find themselves stuck in a cycle of repeated incidents without measurable improvement. The difference between average outcomes and high-performing facilities often comes down to
- [The Ultimate Guide to F585: Grievance Process](https://proactiveltcexperts.com/the-ultimate-guide-to-f585-grievance-process/) - The Ultimate Guide to F585: Grievance Process A strong grievance program is more than a regulatory checkbox—it’s a direct reflection of how your facility listens, responds, and improves. Under F585 in the Centers for Medicare & Medicaid Services State Operations Manual (Appendix PP), facilities must maintain a grievance process that is accessible, responsive, and resident-centered.
- [Ask Proactive - We are in the process of reviewing the Restorative Nursing Ambulation program.  Some residents are only able to walk very short distances.  Would these patients be appropriate for the program?](https://proactiveltcexperts.com/ask-proactive-we-are-in-the-process-of-reviewing-the-restorative-nursing-ambulation-program-some-residents-are-only-able-to-walk-very-short-distances-would-these-patients-be-appropriate-for-the/) - Q: We are in the process of reviewing the Restorative Nursing Ambulation program. Some residents are only able to walk very short distances. Would these patients be appropriate for the program? A: The restorative ambulation program should include activities provided to improve or maintain the resident’s performance with respect to walking. The RAI manual
- [Boosting Staff Retention in Home Health: Strategies That Work](https://proactiveltcexperts.com/boosting-staff-retention-in-home-health-strategies-that-work/) - In today’s competitive healthcare landscape, retaining qualified home health staff has become more challenging than ever. High turnover not only affects team morale but also compromises the continuity of care and increases operational costs. For home health agencies, staff retention isn’t just a staffing issue, it’s a quality-of-care imperative. Why Retention Matters in Home Health
- [Ask Proactive - We recently had a resident fall that resulted in a fracture, and we anticipate this may trigger a complaint survey. Our team is concerned and wants to make sure we’re prepared. What should we be doing right now?](https://proactiveltcexperts.com/ask-proactive-we-recently-had-a-resident-fall-that-resulted-in-a-fracture-and-we-anticipate-this-may-trigger-a-complaint-survey-our-team-is-concerned-and-wants-to-make-sure-were-prepared/) - Q: We recently had a resident fall that resulted in a fracture, and we anticipate this may trigger a complaint survey. Our team is concerned and wants to make sure we’re prepared. What should we be doing right now? A: You’re right to anticipate survey activity—falls with fracture are one of the most common
- [Impact of Primary Diagnosis Selection on the Quality Measures](https://proactiveltcexperts.com/impact-of-primary-diagnosis-selection-on-the-quality-measures/) - Impact of Primary Diagnosis Selection on the Quality Measures A well‑chosen primary diagnosis and accurate coding of all active diagnoses on the MDS does more than impact reimbursement. It shapes a resident’s clinical category, which in turn determines whether the resident is included in, excluded from, or flagged by multiple CMS Quality Measures (QMs). When
- [The Nitty Gritty of SNF Skilled Service Criteria](https://proactiveltcexperts.com/the-nitty-gritty-of-snf-skilled-service-criteria/) - The Nitty Gritty of SNF Skilled Service Criteria Determining whether a resident qualifies for Skilled Nursing Facility (SNF) care is an important, and frequently misunderstood, responsibility in post-acute care. Admission decisions, coverage, documentation, and care planning all hinge on whether services meet the definition of “skilled” under CMS guidelines for Medicare coverage. For interdisciplinary teams,
- [Ask Proactive - One of the residents at my facility was sent out to the hospital in the afternoon and returned to the facility later that evening during the 30-day look-back for my MDS. On reviewing the ED paperwork, I saw that she was diagnosed with a UTI. Because this diagnosis came from the hospital, I understand that I do not need to find support for the McGeer criteria to code this at I2300. Is that correct?](https://proactiveltcexperts.com/ask-proactive-one-of-the-residents-at-my-facility-was-sent-out-to-the-hospital-in-the-afternoon-and-returned-to-the-facility-later-that-evening-during-the-30-day-look-back-for-my-mds-on-reviewing-t/) - Q: One of the residents at my facility was sent out to the hospital in the afternoon and returned to the facility later that evening during the 30-day look-back for my MDS. On reviewing the ED paperwork, I saw that she was diagnosed with a UTI. Because this diagnosis came from the hospital, I understand
- [QAPI and Performance Improvement Projects in Home Health: Turning Compliance into Real Improvement](https://proactiveltcexperts.com/qapi-and-performance-improvement-projects-in-home-health-turning-compliance-into-real-improvement/) - For Medicare-certified home health agencies, QAPI (Quality Assessment and Performance Improvement) is not optional, it’s required under the Centers for Medicare & Medicaid Services Conditions of Participation (CoPs). Strong agencies know QAPI isn’t just about passing survey. It’s about preventing rehospitalizations, improving outcomes, and protecting reimbursement. Let’s break it down clearly. What Is QAPI in Home
- [Ask Proactive - Our IDT was actively working on a discharge plan for a resident to be discharged home on Friday, but on the previous Saturday the family came and told the nurses they were taking the resident home that afternoon. We were able to obtain a discharge order from the MD for this and set up some expedited services for care in the home setting prior to the resident’s departure that afternoon. Would this discharge be considered a planned or unplanned discharge?](https://proactiveltcexperts.com/ask-proactive-our-idt-was-actively-working-on-a-discharge-plan-for-a-resident-to-be-discharged-home-on-friday-but-on-the-previous-saturday-the-family-came-and-told-the-nurses-they-were-taking-the-r/) - Q: Our IDT was actively working on a discharge plan for a resident to be discharged home on Friday, but on the previous Saturday the family came and told the nurses they were taking the resident home that afternoon. We were able to obtain a discharge order from the MD for this and set up
- [Adverse Events and Reportable Incidents: From Response to Prevention](https://proactiveltcexperts.com/adverse-events-and-reportable-incidents-from-response-to-prevention/) - Adverse Events and Reportable Incidents: From Response to Prevention Adverse events and reportable occurrences are among the most closely scrutinized aspects of long-term care. F689 – Free of Accident Hazards/Supervision/Devices and F610– Reporting of Alleged Violations are currently in the top 10 most frequently cited F-tags for FY 2026. While not every event is preventable,
- [What Is a Home Health LUPA and How Does It Impact Your Agency?](https://proactiveltcexperts.com/what-is-a-home-health-lupa-and-how-does-it-impact-your-agency/) - What Is a Home Health LUPA and How Does It Impact Your Agency? If you manage or work in Medicare-certified home health, you’ve likely heard the term LUPA. It’s one of the most important reimbursement concepts in home health billing and one that can significantly affect your agency’s financial health. But what exactly is a
- [Ask Proactive - Why is nursing documentation one of the biggest risks in medical reviews?](https://proactiveltcexperts.com/ask-proactive-why-is-nursing-documentation-one-of-the-biggest-risks-in-medical-reviews/) - Q: Why is nursing documentation one of the biggest risks in medical reviews? A: Nursing documentation is one of the biggest medical review risk areas because it supports Medicare coverage and directly affects the nursing component, Non-Therapy Ancillaries (NTA), and overall HIPPS code in the Patient Driven Payment Model (PDPM). Nursing assessment and documentation
- [The iQIES Reports Every SNF Should Be Reviewing (and When to Run Them)](https://proactiveltcexperts.com/the-iqies-reports-every-snf-should-be-reviewing-and-when-to-run-them/) - The iQIES Reports Every SNF Should Be Reviewing (and When to Run Them) For MDS and Quality Assurance leaders, the internet Quality Improvement & Evaluation System (iQIES) isn’t just another web portal; it’s your early warning system. When reports are run consistently and reviewed intentionally, iQIES can help you catch MDS submission errors, protect your
- [Home Health Turnover: Causes, Costs, and Practical Solutions](https://proactiveltcexperts.com/home-health-turnover-causes-costs-and-practical-solutions/) - Home Health Turnover: Causes, Costs, and Practical Solutions Employee turnover is one of the biggest challenges facing home health agencies today. Whether you provide skilled home health, personal care, or private duty services, keeping quality caregivers and clinicians on staff has a direct impact on patient care, compliance, and profitability. High turnover isn’t just an
- [Ask Proactive - What is CMS Directed In-Service Training?](https://proactiveltcexperts.com/ask-proactive-what-is-cms-directed-in-service-training/) - Q: What is CMS Directed In-Service Training? A: CMS Directed In-Service Training (DIT) is a regulatory enforcement remedy used when surveyors identify serious or systemic noncompliance in a nursing facility. Rather than relying solely on corrective action plans, CMS or the State Survey Agency requires the facility to provide targeted, mandatory education to staff
- [Daily Survey Readiness: The Foundation of Successful Survey Outcomes](https://proactiveltcexperts.com/daily-survey-readiness-the-foundation-of-successful-survey-outcomes/) - Daily Survey Readiness: The Foundation of Successful Survey Outcomes The key to a successful survey outcome is maintaining survey readiness every day. Achieving this requires consistent, intentional actions embedded into daily operations. Consider these critical steps… Training Among all readiness strategies, staff education and training is the most critical. All facility staff should be
- [Ask Proactive - After submitting our quarterly PBJ file we discovered there were hours for agency nursing staff that we omitted.  Are we able to correct this omission?  Will the omission impact our Five Star rating?](https://proactiveltcexperts.com/ask-proactive-after-submitting-our-quarterly-pbj-fille-we-discovered-there-were-hours-for-agency-nursing-staff-that-we-omitted-are-we-able-to-correct-this-omission-will-the-omission-impact-our-f/) - Q: After submitting our quarterly PBJ file we discovered there were hours for agency nursing staff that we omitted. Are we able to correct this omission? Will the omission impact our Five Star rating? A: The ability to correct depends on whether the submission window is still open or not. The deadline for each reporting
- [State Operation Manual Revisions to Chapters 5 and 7](https://proactiveltcexperts.com/state-operation-manual-revisions-to-chapters-5-and-7/) - State Operation Manual Revisions to Chapters 5 and 7 On January 30, 2026 CMS released QSO-26-03-NH which announces the revisions to Chapter 5 and Chapter 7 of the State Operations Manual. CMS indicates that these updates were to “align instructions and guidance with current policies in QSO memos and established practices”. Key revisions to note
- [CMS Revises SFF Selection Focus: Falls Data Takes Center Stage](https://proactiveltcexperts.com/cms-revises-sff-selection-focus-falls-data-takes-center-stage/) - CMS Revises SFF Selection Focus: Falls Data Takes Center Stage CMS announced an update to the Special Focus Facility (SFF) program, with a targeted shift in how facilities are selected and monitored. What’s Changed Greater Emphasis on Resident Falls CMS is revising the SFF selection focus to emphasize a facility’s prevalence of resident falls.
- [Infection Control: Emerging Issues & Survey Readiness](https://proactiveltcexperts.com/infection-control-emerging-issues-survey-readiness/) - Infection Control: Emerging Issues & Survey Readiness Infection prevention and control remains one of the most heavily scrutinized areas in long-term care—and for good reason. As we move into 2026, the Centers for Medicare & Medicaid Services (CMS) has shifted from pandemic-era monitoring to a more standardized, integrated survey approach. While separate focused infection control
- [Home Health VBP Changes for 2026: What Agencies Need to Know Now](https://proactiveltcexperts.com/home-health-vbp-changes-for-2026-what-agencies-need-to-know-now/) - Home Health VBP Changes for 2026: What Agencies Need to Know Now The Home Health Value-Based Purchasing (HHVBP) Model continues to reshape how Medicare evaluates and pays home health agencies and 2026 marks one of the most impactful updates since nationwide expansion. CMS is doubling down on what matters most which is measurable patient outcomes
- [Ask Proactive - What are the necessary components to the plan of care for residents receiving hospice services?](https://proactiveltcexperts.com/ask-proactive-what-are-the-necessary-components-to-the-plan-of-care-for-residents-receiving-hospice-services/) - Q: What are the necessary components to the plan of care for residents receiving hospice services? A: To establish and maintain continuity of care, the facility and hospice must collaborate in the development of the resident’s plan of care and includes the following: The coordinated plan of care must identify the provider responsible for
- [A Big Change Is Showing Up in Your QM Reports: Hybrid Long-Stay Antipsychotic Measure](https://proactiveltcexperts.com/a-big-change-is-showing-up-in-your-qm-reports-hybrid-long-stay-antipsychotic-measure/) - A Big Change Is Showing Up in Your QM Reports: Hybrid Long-Stay Antipsychotic Measure The new Hybrid Long-Stay Antipsychotic Quality Measure is now live and visible on MDS 3.0 QM reports resulting in dramatic shifts in scoring for some facilities. If you haven’t already, now’s the time to run both your facility-level and resident-level QM
- [Ask Proactive - A resident reports that a staff member has mistreated them. What steps should be taken?](https://proactiveltcexperts.com/ask-proactive-a-resident-reports-that-a-staff-member-has-mistreated-them-what-steps-should-be-taken/) - Q: A resident reports that a staff member has mistreated them. What steps should be taken? A: When an allegation of abuse is reported actions should be taken to comply with the Elder Justice Act, state regulations and facility policy. General best practices include: Remain calm, acknowledge their concern, and gather details (description of
- [Strengthen Your Health Inspection Rating — Don’t Leave Stars to Chance](https://proactiveltcexperts.com/strengthen-your-health-inspection-rating-dont-leave-stars-to-chance/) - Strengthen Your Health Inspection Rating — Don’t Leave Stars to Chance The CMS 5-Star Quality Rating System can feel daunting, and few areas cause more stress than the Health Inspection domain. Health Inspection outcomes are a reflection of how care is delivered every day, and survey performance directly influences your star rating. Determining
- [Path to Five Star Quality Measures in 2026](https://proactiveltcexperts.com/path-to-five-star-quality-measures-in-2026/) - The MDS 3.0 Quality Measures User’s Manual v18.0, effective January 1, 2026, includes some notable changes to QM specifications and reporting expectations. In addition, MDS‑driven QMs are becoming increasingly impactful across Care Compare, Five‑Star Ratings, SNF QRP, and the expanding SNF VBP program. A strong Five Star QM strategy in 2026 will require the following…
- [Ask Proactive - Key Expectations, Common Survey Findings, Best Practices, and Steps to Consider to Ensure Survey Readiness](https://proactiveltcexperts.com/ask-proactive-key-expectations-common-survey-findings-best-practices-and-steps-to-consider-to-ensure-survey-readiness/) - Intravenous therapy in skilled nursing facilities care heightens clinical and regulatory risk. Surveyors frequently review IV therapy practices to evaluate compliance related to federal quality of care regulations, nursing standards, infection prevention requirements, and facility-specific policies. The questions and answers below highlight key expectations, common survey findings, best practices, and steps to consider to ensure
- [Ask Proactive - It doesn’t appear that we’ve had any significant changes at our facility this past year. Do we still need to review or revise our Facility Assessment?](https://proactiveltcexperts.com/ask-proactive-it-doesnt-appear-that-weve-had-any-significant-changes-at-our-facility-this-past-year-do-we-still-need-to-review-or-revise-our-facility-assessment/) - Q: It doesn’t appear that we’ve had any significant changes at our facility this past year. Do we still need to review or revise our Facility Assessment? A: Yes. Under F838, the Facility Assessment must be reviewed at least annually, even if no significant changes have occurred. In addition, it must be updated whenever
- [Top 5 Skills of the Successful DON](https://proactiveltcexperts.com/top-5-skills-of-the-successful-don/) - What does it take to be a successful DON? Is it specific training, is it years of experience, or is effective nurse leadership inherent in the DNA of the person? If you were to review the performance characteristics of the most successful Directors of Nursing, these top 5 attributes would stand out… Ability to lead
- [Growing Your Home Health Agency: A Practical, Profitable Approach](https://proactiveltcexperts.com/growing-your-home-health-agency-a-practical-profitable-approach/) - Sustainable growth of a home health agency comes from strong operations, smart referral strategy, and disciplined financial oversight. Agencies that grow well do a few things exceptionally consistently. Here’s a practical roadmap to help your home health agency grow without sacrificing compliance, quality, or margin. Start With Operational Readiness Growth magnifies problems. If your
- [Home Health News: Creating a Successful Home Health Budget](https://proactiveltcexperts.com/home-health-news-creating-a-successful-home-health-budget-a-practical-guide-for-agency-leaders/) - Creating a Successful Home Health Budget: A Practical Guide for Agency Leaders Running a profitable home health agency requires more than growing census, it requires disciplined financial planning. A well-built budget is one of the most powerful tools agency leaders have to control costs, improve margins, and prepare for reimbursement changes. However, many home health
- [Ask Proactive - One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met to discuss a primary diagnosis. Therapy insists we should use Z47.1 Aftercare following joint replacement surgery, but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?](https://proactiveltcexperts.com/ask-proactive-one-of-our-long-term-residents-fell-and-fractured-their-femur-requiring-a-hip-replacement-they-returned-to-our-facility-on-a-skilled-stay-the-idt-met-to-discuss-a-primary-diagnosis/) - Q: One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met to discuss a primary diagnosis. Therapy insists we should use Z47.1 Aftercare following joint replacement surgery, but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture
- [PDPM Precision: Why the Details Matter More Than Ever](https://proactiveltcexperts.com/pdpm-precision-why-the-details-matter-more-than-ever/) - PDPM Precision: Why the Details Matter More Than Ever The Patient-Driven Payment Model (PDPM) isn’t new anymore, but the challenges surrounding it continue to evolve. Most facilities don’t go wrong as a result of a lack of effort or commitment. Instead, dedicated teams often face challenges navigating an increasingly complex system where small documentation
- [Home Health News: The 2026 Home Health Final Rule: What Agencies Need to Know and Do Now](https://proactiveltcexperts.com/home-health-news-the-2026-home-health-final-rule-what-agencies-need-to-know-and-do-now/) - The 2026 Home Health Final Rule: What Agencies Need to Know and Do Now The CMS Calendar Year (CY) 2026 Home Health Final Rule is official, and while the outcome is better than many agencies feared, it still presents meaningful financial and operational challenges. Effective January 1, 2026, the rule finalizes Medicare payment updates, PDGM
- [Ask Proactive - What are some practice tips to determine if an IPA would increase reimbursement?](https://proactiveltcexperts.com/ask-proactive-what-are-some-practice-tips-to-determine-if-an-ipa-would-increase-reimbursement/) - Q: What are some practice tips to determine if an IPA would increase reimbursement? A: The IDT should meet regularly to discuss the status of each resident utilizing their Medicare A benefits. The MDS coordinator and other key IDT members should have a thorough understanding of the components of the PDPM payment system. Helpful
- [Top Deficiencies of 2025 & Compliance Trends Heading Into the New Year](https://proactiveltcexperts.com/top-deficiencies-of-2025-compliance-trends-heading-into-the-new-year/) - Top Deficiencies of 2025 & Compliance Trends Heading Into the New Year As we move into the new year, nursing homes continue to navigate an increasingly complex regulatory environment. While enforcement priorities remain consistent in many areas, how surveyors are applying severity and where they are focusing their time is evolving. Let’s review FY
- [Home Health News: Everything Indiana Home Health Providers Need to Know About the July 2026 Medicare Certification Requirement](https://proactiveltcexperts.com/home-health-news-everything-indiana-home-health-providers-need-to-know-about-the-july-2026-medicare-certification-requirement/) - Everything Indiana Home Health Providers Need to Know About the July 2026 Medicare Certification Requirement Effective July 1, 2026, Indiana will implement a new Medicare certification/enrollment requirement for certain health care providers and it’s critical for home health agencies operating in the state to understand what this means and how to comply. What’s Changing?
- [Ask Proactive - How often should nursing respiratory competencies be evaluated?](https://proactiveltcexperts.com/ask-proactive-how-often-should-nursing-respiratory-competencies-be-evaluated/) - Q: How often should nursing respiratory competencies be evaluated? A: Respiratory competency checks should be performed regularly and anytime there's a specific reason to make sure staff can safely provide respiratory care—such as when new equipment is introduced. At a minimum, competencies should be evaluated: Upon hire: New nurses should demonstrate respiratory skills during
- [F698 Dialysis: Nursing Home Quality Assurance for ESRD Residents on Dialysis](https://proactiveltcexperts.com/f698-dialysis-nursing-home-quality-assurance-for-esrd-residents-on-dialysis/) - F698 Dialysis: Nursing Home Quality Assurance for ESRD Residents on Dialysis How effectively is your facility monitoring dialysis services to ensure regulatory compliance? Consider these guidelines as part of your Quality Assurance (QA) process… Appendix PP of the State Operations Manua (SOM)l includes F698 which defines the requirements for facilities caring for residents
- [Ask Proactive - Can I code Malnutrition (Section I5600) on the MDS based on a dietary assessment that identifies the resident as at risk for malnutrition?](https://proactiveltcexperts.com/ask-proactive-can-i-code-malnutrition-section-i5600-on-the-mds-based-on-a-dietary-assessment-that-identifies-the-resident-as-at-risk-for-malnutrition/) - Q: Can I code Malnutrition (Section I5600) on the MDS based on a dietary assessment that identifies the resident as at risk for malnutrition? A: No. Dietitian assessments alone do not provide sufficient documentation for coding of this item on the MDS. All diagnoses coded in section I of the MDS must meet
- [F695 Respiratory Care: QA Review of Residents on Oxygen](https://proactiveltcexperts.com/f695-respiratory-care-qa-review-of-residents-on-oxygen/) - F695 Respiratory Care: QA Review of Residents on Oxygen Ensuring safe, consistent, and compliant oxygen therapy is a critical responsibility in skilled nursing facilities (SNFs). As of the 2025 survey year, F695 Respiratory Care remains one of the top ten most frequently cited deficiencies nationwide. In many cases, survey findings reveal preventable documentation gaps,
- [The Power of Purposeful Morning Meetings](https://proactiveltcexperts.com/the-power-of-purposeful-morning-meetings/) - The Power of Purposeful Morning Meetings In long-term care (LTC) communities, the first moments of the day set the tone for the team and everything that follows. A well-structured morning meeting is more than a daily huddle-- it should service as an anchor for communication, teamwork, and resident-centered care. When teams come together with
- [Ask Proactive - What types of services are included in the coding of Respiratory Therapy on the MDS? Can this be done by CMTs? What must be included in the documentation to code Respiratory Therapy?](https://proactiveltcexperts.com/ask-proactive-what-types-of-services-are-included-in-the-coding-of-respiratory-therapy-on-the-mds-can-this-be-done-by-cmts-what-must-be-included-in-the-documentation-to-code-respiratory-therapy/) - Q: What types of services are included in the coding of Respiratory Therapy on the MDS? Can this be done by CMTs? What must be included in the documentation to code Respiratory Therapy? A: Appendix A of the RAI manual defines Respiratory Therapy as “Services that are provided by a qualified professional” which includes
- [Home Health News: Therapy Goal Writing in Home Health](https://proactiveltcexperts.com/home-health-news-therapy-goal-writing-in-home-health/) - Therapy Goal Writing in Home Health: A Practical Guide for Better Outcomes In home health, therapy goals serve as a roadmap for meaningful functional progress, Writing clear and measurable PT, OT and/or ST goals that connect to functional outcomes is one of the strongest predictors of patient success. Let’s review a framework for developing
- [Home Health News: The Role of the Governing Body in Home Health](https://proactiveltcexperts.com/home-health-news-the-role-of-the-governing-body-in-home-health/) - The Role of the Governing Body in Home Health: Why It Matters More Than Ever Running a successful home health agency requires strong leadership, clear oversight, and a structure that ensures accountability for clinical excellence. At the center of this structure is the Governing Body, a requirement under the Medicare Conditions of Participation (CoPs) and
- [Ask Proactive - Addressing Weight Accuracy Concerns in Skilled Nursing Facilities](https://proactiveltcexperts.com/ask-proactive-addressing-weight-accuracy-concerns-in-skilled-nursing-facilities/) - Q: Our facility has been flagged on the Weight Loss Quality Measure (QM. Upon reviewing the clinical records of residents identified with unplanned weight loss, we found several cases where a previous monthly weight documented on the prior MDS was likely inaccurate. For example, one resident’s record showed a 10-pound loss one month, followed by
- [Restorative Nursing Recordkeeping](https://proactiveltcexperts.com/restorative-nursing-recordkeeping/) - Restorative Nursing Recordkeeping A strong Restorative Nursing Program is one of the most powerful tools in long-term care for maintaining resident function, reducing falls and hospitalizations, and supporting quality of life. Even excellent restorative programming can fail to meet regulatory and clinical expectations without strong and consistent documentation. Recordkeeping in restorative nursing is not just
- [Medicaid Case Mix Index Under PDPM: What LTC Facilities Need to Know](https://proactiveltcexperts.com/medicaid-case-mix-index-under-pdpm-what-ltc-facilities-need-to-know-in-2025-and-beyond/) - Medicaid Case Mix Index Under PDPM: What LTC Facilities Need to Know As of October 1, 2025, the nationwide transition away from RUG-based Medicaid systems marks a major shift for long-term care. With more states moving to PDPM-based methodologies—and many adopting Nursing Component–only CMI calculations—facilities are navigating a very different landscape. The shift brings
- [Ask Proactive - A resident tells you a personal item is missing. What steps should be taken?](https://proactiveltcexperts.com/ask-proactive-a-resident-tells-you-a-personal-item-is-missing-what-steps-should-be-taken/) - Q: A resident tells you a personal item is missing. What steps should be taken? A: Start by staying calm and acknowledging their concern. Gather the key details — what’s missing, where was the item last seen, and when did they last have it? Document the report right away according to facility policy. Notify
- [Mastering the Home Health Plan of Care: Building the Foundation for Quality and Compliance](https://proactiveltcexperts.com/mastering-the-home-health-plan-of-care-building-the-foundation-for-quality-and-compliance/) - Mastering the Home Health Plan of Care: Building the Foundation for Quality and Compliance In home health care, the Plan of Care (POC) is more than just paperwork, it’s the blueprint that guides every aspect of patient care. A well-developed POC ensures that care is personalized, compliant, and measurable, supporting positive outcomes and Medicare compliance.
- [Unreported Falls in Nursing Homes: OIG Study Findings](https://proactiveltcexperts.com/unreported-falls-in-nursing-homes-oig-study-findings/) - Unreported Falls in Nursing Homes: OIG Study Findings In September 2025, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a concerning report related to a study with findings indicating that falls with major injury were significantly underreported by skilled nursing facilities. Study Purpose: The intent of the study
- [Home Health News: Ins & Outs of Medicare Certification for Your Home Health Agency](https://proactiveltcexperts.com/home-health-news-ins-outs-of-medicare-certification-for-your-home-health-agency/) - Ins & Outs of Medicare Certification for Your Home Health Agency Becoming a Medicare-certified home health agency (HHA) opens the door to serving a wider range of patients and securing reimbursement for covered home health services. However, the path to certification requires traversing a structured process with specific federal and state requirements. Let’s review the
- [Home Health News: The Importance of an Individualized Plan of Care in Home Health](https://proactiveltcexperts.com/home-health-news-the-importance-of-an-individualized-plan-of-care-in-home-health/) - The Importance of an Individualized Plan of Care in Home Health In home health care, every patient’s journey is unique — and their care should be too. That’s where an Individualized Plan of Care (POC) comes into play. The POC serves as the foundation for all care provided, ensuring that every intervention, medication, and visit
- [F697 Pain Management Updates: What SNFs Need to Know](https://proactiveltcexperts.com/f697-pain-management-updates-what-snfs-need-to-know/) - F697 Pain Management Updates: What SNFs Need to Know Managing pain effectively isn’t just about comfort — it’s a core component of quality care and compliance in post-acute care environments. The Centers for Medicare & Medicaid Services (CMS) recently updated F697 Pain Management guidance, and these changes are now impacting how facilities assess, treat, and
- [Ask Proactive - How are residents and their families involved in the CAA process?](https://proactiveltcexperts.com/ask-proactive-how-are-residents-and-their-families-involved-in-the-caa-process/) - Q: How are residents and their families involved in the CAA process? A: The Care Area Assessment (CAA) process is the foundation for developing each residents individualized care plan. The information gathered during CAAs helps the interdisciplinary team identify resident-specific goals, preferences, and interventions. Residents and their families play a key role in this
- [Ask Proactive - Why is monitoring enteral feedings important in LTC?](https://proactiveltcexperts.com/ask-proactive-why-is-monitoring-enteral-feedings-important-in-ltc/) - Q: Why is monitoring enteral feedings important in LTC? A: Monitoring ensures the resident is receiving the correct nutrition safely and effectively. It helps identify complications early, such as: Tube blockage or displacement Aspiration risk Intolerance (vomiting, diarrhea, abdominal distension) Infection or contamination Skin breakdown at the insertion site Changes in hydration or nutritional
- [Capturing Required Transfer/Discharge Documentation](https://proactiveltcexperts.com/capturing-required-transfer-discharge-documentation/) - Capturing Required Transfer/Discharge Documentation Significant emphasis is placed on the need for comprehensive documentation to support that resident transfers/discharges are justified and in compliance with the regulations outlined in the April 28, 2025 update to Appendix PP of the State Operations Manual. Regulatory Overview Section (c)(1)(i) of F627 in Appendix PP lists the reasons
- [Ask Proactive - Coding a Pressure Injury That Worsened During Hospitalization](https://proactiveltcexperts.com/ask-proactive-coding-a-pressure-injury-that-worsened-during-hospitalization/) - Q: I have a resident with an in-house acquired Stage 2 pressure injury. He went out to the hospital for three days and upon return, it was documented as Stage 4. How should this be coded on the MDS? A: The RAI User’s Manual (v1.18.11, effective Oct. 1, 2025) provides clear instructions for coding
- [Ask Proactive - What are best practices for developing a facility cannabis policy, and can staff administer medical marijuana to residents?](https://proactiveltcexperts.com/ask-proactive-what-are-best-practices-for-developing-a-facility-cannabis-policy-and-can-staff-administer-medical-marijuana-to-residents/) - Q: What are best practices for developing a facility cannabis policy, and can staff administer medical marijuana to residents? A: As more states legalize medical and recreational cannabis, long-term care facilities are increasingly faced with questions about how to manage resident use while maintaining compliance with federal regulations. Because marijuana remains a Schedule I
- [Major Changes to SNF VBP Program: What You Need to Know to be Successful](https://proactiveltcexperts.com/major-changes-to-snf-vbp-program-what-you-need-to-know-to-be-successful/) - Major Changes to SNF VBP Program: What You Need to Know to be Successful The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program continues to evolve, with CMS expanding the scope of this quality incentive program beyond the hospital readmission measure to include additional measures reflective of both clinical outcomes and operational performance. These measures
- [Ask Proactive - Your MDS Coordinator could come to you at any time needing an emergency medical leave, giving notice, or simply deciding that the role is no longer a good fit. What potential challenges could arise if you don’t have an experienced person to fill the position, and what can you do to prevent issues?](https://proactiveltcexperts.com/ask-proactive-your-mds-coordinator-could-come-to-you-at-any-time-needing-an-emergency-medical-leave-giving-notice-or-simply-deciding-that-the-role-is-no-longer-a-good-fit-what-potential-challenge/) - Q: Your MDS Coordinator could come to you at any time needing an emergency medical leave, giving notice, or simply deciding that the role is no longer a good fit. What potential challenges could arise if you don’t have an experienced person to fill the position, and what can you do to prevent issues?
- [5 Minute Staff Retention Strategies for the Busy DON](https://proactiveltcexperts.com/5-minute-staff-retention-strategies-for-the-busy-don/) - 5 Minute Staff Retention Strategies for the Busy DON Most experts agree that the main reasons for high turnover in all areas of healthcare, especially nurses and nursing assistants, include burnout, aging of the workforce and fierce competition to attract qualified people in the midst of industrywide labor shortages. It has become increasingly critical
- [Home Health News: Mastering Home Health PDGM - A Guide to Thriving Under the New Payment Model](https://proactiveltcexperts.com/home-health-news-mastering-home-health-pdgm-a-guide-to-thriving-under-the-new-payment-model/) - Mastering Home Health PDGM: A Guide to Thriving Under the New Payment Model The Patient-Driven Groupings Model (PDGM) has reshaped the landscape of home health reimbursement. Designed by CMS to improve accuracy and reduce overreliance on therapy treatment volume, PDGM rewards patient characteristics and clinical needs rather than visit counts. To succeed, agencies must
- [Stepping into Infection Prevention: Key Questions Every New IP Should Ask](https://proactiveltcexperts.com/stepping-into-infection-prevention-key-questions-every-new-ip-should-ask/) - Stepping into Infection Prevention: Key Questions Every New IP Should Ask Starting as an Infection Preventionist (IP) may feel overwhelming – balancing surveillance, education, data tracking, and compliance all at once. This Q&A highlights common questions new IPs ask and offers practical, experience-based answers to help you build confidence and consistency in your new
- [Hot Topics in F550 Resident Rights: Real-World Challenges and Practical Solutions](https://proactiveltcexperts.com/hot-topics-in-f550-resident-rights-real-world-challenges-and-practical-solutions/) - Hot Topics in F550 Resident Rights: Real-World Challenges and Practical Solutions Ensuring residents are treated with respect, dignity, and compassion is the foundation of quality care. But in the fast-paced environment of long-term care, even the best intentions can fall short. Recent case reviews and facility audits reveal recurring challenges that affect residents’ quality
- [Home Health News: The Impact of an Effective Intake Process in Home Health](https://proactiveltcexperts.com/home-health-news-the-impact-of-an-effective-intake-process-in-home-health/) - The Impact of an Effective Intake Process in Home Health In home health care, the intake process is much more than paperwork. A strong intake process sets the tone for the patient’s experience, ensures compliance with regulatory requirements, and streamlines operations for the agency. When done effectively, intake transforms referrals into successful admissions while
- [Ask Proactive - I have recently been directed, when completing the PHQ-2 to 9, that if a resident acknowledges a symptom, but is unable to give a frequency, I should dash both questions (column 1 and 2). Is this correct?](https://proactiveltcexperts.com/ask-proactive-i-have-recently-been-directed-when-completing-the-phq-2-to-9-that-if-a-resident-acknowledges-a-symptom-but-is-unable-to-give-a-frequency-i-should-dash-both-questions-column-1-and/) - Q: I have recently been directed, when completing the PHQ-2 to 9, that if a resident acknowledges a symptom, but is unable to give a frequency, I should dash both questions (column 1 and 2). Is this correct? A: No, this is incorrect. If a resident answers “yes” to a symptom (column 1), then
- [Rounding for Outcomes for Nurse Leaders](https://proactiveltcexperts.com/rounding-for-outcomes-for-nurse-leaders/) - Rounding for Outcomes for Nurse Leaders Compliance rounds can be instrumental to ensuring accountability, improving resident outcomes, and supporting QAPI initiatives. Rounding consistently and with purpose ensures that care processes meet regulatory standards while building a culture of quality and responsiveness. Read on for a practical framework for nurse leaders to incorporate compliance rounds
- [SNF ADR Update](https://proactiveltcexperts.com/snf-adr-update/) - SNF ADR Management: Prepare for Post-Probe Surge The SNF 5-Claim Probe & Educate officially ended on June 30, 2025, but for many providers, the scrutiny is just beginning. While CMS guidance indicates that providers with 100% error rates (5/5 claims in error) would be prioritized for Targeted Probe & Educate (TPE), we are finding
- [Ask Proactive - We’ve been receiving complaints from residents and families about slow call light response times. What are some simple interventions we can put in place to improve this?](https://proactiveltcexperts.com/ask-proactive-weve-been-receiving-complaints-from-residents-and-families-about-slow-call-light-response-times-what-are-some-simple-interventions-we-can-put-in-place-to-improve-this/) - Q: We’ve been receiving complaints from residents and families about slow call light response times. What are some simple interventions we can put in place to improve this? A: A few practical steps can make a big difference: Acknowledge quickly: If you can’t meet the request right away, go to the room, let the
- [Ask Proactive - When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)?](https://proactiveltcexperts.com/ask-proactive-when-completing-an-mds-how-to-we-know-which-diagnosis-should-be-coded-as-the-primary-diagnosis-for-a-resident-with-multiple-conditions-for-example-chf-diabetes-and-pressure-ulcer/) - Q: When completing an MDS, how do we know which diagnosis should be coded as the primary diagnosis for a resident with multiple conditions (for example, CHF, diabetes, and pressure ulcer)? A: This question comes up often in SNFs. The primary diagnosis should be the condition that is actively being treated and has the
- [October 1, 2025 MDS Changes: What You Need to Know!](https://proactiveltcexperts.com/october-1-2025-mds-changes-what-you-need-to-know/) - October 1, 2025 MDS Changes: What You Need to Know! CMS has released the RAI User’s Manual v1.20.1, effective October 1, 2025, with updates across multiple MDS sections. While Sections GG and J bring the most significant changes, every adjustment matters for compliance, reimbursement, and care planning. Here’s what you need to know: Section
- [Home Health News: The Benefits of Outsourcing ICD-10 Coding for Home Health Agencies](https://proactiveltcexperts.com/home-health-news-the-benefits-of-outsourcing-icd-10-coding-for-home-health-agencies/) - The Benefits of Outsourcing ICD-10 Coding for Home Health Agencies Home health agencies face increasing pressure to maintain compliance, optimize reimbursement, and ensure high-quality patient care. One of the most critical areas impacting all three is ICD-10 coding. Accurate and timely coding is essential for proper billing, reporting, and regulatory compliance. Many agencies are
- [Ask Proactive - When does the state survey agency or CMS usually apply the remedy of a Directed Plan of Correction?](https://proactiveltcexperts.com/ask-proactive-when-does-the-state-survey-agency-or-cms-usually-apply-the-remedy-of-a-directed-plan-of-correction/) - Q: When does the state survey agency or CMS usually apply the remedy of a Directed Plan of Correction? A: A Directed Plan of Correction (DPoC) is a remedy that provides for directed action(s) from either the State or CMS Regional Office (RO) that the facility must take to address the noncompliance or a
- [BIG Changes to the Falls with Major Injury QM: What Changed and Why it Matters](https://proactiveltcexperts.com/big-changes-to-the-falls-with-major-injury-qm-what-changed-and-why-it-matters/) - BIG Changes to the Falls with Major Injury QM: What Changed and Why it Matters In the ever changing environment of quality reporting in healthcare, few metrics carry more weight than the Falls with Major Injury (FMI) measure. The Falls with Major Injury (FMI) Quality Measure (QM) is a key metric in the SNF
- [Best Practices for Establishing and Honoring Code Status](https://proactiveltcexperts.com/best-practices-for-establishing-and-honoring-code-status/) - Best Practices for Establishing and Honoring Code Status When a new resident arrives at your nursing facility, one of the most critical steps in the admission process is confirming and documenting their code status - the instructions for how medical providers should respond if the resident experiences a life-threatening event such as cardiac or
- [Ask Proactive - I struggle with identifying Moisture Associated Skin Damage (MASD) from some pressure injuries. How can MASD and pressure injury be differentiated?](https://proactiveltcexperts.com/ask-proactive-i-struggle-with-identifying-moisture-associated-skin-damage-masd-from-some-pressure-injuries-how-can-masd-and-pressure-injury-be-differentiated/) - Q: I struggle with identifying Moisture Associated Skin Damage (MASD) from some pressure injuries. How can MASD and pressure injury be differentiated? A: Differentiating between Moisture Associated Skin Damage (MASD) and pressure injuries can be challenging, even for experienced clinicians. Both conditions can present with redness, irritation, and skin breakdown, but their underlying causes,
- [Home Health News: QAPI as Driver of Home Health Care Quality](https://proactiveltcexperts.com/home-health-news-qapi-as-driver-of-home-health-care-quality/) - QAPI as Driver of Home Health Care Quality Quality is at the heart of home health care. Every patient deserves safe, effective, and compassionate care delivered in their home. To achieve this goal, Quality Assurance and Performance Improvement (QAPI) must be a cornerstone of every home health agency. This week, let’s review one of
- [Ask Proactive - What documentation and information must skilled nursing facilities obtain and retain from hospice?](https://proactiveltcexperts.com/ask-proactive-what-documentation-and-information-must-skilled-nursing-facilities-obtain-and-retain-from-hospice/) - Q: What documentation and information must skilled nursing facilities obtain and retain from hospice? A: The following are required: The most recent hospice plan of care specific to each patient Hospice election form Physician certification and recertification of the terminal illness specific to each patient Names and contact information for hospice personnel involved in
- [Tips for an Effective Plan of Correction](https://proactiveltcexperts.com/tips-for-an-effective-plan-of-correction/) - When a deficiency is cited, the clock starts ticking. How you respond through your Plan of Correction can set the tone for your survey outcome—and your facility’s reputation. This week, we’re sharing practical tips to help you craft a PoC that not only meets regulatory requirements, but also drives lasting quality improvement. Tips for
- [New SNF Audits Coming—How to be Ready](https://proactiveltcexperts.com/new-snf-audits-coming-how-to-be-ready/) - The Minimum Data Set (MDS) plays a vital role in driving resident care through the resident-centered care plan process, regulatory compliance, Medicare and Medicaid reimbursement, quality outcomes, and reporting programs. MDS data accuracy has been under increased scrutiny from surveyors on the regulatory side and Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs) and other
- [Managing Medications in the Home: A Home Health Guide](https://proactiveltcexperts.com/managing-medications-in-the-home-a-home-health-guide/) - Managing Medications in the Home: A Home Health Guide One of the most important parts of successful home health care is making sure patients take their medications safely and correctly. Missed doses, duplicate medications, or confusion about instructions can quickly lead to hospitalizations or setbacks in recovery. In fact, medication mismanagement is one of
- [Ask Proactive - I'm a charge nurse, and a resident just passed away. The family is asking to take the medications home since they paid for them. What should I do?](https://proactiveltcexperts.com/ask-proactive-im-a-charge-nurse-and-a-resident-just-passed-away-the-family-is-asking-to-take-the-medications-home-since-they-paid-for-them-what-should-i-do/) - Q: I'm a charge nurse, and a resident just passed away. The family is asking to take the medications home since they paid for them. What should I do? A: This can be a difficult situation to navigate with grieving families. Even though the family may have paid for the medications, regulations and facility
- [Year-Round Survey Readiness](https://proactiveltcexperts.com/year-round-survey-readiness/) - Year-Round Survey Readiness Regulatory changes have been plentiful for the long-term care profession over the past five years—with operators persevering through the COVID pandemic, changes to government funding policies, and significant revisions to Appendix PP to name a few. Each policy revision adds to the substantial task of achieving successful survey outcomes. Last-minute survey
- [LTC Social Services Director Essentials —  A Guide to Daily, Weekly & Monthly Responsibilities](https://proactiveltcexperts.com/social-services-director-ssd-essentials-your-guide-to-daily-weekly-monthly-responsibilities/) - LTC Social Services Director Essentials—A Guide to Daily, Weekly & Monthly Responsibilities The Social Services Director plays a vital, multifaceted role in nursing home care. Among key responsibilities, the SSD position ensures that residents’ psychosocial needs are met with compassion, consistency, and in compliance with federal and state regulations. If you've ever wondered what
- [Home Health News: Strategies for Sustainable Growth in Home Health Care](https://proactiveltcexperts.com/home-health-news-strategies-for-sustainable-growth-in-home-health-care/) - Strategies for Sustainable Growth in Home Health Care The home health industry is growing faster than ever. With an aging population, advances in technology, and increased preference for receiving care at home, agencies have a golden opportunity to expand their services and reach more patients. However, growth doesn’t just happen, it requires a clear
- [FAQs on Systems for LTC Policies and Procedures](https://proactiveltcexperts.com/faqs-on-systems-for-ltc-policies-and-procedures/) - FAQs on Systems for LTC Policies and Procedures Policies and procedures are far more than written guidelines – they provide a backbone of safety and consistency. Skilled nursing policies and procedures outline expectations and play a crucial role in regulatory compliance, providing quality of care, and staff empowerment. Well-developed policies provide clear direction to
- [Home Health News: Emergency Preparedness for Home Health](https://proactiveltcexperts.com/home-health-news-emergency-preparedness-for-home-health/) - Emergency Preparedness for Home Health Emergencies can strike without warning natural disasters, power outages, pandemics, or severe weather events all pose serious risks to home health patients and staff. That’s why an effective Emergency Preparedness Plan (EPP) isn’t just a regulatory requirement, it’s a critical lifeline for safety and continuity of care. Whether you’re
- [Ask Proactive - Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents?](https://proactiveltcexperts.com/ask-proactive-our-facility-has-been-issued-a-denial-of-payment-for-new-admissions-due-to-survey-deficiencies-should-we-continue-to-submit-the-mds-for-current-and-newly-admitted-residents/) - Q: Our facility has been issued a Denial of Payment for new admissions due to survey deficiencies. Should we continue to submit the MDS for current and newly admitted residents? A: A Denial of Payment for new admissions (DPNA) is a CMS enforcement remedy that might be imposed for deficiencies cited at a facility.
- [Home Health News: Navigating Home Health Targeted Probe and Education (TPE)](https://proactiveltcexperts.com/home-health-news-navigating-home-health-targeted-probe-and-education-tpe/) - Navigating Home Health Targeted Probe and Education (TPE) Staying compliant with Medicare billing guidelines is essential. One of the tools CMS uses to ensure accuracy and reduce improper payments is the Targeted Probe and Education (TPE) program, a medical review process aimed at monitoring Medicare compliance, reducing denials and improving documentation. Here’s what you
- [Ask Proactive - A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the SNF. Would we use the respiratory failure or presence of tracheostomy as the primary diagnosis?](https://proactiveltcexperts.com/ask-proactive-a-resident-was-admitted-with-a-diagnosis-of-acute-on-chronic-respiratory-failure-requiring-a-new-tracheostomy-the-trach-was-placed-during-the-hospital-stay-and-the-resident-continues/) - Q: A resident was admitted with a diagnosis of acute on chronic respiratory failure requiring a new tracheostomy. The trach was placed during the hospital stay and the resident continues to require suctioning, respiratory monitoring, and oxygen therapy here in the SNF. Would we use the respiratory failure or presence of tracheostomy as the primary
- [F695—Respiratory & Tracheostomy Care in LTC](https://proactiveltcexperts.com/f695-respiratory-tracheostomy-care-in-ltc/) - F695—Respiratory & Tracheostomy Care in LTC In today's skilled nursing environment, respiratory and tracheostomy care isn't just a specialized service—it's an essential competency. With increasing acuity among residents and heightened regulatory scrutiny, facilities must ensure staff are not only trained, but consistently compliant in delivering needed respiratory care. Unfortunately, that's not always what we
- [Home Health News: The Importance of Proper Orientation in Home Health Care](https://proactiveltcexperts.com/home-health-news-the-importance-of-proper-orientation-in-home-health-care/) - The Importance of Proper Orientation in Home Health Care Home health care is unique. Care is delivered in the patient’s personal space, where clinicians must adapt quickly while upholding high standards of safety, compliance, and compassion. A critical first step in ensuring high-quality care and reduction of risk is through proper orientation for all
- [Ask Proactive - Is there any federal regulation regarding how many references and job verifications must be done for a job applicant i.e. CNA or nurse?](https://proactiveltcexperts.com/ask-proactive-is-there-any-federal-regulation-regarding-how-many-references-and-job-verifications-must-be-done-for-a-job-applicant-i-e-cna-or-nurse/) - Q: Is there any federal regulation regarding how many references and job verifications must be done for a job applicant i.e. CNA or nurse? A: There is no specific federal regulation that mandates an exact number of employment references or job verifications that must be completed for Certified Nurse Aides (CNAs) or nurses before
- [F678—CPR Appendix PP Revisions](https://proactiveltcexperts.com/f678-cpr-appendix-pp-revisions/) - F678—CPR Appendix PP Revisions CMS revisions to F 678 Cardiopulmonary Resuscitation were significant in bringing the regulations to align with current nationally accepted standards for CPR training. Here’s what you need to know to bring your training and policies and procedures up to date… In regulatory grouping §483.24(a)(3) in Appendix PP we find
- [F605 Gradual Dose Reduction Updates for Nursing Homes](https://proactiveltcexperts.com/f605-gradual-dose-reduction-updates-for-nursing-homes/) - F605 Gradual Dose Reduction Updates for Nursing Homes Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued revised guidance under F605, sharpening its focus on the misuse of psychotropic medications as chemical restraints and reinforcing the importance of gradual dose reduction (GDR) as a clinical and regulatory safeguard. These updates have
- [Home Health News: Understanding Medicare Secondary Payer (MSP)](https://proactiveltcexperts.com/home-health-news-understanding-medicare-secondary-payer-msp/) - Understanding Medicare Secondary Payer (MSP) in Home Health For home health agencies, accurate billing is critical, especially when Medicare is not the primary payor. Understanding Medicare Secondary Payer (MSP) rules ensures compliance and reduces the risk of claim denials or audit findings. What is Medicare Secondary Payer (MSP)? Medicare Secondary Payer means Medicare
- [Ask Proactive - Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria?](https://proactiveltcexperts.com/ask-proactive-do-we-need-to-obtain-prior-authorization-for-every-managed-care-resident-who-requires-skilled-services-even-if-they-clearly-meet-criteria/) - Q: Do we need to obtain prior authorization for every managed care resident who requires skilled services, even if they clearly meet criteria? A: Unfortunately, yes — at least for now. Most managed care plans (including Medicare Advantage) still require prior authorization before approving and paying for skilled nursing services, even when the resident
- [Home Health News: Home Health Proposed Final Rule CY 2026](https://proactiveltcexperts.com/home-health-news-home-health-proposed-final-rule-cy-2026/) - Home Health Proposed Final Rule CY 2026 CMS issued the proposed home health rule (for Calendar Year 2026) which includes a proposed 6.4% reduction in home health payments—let’s review what you need to know… CY 2026 Home Health Payment Update (Proposed) Payment rate cut: CMS proposes a 6.4% reduction in home health payments, equivalent
- [In Case You Missed It….Major Update to Nursing Home Care Compare](https://proactiveltcexperts.com/in-case-you-missed-it-major-update-to-nursing-home-care-compare/) - In Case You Missed It….Major Update to Nursing Home Care Compare On June 18, 2025 CMS released update memos QSO-25-19-All and QSO-25-20-NH with significant information related to information to be made available via Nursing Home Care Compare. The first memo notifies that the official FORM CMS-2567: Statement of Deficiencies and Plan of Correction will
- [Ask Proactive - What is the difference between avoidable and unavoidable pressure injuries?](https://proactiveltcexperts.com/ask-proactive-what-is-the-difference-between-avoidable-and-unavoidable-pressure-injuries/) - Q: What is the difference between avoidable and unavoidable pressure injuries? A: The determination of whether a pressure injury is avoidable versus unavoidable depends on the facility meeting the following criteria. The facility must ensure the following: Evaluation of the resident’s clinical condition and risk factors Determination and implementation of interventions that are consistent
- [Discharge Function Score: Getting it Right!](https://proactiveltcexperts.com/discharge-function-score-getting-it-right/) - Discharge Function Score: Getting it Right! Are your Discharge Function Scores working for or against you? If you’re still treating Section GG like “just another MDS task,” you’re missing one of the most influential performance measures in the SNF Quality Reporting Program (QRP). The Discharge Function Score is not only publicly reported on Care
- [PBJ Policy Manual & FAQs Updated](https://proactiveltcexperts.com/pbj-policy-manual-faqs-updated/) - PBJ Policy Manual & FAQs Updated PBJ Policy Manual Final - V2.7 - 06.30.2025 (PDF) PBJ Policy Manual FAQ 06.30.2025 (PDF) Updates were posted to the PBJ Policy Manual and FAQs on June 30, 2025. New Additions to the policy manual include: Facilities should run the staffing and census reports that are available in
- [Top Nursing Home Missed Reimbursement Opportunities](https://proactiveltcexperts.com/top-nursing-home-missed-reimbursement-opportunities/) - Top Nursing Home Missed Reimbursement Opportunities Practical Strategies to Capture What You’ve Rightfully Earned In today’s long-term care environment, nursing homes are under more pressure than ever to deliver high-quality care while navigating increasingly complex reimbursement systems. Between PDPM, Medicaid Case Mix, managed care rules, and ever-evolving CMS guidance, it's no surprise that many
- [Home Health News: Mandatory “All-Payer” OASIS Changes Effective 7/1/25](https://proactiveltcexperts.com/home-health-news-mandatory-all-payer-oasis-changes-effective-7-1-25/) - Mandatory “All-Payer” OASIS Changes Effective 7/1/25 As of July 1, 2025, every qualified home health patient—regardless of payer—must have a complete OASIS assessment reported. Exclusions remain unchanged. This update represents a shift toward more inclusive data that will likely impact quality scores, reimbursement, and competitive standing. The key OASIS changes effective July 1, 2025,
- [Ask Proactive - Our facility is thinking about implementing flexible time ranges for medications rather than a specific time to help us stay in compliance with our heavy morning and evening medication passes. What are the pros and cons of making this change?](https://proactiveltcexperts.com/ask-proactive-our-facility-is-thinking-about-implementing-flexible-time-ranges-for-medications-rather-than-a-specific-time-to-help-us-stay-in-compliance-with-our-heavy-morning-and-evening-medication/) - Q: Our facility is thinking about implementing flexible time ranges for medications rather than a specific time to help us stay in compliance with our heavy morning and evening medication passes. What are the pros and cons of making this change? A: Deciding between using a specific scheduled time (e.g., 8:00 AM) versus a
- [Home Health: Successfully Navigating the Post Acute Continuum](https://proactiveltcexperts.com/home-health-successfully-navigating-the-post-acute-continuum/) - Successfully Navigating the Post Acute Continuum Many home health providers are connected to other business lines within the post-acute home care continuum including private duty and hospice. Owners and operators often find it challenging to successfully integrate these services and promote growth within their various business lines while offering patients access to the beneficial
- [Home Health and Hospice Revenue Cycle Management](https://proactiveltcexperts.com/home-health-and-hospice-revenue-cycle-management/) - Home Health and Hospice Revenue Cycle Management Efficiencies with revenue cycle management begin with intake and end with collections. Let’s review the key considerations for agencies to effectively manage billing processes for compliance, ample cash flow and financial success. What is revenue cycle management (RCM) in home health and hospice? RCM in home
- [Private Duty: The Impact of Recruiting on Revenue](https://proactiveltcexperts.com/private-duty-recruiting-impacts-on-revenue/) - Private Duty: The Impact of Recruiting on Revenue Are you a home health agency or private duty provider struggling to build census and billable hours? The financial success of private duty is truly an art that begins with recruiting. Private Duty Financial Success Equation: Recruiting + Retention = Revenue Referrals and opportunities for private
- [Benefits of Home Health Consulting](https://proactiveltcexperts.com/benefits-of-home-health-consulting/) - Optimize your home health agency with expert consulting. Improve patient care, streamline operations, and ensure compliance for long-term success.
- [Home Health News: Home Health Infection Control Program Essentials](https://proactiveltcexperts.com/home-health-news-home-health-infection-control-program-essentials/) - Home Health Infection Control Program Essentials As part of the home health conditions of participation home health agencies must have a robust infection control program aimed at preventing and controlling infections and communicable diseases. § 484.70 Condition of participation: Infection prevention and control is an area of focus for many home health surveyors. Home
- [Home Health News: EMR Set-up Negatively Impacting Your HHA’s Cashflow?](https://proactiveltcexperts.com/home-health-news-emr-set-up-negatively-impacting-your-hhas-cashflow/) - EMR Set-up Negatively Impacting Your HHA’s Cashflow? A properly implemented EMR system significantly streamlines and improves home health billing. By automating data capture, reducing manual input, and enhancing data accuracy, an effective EMR promotes fewer claim denials, faster reimbursement, and greater billing efficiency. How EMR setup impacts home health billing: Enhanced Accuracy and
- [Home Health News: Boosting Staff Retention in Home Health: Strategies That Work](https://proactiveltcexperts.com/home-health-news-boosting-staff-retention-in-home-health-strategies-that-work/) - Boosting Staff Retention in Home Health: Strategies That Work In today’s competitive healthcare landscape, retaining qualified home health staff has become more challenging than ever. High turnover not only affects team morale but also compromises the continuity of care and increases operational costs. For home health agencies, staff retention isn’t just a staffing issue,
- [Home Health News: Preventing Home Health Denials](https://proactiveltcexperts.com/home-health-news-preventing-home-health-denials/) - Preventing Home Health Denials A proactive approach to Home Health claim denial prevention is crucial. Areas of focus should include supportive documentation accuracy, thorough verification of patient coverage, and understanding payer-specific requirements. This includes verifying insurance before services are initiated, communicating clearly with patients about coverage, and using technology effectively to streamline the claims
- [Ask Proactive - I heard a rumor that the antipsychotic QMs are about to go through a complete change. Is this true?](https://proactiveltcexperts.com/ask-proactive-i-heard-a-rumor-that-the-antipsychotic-qms-are-about-to-go-through-a-complete-change-is-this-true/) - Q: I heard a rumor that the antipsychotic QMs are about to go through a complete change. Is this true? A: Not entirely - but there is an important change on the horizon. In a recent memorandum, CMS announced a significant update to the long-stay antipsychotic measure. Currently, this measure is calculated solely from
- [Is Your Facility Truly Prepared for an Emergency? The OIG Says “Maybe Not”](https://proactiveltcexperts.com/is-your-facility-truly-prepared-for-an-emergency-the-oig-says-maybe-not/) - Is Your Facility Truly Prepared for an Emergency? The OIG Says “Maybe Not” Nursing homes play a vital role in keeping vulnerable residents safe, but recent emergencies in facilities (e.g., hurricanes, infectious outbreaks, fires) have revealed critical vulnerabilities. Recently, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a
- [CMS Announces Major Updates to Nursing Home Care Compare](https://proactiveltcexperts.com/cms-announces-major-updates-to-nursing-home-care-compare/) - CMS Announces Major Updates to Nursing Home Care Compare CMS released QSO-25-20-NH on June 18, 2025, detailing several important updates that will impact how nursing home performance is displayed on Nursing Home Care Compare. These changes aim to provide a more accurate and consumer-friendly view of facility quality and operations. Here's a quick breakdown
- [QAPI & Health Equity: What New Surveyor Guidance Means for Nursing Homes](https://proactiveltcexperts.com/qapi-health-equity-new-surveyor-guidance-means-for-nursing-homes/) - QAPI & Health Equity: What New Surveyor Guidance Means for Nursing Homes If you’ve worked in long-term care for more than a minute, you understand that QAPI is the backbone of quality improvement. But there’s a new layer added with the recent CMS updates--- health equity is now explicitly baked into QAPI expectations. So
- [Ask Proactive - I recently started working as the MDS coordinator at a facility. MDS assessments have been scheduled, but no one completed them. What should I do to get back in compliance?](https://proactiveltcexperts.com/ask-proactive-i-recently-started-working-as-the-mds-coordinator-at-a-facility-mds-assessments-have-been-scheduled-but-no-one-completed-them-what-should-i-do-to-get-back-in-compliance/) - Q: I recently started working as the MDS coordinator at a facility. MDS assessments have been scheduled, but no one completed them. What should I do to get back in compliance? A: 1. Assess the Extent of the Delay Identify how many assessments are overdue and how far behind they are. Prioritize assessments based
- [Home Health News: Understanding the Private Duty Letter of Medical Necessity - What It Is and Why It Matters](https://proactiveltcexperts.com/home-health-news-understanding-the-private-duty-letter-of-medical-necessity-what-it-is-and-why-it-matters/) - Understanding the Private Duty Letter of Medical Necessity: What It Is and Why It Matters When a loved one requires around-the-clock care at home, families often look to private duty nursing services. However, obtaining coverage or approval for this care—especially through insurance or Medicaid—typically requires more than a diagnosis. That’s where a Letter of
- [Ask Proactive - We are caring for a resident who recently admitted with a new G-tube. Can I code the G-tube site as a surgical wound in Section M?](https://proactiveltcexperts.com/ask-proactive-we-are-caring-for-a-resident-who-recently-admitted-with-a-new-g-tube-can-i-code-the-g-tube-site-as-a-surgical-wound-in-section-m/) - Q: We are caring for a resident who recently admitted with a new G-tube. Can I code the G-tube site as a surgical wound in Section M? A: The RAI describes surgical wounds as any healing and non-healing, open or closed surgical incisions, skin grafts, or drainage sites. The coding tips go on to
- [F761 – Maintaining Compliance through Strong Partnerships](https://proactiveltcexperts.com/f-761-maintaining-compliance-through-strong-partnerships/) - F761 – Maintaining Compliance through Strong Partnerships Maintaining compliance with F761 – Storage and Labeling of Drugs and Biologicals requires ensuring medications are properly stored, secured, and destroyed based on state and federal guidelines. Partnering with a contracted pharmacy service may improve survey outcomes and ongoing compliance. A few steps towards a successful partnership
- [Learning from Adverse Events & Incidents](https://proactiveltcexperts.com/learning-from-adverse-events-incidents/) - Learning from Adverse Events & Incidents Studies show that nearly one in three skilled nursing facility residents experience an adverse event during their stay, with approximately 60% of these events being potentially preventable. Adverse events in skilled nursing facilities may include falls, medication errors, the development of pressure areas, elopements, and/or healthcare associated infections.
- [Ask Proactive - Each skilled nursing facility arranging for the provision of hospice care under a written agreement must designate a member of the facility’s interdisciplinary team who is responsible for working with hospice representatives to coordinate care to the resident provided by the LTC facility staff and hospice staff. What do those responsibilities entail?](https://proactiveltcexperts.com/ask-proactive-each-skilled-nursing-facility-arranging-for-the-provision-of-hospice-care-under-a-written-agreement-must-designate-a-member-of-the-facilitys-interdisciplinary-team-who-is-resp/) - Q: Each skilled nursing facility arranging for the provision of hospice care under a written agreement must designate a member of the facility’s interdisciplinary team who is responsible for working with hospice representatives to coordinate care to the resident provided by the LTC facility staff and hospice staff. What do those responsibilities entail? A:
- [Ask Proactive - What are the most common reasons for the citing of F761 – Storage of Drugs and Biologicals?](https://proactiveltcexperts.com/ask-proactive-what-are-the-most-common-reasons-for-the-citing-of-f761-storage-of-drugs-and-biologicals/) - Q: What are the most common reasons for the citing of F761 – Storage of Drugs and Biologicals? A: In Appendix PP the regulatory guidance for F761 is as follows: §483.45(g) Labeling of Drugs and Biologicals Drugs and biologicals used in the facility must be labeled in accordance with currently accepted professional principles, and
- [Documentation To Support Transfer or Discharge for F622 & F623 Compliance](https://proactiveltcexperts.com/documentation-to-support-transfer-or-discharge-for-f622-f623-compliance/) - Documentation To Support Transfer or Discharge for F622 & F623 Compliance The decision to transfer or discharge a resident from the nursing facility is not to be taken lightly. Recent updates to Appendix PP of the State Operations Manual are a reminder to providers that discharge or transfer is a serious measure—one that requires
- [Ask Proactive - What are the necessary components of a hospice services agreement?](https://proactiveltcexperts.com/ask-proactive-how-often-does-the-at-risk-for-elopement-assessment-need-to-be-completed/) - Q: What are the necessary components of a hospice services agreement? A: The following provisions are required: Ensuring that the hospice services meet professional standards and principles that apply to individuals providing services in the facility, and to the timeliness of the services Having a written agreement with the hospice that is signed by
- [Fresh Take on Medical Director Oversight in LTC: F841 Compliance & Schizophrenia Diagnosis Standards](https://proactiveltcexperts.com/fresh-take-on-medical-director-oversight-in-ltc-f841-compliance-schizophrenia-diagnosis-standards/) - Fresh Take on Medical Director Oversight in LTC: F841 Compliance & Schizophrenia Diagnosis Standards Recent updates to the Appendix PP guidance for F841, along with heightened focus on accurate schizophrenia diagnoses, place renewed emphasis on the medical director’s leadership in both compliance and care quality. Is your facility compliant with updated guidance related to
- [Ask Proactive - What are the necessary components of a hospice services agreement?](https://proactiveltcexperts.com/ask-proactive-what-are-the-necessary-components-of-a-hospice-services-agreement/) - Q: What are the necessary components of a hospice services agreement? A: The following provisions are required: Ensuring that the hospice services meet professional standards and principles that apply to individuals providing services in the facility, and to the timeliness of the services Having a written agreement with the hospice that is signed by
- [Is Your SNF’s Behavioral Health Program Hitting the Mark?](https://proactiveltcexperts.com/is-your-snfs-behavioral-health-program-hitting-the-mark/) - Is Your SNF’s Behavioral Health Program Hitting the Mark? When it comes to running a great behavioral health program in your facility, there’s a lot to keep track of, including resident needs, staff training, documentation, compliance… the list goes on. That’s where an audit tool or checklist can be an effective way to maintain
- [Home Health News: Preliminary April 2025 Interim Performance Reports (IPRs) are Available on iQIES](https://proactiveltcexperts.com/home-health-news-preliminary-april-2025-interim-performance-reports-iprs-are-available-on-iqies/) - Preliminary April 2025 Interim Performance Reports (IPRs) are Available on iQIES The Preliminary April 2025 IPRs for the expanded HHVBP Model have been published on the Internet Quality Improvement and Evaluation System (iQIES). The quarterly IPRs provide home health agencies (HHAs) with the cohort assignment, performance year measure data for the 12 most recent
- [Ask Proactive - Is the nursing home required to have Compliance and Ethics Program meetings with a certain frequency?](https://proactiveltcexperts.com/ask-proactive-is-the-nursing-home-required-to-have-compliance-and-ethics-program-meetings-with-a-certain-frequency/) - Q: Is the nursing home required to have Compliance and Ethics Program meetings with a certain frequency? A: While there is no requirement related to a specific meeting frequency at 483.85, the General Compliance Program Guidance states that “The Compliance Committee’s purpose is to aid and support the compliance officer in implementing, operating, and
- [LTC Smoking/Vaping Safety 101](https://proactiveltcexperts.com/ltc-smoking-vaping-safety-101/) - LTC Smoking/Vaping Safety 101 As the use of tobacco and vaping products continues to evolve, nursing homes must address the unique challenges these habits pose to resident safety, health outcomes, and regulatory compliance. Whether accommodating individuals who smoke or use e-cigarettes, or enforcing a smoke-free environment, comprehensive care planning is essential. Let’s review the
- [Ask Proactive - Q: What are some scenarios in which an IDR (Informal Dispute Resolution) might be requested?](https://proactiveltcexperts.com/ask-proactive-q-what-are-some-scenarios-in-which-an-idr-informal-dispute-resolution-might-be-requested/) - Q: What are some scenarios in which an IDR (Informal Dispute Resolution) might be requested? A: The IDR process gives nursing facilities one informal opportunity to dispute cited deficiencies after any survey of Federal requirements for participation. The facility must evaluate the proof used by the State Agency to support the deficiency cited and
- [Fixing Broken Facilities – Case Studies in QAPI](https://proactiveltcexperts.com/fixing-broken-facilities-case-studies-in-qapi/) - Fixing Broken Facilities – Case Studies in QAPI Strong Quality Assurance Performance Improvement (QAPI) programs lead long term care facilities to positive outcomes. QAPI also helps to foster an engaged culture due to its emphasis on improving systems to affect quality of care and improve staff satisfaction. Regardless of specific areas of concern, using
- [Safeguarding Residents: F880 Infection Prevention and Control](https://proactiveltcexperts.com/safeguarding-residents-f880-infection-prevention-and-control/) - Safeguarding Residents: F880 Infection Prevention and Control F880 Infection prevention and control is the most frequently cited deficiency for surveys conducted during FY2025, with over 3,000 violations according to Casper data. When assessing compliance with F880 surveyors are looking to validate that the facility has established an infection control program designed to provide a
- [Ask Proactive - Q: Are wounds not otherwise classified on the MDS supposed to be coded at M1040D. Open lesion(s) other than ulcers, rashes, cuts?](https://proactiveltcexperts.com/ask-proactive-q-are-wounds-not-otherwise-classified-on-the-mds-supposed-to-be-coded-at-m1040d-open-lesions-other-than-ulcers-rashes-cuts/) - Q: Are wounds not otherwise classified on the MDS supposed to be coded at M1040D. Open lesion(s) other than ulcers, rashes, cuts? A: Accurate coding of skin conditions on the MDS must begin with determining the underlying cause (etiology) of the skin issue. Keep in mind that not all skin conditions are captured on
- [Safeguarding Residents – F689 Managing Elopement in LTC](https://proactiveltcexperts.com/safeguarding-residents-f689-managing-elopement-in-ltc/) - Safeguarding Residents – F689 Managing Elopement in LTC Elopement is one of the most urgent safety risks in long term care, often leading to devastating outcomes and serious regulatory citations. Ensuring the safety and well-being of residents is a top priority in every nursing facility, and diligent management is particularly important for individuals with
- [CMS Releases Draft MDS 3.0 RAI User’s Manual v1.20.1](https://proactiveltcexperts.com/cms-releases-draft-mds-3-0-rai-users-manual-v1-20-1/) - CMS has released the draft version of the MDS 3.0 RAI User’s Manual (v1.20.1), now available on the MDS 3.0 RAI Manual page. While the manual is still in draft form, the changes are significant and go into effect October 1, 2025. Facilities should begin planning now to prepare teams and systems for the transition.
- [Home Health News: Home Health Care CAHPS Survey of Patient Experience](https://proactiveltcexperts.com/home-health-news-home-health-care-cahps-survey-of-patient-experience/) - Home Health Care CAHPS Survey of Patient Experience Moving the needle on the HHCAHPS in home health requires a targeted approach to implementing standard care practices, prioritizing education for clinicians, patients, and caregivers, and emphasizing patient satisfaction. For improved outcomes, consider these action steps… The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Home
- [Ask Proactive - I am having difficulty keeping up with care plan updates. What are some tips and strategies to keep care plans up-to-date?](https://proactiveltcexperts.com/ask-proactive-i-am-having-difficulty-keeping-up-with-care-plan-updates-what-are-some-tips-and-strategies-to-keep-care-plans-up-to-date/) - Q: I am having difficulty keeping up with care plan updates. What are some tips and strategies to keep care plans up-to-date? A: Maintaining timely and accurate updates to resident care plans is essential not only for delivering quality, person-centered care, but also for ensuring compliance with regulatory standards, including F656, which addresses requirements
- [Home Health News: Preview Reports and Star Rating Preview Reports for the July 2025 Refresh](https://proactiveltcexperts.com/home-health-news-preview-reports-and-star-rating-preview-reports-for-the-july-2025-refresh/) - Preview Reports and Star Rating Preview Reports for the July 2025 Refresh The HHA Provider Preview Reports have been updated and are now available. These reports contain provider performance scores for quality measures, which will be published on the compare tool on Medicare.gov and the Provider Data Catalog (PDC) during the July 2025 refresh. Agencies
- [Ask Proactive - My IDT team determined one of our residents needs a Significant Change assessment completed. I set the ARD, is it correct that I have 14 days from the ARD to complete this?](https://proactiveltcexperts.com/ask-proactive-my-idt-team-determined-one-of-our-residents-needs-a-significant-change-assessment-completed-i-set-the-ard-is-it-correct-that-i-have-14-days-from-the-ard-to-complete-this/) - Q: My IDT team determined one of our residents needs a Significant Change assessment completed. I set the ARD, is it correct that I have 14 days from the ARD to complete this? A: No, the completion date for a Significant Change assessment is not based on the ARD. Instead, it is based on
- [Crack the Code to Payment Accuracy: Why ICD-10 Coding Proficiency Matters Now More Than Ever](https://proactiveltcexperts.com/crack-the-code-to-payment-accuracy-why-icd-10-coding-proficiency-matters-now-more-than-ever/) - Crack the Code to Payment Accuracy: Why ICD-10 Coding Proficiency Matters Now More Than Ever In today’s reimbursement-driven healthcare environment, one thing is clear: accurate coding isn’t optional—it’s essential. For Skilled Nursing Facilities, ICD-10 coding plays a pivotal role in reimbursement, regulatory compliance, care planning, and risk adjustment. Yet despite its importance, many facilities
- [The State of SNF Medical Review in 2025: Trends, Challenges, and Key Findings](https://proactiveltcexperts.com/the-state-of-snf-medical-review-in-2025-trends-challenges-and-key-findings/) - The State of SNF Medical Review in 2025: Trends, Challenges, and Key Findings Medical review of Skilled Nursing Facilities (SNFs) continues to be a focus of Medicare and Medicare Advantage oversight activities in 2025. With increased scrutiny from Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and Unified Program Integrity Contractors (UPICs), providers are facing
- [Ask Proactive - What is the time frame in which a 5-day assessment should be completed?](https://proactiveltcexperts.com/ask-proactive-what-is-the-time-frame-in-which-a-5-day-assessment-should-be-completed/) - Q: What is the time frame in which a 5-day assessment should be completed? A: The answer depends on whether the 5-day MDS is combined with the OBRA admission assessment or completed as a stand-alone Medicare 5-day MDS. When combined with the OBRA admission assessment, the 5-day must be completed within 14 days of
- [F641 Accuracy of MDS Assessments – Revised LTC Surveyor Guidance](https://proactiveltcexperts.com/f641-accuracy-of-mds-assessments-revised-ltc-surveyor-guidance/) - F641 Accuracy of MDS Assessments – Revised LTC Surveyor Guidance CMS and the Department of Health & Human Services released an updated version of the LTC Surveyor Guidance on March 10, 2025. This update, which revises the earlier January 16th release, takes effect April 28, 2025—so mark your calendars. One key change impacts how
- [Don’t Postpone Preparing for CMS’ Revised Surveyor Guidance](https://proactiveltcexperts.com/dont-postpone-preparing-for-cms-revised-surveyor-guidance-survey-compliance-psychotropics-qapi-pain-nursing-physicians/) - Don't Postpone Preparing for CMS' Revised Surveyor Guidance Take advantage of the revisions to the surveyor guidance being delayed until April 28, 2025 to hardwire preparation for the changes. Now is the opportunity to complete a thorough review of the Appendix PP and CMS Critical Element Pathway revisions with facility staff and all key
- [Ask Proactive - How can behavior tracking help identify the root cause of a resident's agitation?](https://proactiveltcexperts.com/ask-proactive-how-can-behavior-tracking-help-identify-the-root-cause-of-a-residents-agitation-behavioral-health-dementia-documentation-nursing/) - Q: How can behavior tracking help identify the root cause of a resident's agitation? A: Behavior tracking allows staff to analyze patterns and triggers contributing to a resident's agitation. By documenting factors such as time, environment, interactions, and preceding events, staff can determine potential causes including pain, hunger, boredom, noise levels, medication side effects,
- [Addressing Top Complaints of Residents & Family](https://proactiveltcexperts.com/addressing-top-complaints-of-residents-family-quality-survey-admissions-dietary-nursing-staffing/) - Addressing Top Complaints of Residents & Family Did you know that communication breakdowns, staffing shortages, and dining concerns are among the most frequent complaints in long-term care facilities? Resident and family satisfaction is critical to maintaining high-quality care, a strong community reputation, and regulatory compliance. By identifying and proactively addressing common complaints, facilities can enhance
- [Home Health VBP: Potentially Preventable Hospitalization](https://proactiveltcexperts.com/home-health-vbp-potentially-preventable-hospitalization/) - Home Health VBP: Potentially Preventable Hospitalization In Home Health Value Based Purchasing (HHVBP), the new Potentially Preventable Hospitalization (PPH) measure, introduced in 2025, aims to assess and reduce preventable hospitalizations and observation stays during a patient's stay in home health care, replacing the previous Acute Care Hospitalization (ACH) and Emergency Department (ED) Use measures. This
- [Ask Proactive - What are key steps to ensure compliance with the updated Enhanced Barrier Precautions (EBP) guidance that takes effect 4/28/25?](https://proactiveltcexperts.com/ask-proactive-what-are-key-steps-to-ensure-compliance-with-the-updated-enhanced-barrier-precautions-ebp-guidance-that-takes-effect-3-24-25-infection-nursing-regulatory-compliance/) - Q: What are key steps to ensure compliance with the updated Enhanced Barrier Precautions (EBP) guidance that takes effect 4/28/25? A: Facilities should take the following steps to prepare for surveyor evaluation of EBP implementation: 1. Identify Residents Who Require EBP – Review the updated criteria and ensure that residents with CDC-targeted MDROs, chronic
- [Dietary QA Essentials in Nursing Homes: Ensuring Excellence in Resident Nutrition](https://proactiveltcexperts.com/dietary-qa-essentials-in-nursing-homes-ensuring-excellence-in-resident-nutrition/) - Dietary QA Essentials in Nursing Homes: Ensuring Excellence in Resident Nutrition In nursing homes, dietary services play a crucial role in maintaining residents’ health and well-being. A strong Quality Assurance (QA) program for the dietary department ensures compliance, promotes resident satisfaction, and supports optimal nutritional outcomes. Here’s a guide to the essentials of developing and
- [Understanding Interpretive Guidance for F656: Comprehensive Care Plans](https://proactiveltcexperts.com/understanding-interpretive-guidance-for-f656-comprehensive-care-plans-mds-nursing-quality-survey-regulatory/) - Understanding Interpretive Guidance for F656: Comprehensive Care Plans Care planning is a fundamental component of quality patient care, offering an organized structure for identifying resident needs through comprehensive assessment. So far in Calendar Year 2025, F656 was cited 4,087 times nationally, with 67 Immediate Jeopardy (IJ) citations and 81 harm-level deficiencies, highlighting the importance
- [Ask Proactive - Our Resident Council has poor attendance. What documentation do we need to keep, and how can we improve participation?](https://proactiveltcexperts.com/ask-proactive-our-resident-council-has-poor-attendance-what-documentation-do-we-need-to-keep-and-how-can-we-improve-participation-quality-compliance/) - Q: Our Resident Council has poor attendance. What documentation do we need to keep, and how can we improve participation? A: Documentation: Maintain detailed Resident Council Minutes for each meeting. These minutes should capture attendance, discussion points, decisions made, follow-up actions, and any feedback received. Consider These Strategies to Improve Participation: Consistently promote
- [F812: Food Procurement, Storage, Preparation, & Sanitation Compliance](https://proactiveltcexperts.com/f812-food-procurement-storage-preparation-sanitation-compliance-dietary-survey-quality/) - F812: Food Procurement, Storage, Preparation, & Sanitation Compliance F812 Food Procurement, Storage, Preparation, and Sanitary Practices is the third most frequently cited deficiency for the 2025 fiscal year. Most citations have been issued at a scope and severity level of E or F; however, some facilities have been cited at the Immediate Jeopardy level.
- [Ask Proactive - The resident admitted with an unstageable pressure injury to the right heel. Now the pressure injury is stage 3. I coded stage 3 at M0300. Would the pressure injury be coded as present on admission?](https://proactiveltcexperts.com/ask-proactive-how-does-consolidated-billing-apply-to-dialysis-services-during-a-skilled-nursing-facility-snf-stay-and-what-is-covered-versus-not-covered-2-nursing-quality-measure-mds/) - Q: The resident admitted with an unstageable pressure injury to the right heel. Now the pressure injury is stage 3. I coded stage 3 at M0300. Would the pressure injury be coded as present on admission? A: If a pressure ulcer or injury is documented as unstageable upon admission, entry, or reentry and later
- [The Vital Role of the Infection Preventionist in Long-Term Care](https://proactiveltcexperts.com/the-vital-role-of-the-infection-preventionist-in-long-term-care-compliance-quality-regulatory-nursing/) - The Vital Role of the Infection Preventionist in Long-Term Care The Infection Preventionist (IP) plays a crucial role in preventing and controlling infections in long-term care facilities. An Infection Prevention and Control (IPC) program ensures compliance with regulatory standards, reduces healthcare-associated infections (HAIs), and promotes safety for residents and staff. Key areas of
- [Ask Proactive - How does Consolidated Billing apply to dialysis services during a Skilled Nursing Facility (SNF) stay, and what is covered versus not covered?](https://proactiveltcexperts.com/ask-proactive-how-does-consolidated-billing-apply-to-dialysis-services-during-a-skilled-nursing-facility-snf-stay-and-what-is-covered-versus-not-covered/) - Q: How does Consolidated Billing apply to dialysis services during a Skilled Nursing Facility (SNF) stay, and what is covered versus not covered? A: The consolidated billing requirement assigns the SNF the responsibility for billing the entire package of care provided during a covered Part A stay, as well as for physical, occupational, and
- [Updated 5 Star Ratings Released with Unfrozen QMs! What You Need to Know](https://proactiveltcexperts.com/updated-5-star-ratings-released-with-unfrozen-qms-what-you-need-to-know/) - Updated 5 Star Ratings Released with Unfrozen QMs! What You Need to Know CMS has officially released the January 2025 Five-Star Quality Rating updates on Care Compare, and providers across the country are reviewing their new ratings. The January 2025 Care Compare refresh brings significant updates with the introduction of new data for four
- [Conducting Thorough Incident Investigations: Key Steps for F610 Compliance](https://proactiveltcexperts.com/conducting-thorough-incident-investigations-key-steps-for-f610-compliance/) - Conducting Thorough Incident Investigations: Key Steps for F610 Compliance Nursing homes must have evidence that all allegations of abuse, neglect, exploitation, or mistreatment are thoroughly investigated. A detailed and thorough investigation is essential-- not only for compliance, but also to uncover all of the facts, preventing recurrence, and ensuring resident safety moving forward. To
- [Ask Proactive - When is a Gradual Dose Reduction (GDR) required for antipsychotic and psychotropic medications in a Skilled Nursing Facility (SNF)?](https://proactiveltcexperts.com/ask-proactive-when-is-a-gradual-dose-reduction-gdr-required-for-antipsychotic-and-psychotropic-medications-in-a-skilled-nursing-facility-snf/) - Q: When is a Gradual Dose Reduction (GDR) required for antipsychotic and psychotropic medications in a Skilled Nursing Facility (SNF)? A: For a resident who is receiving an antipsychotic, a GDR is required unless it is clinically contraindicated. An attempt to reduce the dose should be made during the first year of the resident’s
- [Ask Proactive - Our facility tracks infection control in the computer, is it necessary to keep a facility map with locations of infections?](https://proactiveltcexperts.com/ask-proactive-our-facility-tracks-infection-control-in-the-computer-is-it-necessary-to-keep-a-facility-map-with-locations-of-infections/) - Q: Our facility tracks infection control in the computer, is it necessary to keep a facility map with locations of infections? A: While infection control software can provide valuable data visualization tools, maintaining an updated facility map is still essential. A facility map serves as a visual aid to help the QAPI team quickly
- [Key Focus Areas for Home Health QAPI](https://proactiveltcexperts.com/key-focus-areas-for-home-health-qapi/) - Key Focus Areas for Home Health QAPI Is your Home Health Agency’s QAPI program making a positive impact? QAPI can seem challenging at times, but the benefits of a robust QAPI plan can significantly improve the quality of care that your patients receive. QAPI (Quality Assessment and Performance Improvement) is required for home health
- [Nursing Home Care Compare Update Delay: 5 Star Implications for Nursing Homes](https://proactiveltcexperts.com/nursing-home-care-compare-update-delay-5-star-implications-for-nursing-homes/) - Nursing Home Care Compare Update Delay: 5 Star Implications for Nursing Homes Recent developments have left nursing homes without the anticipated update on CMS’s Care Compare website. The scheduled January 29th refresh of key quality measures—including discharge function scores, changes in resident assistance needs, mobility decline, and pressure ulcer prevalence—has been postponed. These measures,
- [Family Engagement in LTC: Building Bridges for Better Care](https://proactiveltcexperts.com/family-engagement-in-ltc-building-bridges-for-better-care/) - Family Engagement in LTC: Building Bridges for Better Care Family engagement plays an important role in enhancing the quality of life for nursing home residents. While nursing homes provide essential medical care and support, the involvement of families can make a significant difference in residents’ mental, emotional, and social well-being. When families and care
- [Preventing Rehospitalizations in Home Health](https://proactiveltcexperts.com/preventing-rehospitalizations-in-home-health/) - Preventing Rehospitalizations in Home Health A home health agency's success in helping patients stay safely in their home through high quality care is important for patients, physicians, SNFs, ALFs, ILFs and CMS. Preventing rehospitalization is a home health industry challenge with the annual cost of rehospitalization within 30 days of discharge estimated at $41.3
- [LTC Business Office Survey Prep Refresher](https://proactiveltcexperts.com/ltc-business-office-survey-prep-refresher/) - LTC Business Office Survey Prep Refresher The Business Office Manager (BOM) in a long-term care (LTC) facility plays a pivotal role in ensuring the seamless financial and administrative operations of the facility. While their day-to-day duties primarily revolve around billing, payroll, and accounts receivable, their role in preparing for the annual state survey cannot
- [F689 Accidents - Fresh Eyes on Frequent Fallers](https://proactiveltcexperts.com/f689-accidents-fresh-eyes-on-frequent-fallers/) - F689 Accidents – Fresh Eyes on Frequent Fallers Falls are a critical concern in long-term care facilities, impacting resident safety, health outcomes, and compliance with regulatory standards. Understanding fall statistics, root causes, and regulatory requirements help providers to develop actionable strategies to address falls proactively… Statistics at a Glance F689 ranks as the #3
- [Employee Retention: Building for Success](https://proactiveltcexperts.com/employee-retention-building-for-success/) - Employee Retention: Building for Success Is your agency struggling with staffing retention? You aren’t alone. It’s estimated that Home Care providers turnover rate was almost 80% with over a 12% increase in turnover in the past two years. [i] To ensure quality care and patient outcomes, hiring and retaining skilled staff is more important
- [Compliance Risk Assessment Considerations for the New Year](https://proactiveltcexperts.com/compliance-risk-assessment-considerations-for-the-new-year/) - Compliance Risk Assessment Considerations for the New Year As we enter 2025, nursing home providers face many regulatory and administrative challenges. January is a good time to conduct a compliance risk assessment that considers the updated nursing facility specific compliance program guidance released in November 2024 by the HHS Office of Inspector General (OIG).
- [How to Be Survey Ready Every Day - An Interview with Shelly Maffia](https://proactiveltcexperts.com/how-to-be-survey-ready-every-day-an-interview-with-shelly-maffia/) - 24/7 Survey Ready How to Prepare for a Survey and Be Ready Every Day: An interview with Shelly Maffia, Director of Regulatory Services Q: Why is it important for facilities to be survey-ready every day, not just during survey windows? A: Being survey-ready every day ensures that facilities maintain consistent compliance with regulatory standards, which
- [OASIS E-1: Is Your Agency Ready?](https://proactiveltcexperts.com/oasis-e-1-is-your-agency-ready/) - OASIS E-1: Is Your Agency Ready? The transition from OASIS-E to OASIS E-1 is just around the corner. This blog will walk you through the upcoming changes to ensure your agency is prepared. Beginning January 1, 2025, home health agencies will transition to OASIS E-1. The primary revision in OASIS E-1 is the addition
- [Long-Term Care Litigation: Evolving Challenges and Proactive Solutions](https://proactiveltcexperts.com/long-term-care-litigation-evolving-challenges-and-proactive-solutions/) - Long-Term Care Litigation: Evolving Challenges and Proactive Solutions Long Term Care (LTC) litigation has transformed into a highly focused and increasingly intimidating process for facilities. Providers can reduce litigation risk by understanding the LTC litigation process and implementing proactive systems and processes of care to address those care issues with the highest risk of legal
- [Ask Proactive - How long do we have to make corrections to an erroneously coded MDS assessment that has been submitted and accepted into IQIES?](https://proactiveltcexperts.com/ask-proactive-how-long-do-we-have-to-make-corrections-to-an-erroneously-coded-mds-assessment-that-has-been-submitted-and-accepted-into-iqies/) - Q: How long do we have to make corrections to an erroneously coded MDS assessment that has been submitted and accepted into IQIES? A: A correction can be submitted for any accepted record within 2 years of the target date of the record for facilities that are still open. If a facility is terminated,
- [Home Health Survey Preparedness](https://proactiveltcexperts.com/home-health-survey-preparedness/) - Home Health Survey Preparedness Survey windows are a source of anxiety for many home health operators. Ensuring your agency is consistently survey ready is imperative for survey success. Surveys must be unannounced, so home health agencies must always be prepared for a surveyor visit. Consider these strategies to ensure survey preparedness… Top Deficiencies
- [Ask Proactive - How can I ensure that claims are accurate prior to billing?](https://proactiveltcexperts.com/ask-proactive-how-can-i-ensure-that-claims-are-accurate-prior-to-billing/) - Q: How can I ensure that claims are accurate prior to billing? A: The key to accurate claims submission is an effective Triple Check or Clean Claim review process. The Triple Check process is an interdisciplinary self-audit that aims to reduce the risk of billing and coding errors by reconciling the claim to the
- [The Top 10 Nursing Home Citations of 2024: Insights and Prevention Strategies](https://proactiveltcexperts.com/the-top-10-nursing-home-citations-of-2024-insights-and-prevention-strategies/) - The Top 10 Nursing Home Citations of 2024: Insights and Prevention Strategies Understanding citation trends is critical to improving quality and compliance. By analyzing deficiency data, facilities can focus on priority areas of improvement to prepare for surveys and enhance resident care using a data driven approach. Why Are the Top Citations Important? Tracking trends
- [The Missing Piece in Reducing Rehospitalization](https://proactiveltcexperts.com/the-missing-piece-in-reducing-rehospitalization/) - Home Health: The Missing Piece in Reducing Rehospitalization Are you a SNF owner or operator who currently has a home health affiliation or the desire to have an affiliation? Home Health may be the missing piece to close the gap in the continuum of care for your patients. What are the benefits of home health
- [Keys to Effective Pre-Admission Screening](https://proactiveltcexperts.com/keys-to-effective-pre-admission-screening/) - Keys to Effective Pre-Admission Screening Ensuring that your facility is a good fit for prospective residents (and they are a good fit for your facility) is critical for delivering high-quality care and maintaining operational efficiency. A thorough and structured pre-admission screening process can facilitate smooth transitions for residents and minimize potential risks for your facility.
- [Ask Proactive - Fall with major injury has triggered under my SNF QRP reports but no fall with major injury was coded on the 5-Day assessment or the PPS Discharge assessment that were submitted. Where did the information pull from?](https://proactiveltcexperts.com/ask-proactive-fall-with-major-injury-has-triggered-under-my-snf-qrp-reports-but-no-fall-with-major-injury-was-coded-on-the-5-day-assessment-or-the-pps-discharge-assessment-that-were-submitted-where/) - Q: Fall with major injury has triggered under my SNF QRP reports but no fall with major injury was coded on the 5-Day assessment or the PPS Discharge assessment that were submitted. Where did the information pull from? A: The SNF QRP measure for falls with major injury derives its data from the MDS
- [OASIS E-1: Is Your Agency Ready for January 1st Updates?](https://proactiveltcexperts.com/oasis-e-1-is-your-agency-ready-for-january-1st-updates/) - OASIS E-1: Is Your Agency Ready for January 1st Updates? The transition from OASIS-E to OASIS E-1 is just around the corner. This blog will walk you through the upcoming changes to ensure your agency is prepared. Beginning January 1, 2025, home health agencies will transition to OASIS E-1. The primary revision in OASIS E-1
- [Tips for Writing Effective Performance Improvement Plans (PIPs)](https://proactiveltcexperts.com/tips-for-writing-effective-performance-improvement-plans-pips/) - Tips for Writing Effective Performance Improvement Plans (PIPs) Performance Improvement Projects (PIPs) are critical to driving quality improvement and ensuring compliance in skilled nursing facilities. A well-structured PIP not only identifies areas for improvement, but also outlines actionable steps to achieve measurable outcomes. Consider these tips to help you develop and implement impactful PIPs for
- [Ask Proactive - Many facilities have gone 3 years or more since their last standard survey. What are the best ways that the facility can communicate with the survey team to enhance the survey process and promote successful outcomes?](https://proactiveltcexperts.com/ask-proactive-many-facilities-have-gone-3-years-or-more-since-their-last-standard-survey-what-are-the-best-ways-that-the-facility-can-communicate-with-the-survey-team-to-enhance-the-survey-process/) - Q: Many facilities have gone 3 years or more since their last standard survey. What are the best ways that the facility can communicate with the survey team to enhance the survey process and promote successful outcomes? A: It is vital that the facility communicate effectively with the survey team from the time they
- [Medical Necessity: The Key to Successful Home Health Documentation](https://proactiveltcexperts.com/medical-necessity-the-key-to-successful-home-health-documentation/) - Medical Necessity: The Key to Successful Home Health Documentation One of the top denial reasons for home health claims is “services were not medically necessary”. Many home health agencies face challenges related to documenting medical necessity for both nursing and therapy services. Clinicians must “paint the picture” of the care and services provided at
- [PBJ Insights into Five-Star Success: Your Path to Excellence in Nursing Home Staffing](https://proactiveltcexperts.com/pbj-insights-into-five-star-success-your-path-to-excellence-in-nursing-home-staffing/) - PBJ Insights into Five-Star Success: Your Path to Excellence in Nursing Home Staffing Achieving a five-star staffing rating is a critical measure of success for nursing homes. This rating not only reflects the quality of care provided but also impacts the facility's reputation, marketability, and financial performance. In this blog, we’ll break down the key
- [Ask Proactive - How does the activities CAA influence care planning?](https://proactiveltcexperts.com/ask-proactive-how-does-the-activities-caa-influence-care-planning/) - Q: How does the activities CAA influence care planning? A: The Activities Critical Assessment Area (CAA) triggers when the MDS identifies that an individual’s activity preferences or needs require further evaluation. This process ensures that the care plan is personalized to the resident's unique preferences, abilities, and barriers, enhancing their quality of life through
- [Ask Proactive - Can we place the room/bed number for a semi-private room on the Enhanced Barrier Precaution sign located outside the resident’s room to notify staff which resident requires PPE for high contact activities or is this a HIPAA violation?](https://proactiveltcexperts.com/ask-proactive-can-we-place-the-room-bed-number-for-a-semi-private-room-on-the-enhanced-barrier-precaution-sign-located-outside-the-residents-room-to-notify-staff-which-resident-requires-ppe/) - Q: Can we place the room/bed number for a semi-private room on the Enhanced Barrier Precaution sign located outside the resident’s room to notify staff which resident requires PPE for high contact activities or is this a HIPAA violation? A: CMS addresses the signage in Frequently Asked Questions (FAQ) listed below. The signage
- [Ask Proactive - What are the proper infection control measures for linen handling?](https://proactiveltcexperts.com/ask-proactive-what-are-the-proper-infection-control-measures-for-linen-handling/) - Q: What are the proper infection control measures for linen handling? A: To maintain infection control, follow these best practices: Wear Appropriate PPE: Always wear gloves, and additional personal protective equipment (PPE) as needed, when handling soiled linen. Avoid Contact with the Body: Carry both soiled and clean linen away from your body to
- [Medication Reconciliation: Who, What, When, Why and How](https://proactiveltcexperts.com/medication-reconciliation-who-what-when-why-and-how/) - Medication Reconciliation: Who, What, When, Why and How Medication reconciliation is a critical process designed to ensure the safe and effective use of medications. It involves a comprehensive review of a resident’s medication regimen to identify and address potential or actual adverse consequences. Consider these factors when assessing the quality of your Medication Reconciliation
- [Ask Proactive - Do beneficiary notices have to be issued for Medicare Advantage patients?](https://proactiveltcexperts.com/ask-proactive-do-beneficiary-notices-have-to-be-issued-for-medicare-advantage-patients/) - Q: Do beneficiary notices have to be issued for Medicare Advantage patients? A: The NOMNC is required to be issued to both Medicare Beneficiaries and Medicare Advantage Plan members. The SNF ABN is only required to be issued to Traditional Medicare beneficiaries and not Medicare Advantage Plan members. The SNF ABN is issued to
- [Survey Alert! Revised LTC Surveyor Guidance: What You Need to Know](https://proactiveltcexperts.com/survey-alert-revised-ltc-surveyor-guidance-what-you-need-to-know/) - Survey Alert! Revised LTC Surveyor Guidance: What You Need to Know Long-term care facilities are about to undergo significant changes as CMS releases revised surveyor guidance aimed at elevating care quality and resident safety. On November 18, 2024, the Centers for Medicare & Medicaid Services (CMS) issued significant revisions to the Long-Term Care (LTC) Surveyor
- [Understanding Hospital QMs, Episodic Care & the Impact on Post-Acute Providers](https://proactiveltcexperts.com/understanding-hospital-qms-episodic-care-the-impact-on-post-acute-providers/) - Understanding Hospital QMs, Episodic Care & the Impact on Post-Acute Providers In post-acute care, providers are accustomed to monitoring Minimum Data Set (MDS) accuracy and focusing on clinical programs in quality measure target areas in order to drive Five Star Rating performance. The Five- Star Rating System can significantly impact everything from admissions and
- [Ask Proactive - What are the top priorities for an effective Infection Prevention Program in long-term care?](https://proactiveltcexperts.com/ask-proactive-what-are-the-top-priorities-for-an-effective-infection-prevention-program-in-long-term-care/) - Q: What are the top priorities for an effective Infection Prevention Program in long-term care? A: An effective program should focus on: Conducting a facility-wide infection control risk assessment to identify vulnerabilities. Implementing robust surveillance systems for early detection and response to outbreaks. Ensuring compliance with hand hygiene and environmental cleaning protocols. Providing ongoing
- [The Landscape of Skilled Service Justification in Skilled Nursing Facilities - Part II](https://proactiveltcexperts.com/the-landscape-of-skilled-service-justification-in-skilled-nursing-facilities-part-ii/) - The Landscape of Skilled Service Justification in Skilled Nursing Facilities Compliance and accountability related to justifying skilled services is more important than ever. In Part 2 of this blog addressing justification of SNF Skilled Care, we’ll take a deeper look at specific skilled nursing and therapy skilled service case examples, providing targeted tips for supportive
- [Ask Proactive - Are there specific requirements for notifying the MD of incidents?](https://proactiveltcexperts.com/ask-proactive-are-there-specific-requirements-for-notifying-the-md-of-incidents/) - Q: Are there specific requirements for notifying the MD of incidents? A: Yes, specific regulatory requirements apply to notifying the physician, as incidents may fall under various categories. These guidelines ensure that physicians are informed in a timely and appropriate manner, depending on the nature of the incident. Incidents Involving Accidents Requirements
- [Keys to Active Diagnosis Documentation and the Provider Query Process](https://proactiveltcexperts.com/keys-to-active-diagnosis-documentation-and-the-provider-query-process/) - Keys to Active Diagnosis Documentation and the Provider Query Process Supportive documentation of active diagnosis is crucial—supporting quality care as well as playing a vital role in regulatory compliance, reimbursement, and overall patient outcomes. This week, we’ll delve into the importance of active diagnosis documentation and the essential provider query process that supports it. What
- [Ask Proactive - I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A?](https://proactiveltcexperts.com/ask-proactive-i-have-a-resident-that-routinely-receives-an-injection-of-fluphenazine-decanoate-every-4-weeks-the-injection-was-not-administered-during-the-7-day-observation-period-but-its-a-l/) - Q: I have a resident that routinely receives an injection of fluphenazine decanoate every 4 weeks. The injection was not administered during the 7-day observation period, but its a long-lasting medication. Should I code it under N0415A? A: Page N-9 of the RAI manual includes the following coding instructions for N0415A1: “Count long-acting medications,
- [Mandatory Update to SNF ABN (CMS-10055) - 10/31/2024](https://proactiveltcexperts.com/mandatory-update-to-snf-abn-cms-10055-10-31-2024/) - Mandatory update to SNF ABN (CMS-10055) – 10/31/2024 The Centers for Medicare & Medicaid Services (CMS) released an update to the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN)—Form CMS-10055 in August. The revised form and updated instructions are available for immediate use and will become mandatory on 10/31/2024. The SNF ABN (CMS-10055)
- [Ask Proactive - We have a resident with a chronic stage IV pressure ulcer who recently had flap surgery to close the wound. Do I continue to code the stage IV on the MDS?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-with-a-chronic-stage-iv-pressure-ulcer-who-recently-had-flap-surgery-to-close-the-wound-do-i-continue-to-code-the-stage-iv-on-the-mds/) - Q: We have a resident with a chronic stage IV pressure ulcer who recently had flap surgery to close the wound. Do I continue to code the stage IV on the MDS? A: According to the RAI (pg. M-6), if a pressure ulcer is surgically closed with a flap or graft, it should
- [Mandatory Off-Cycle SNF Revalidation Process—What You Need to Know](https://proactiveltcexperts.com/mandatory-off-cycle-snf-revalidation-process-what-you-need-to-know/) - Mandatory Off-cycle SNF Revalidation Process—What You Need to Know CMS will be notifying facilities via letter sent from their Medicare Administrative Contractor (MAC) sometime between October to December 2024 that they must complete the off-cycle revalidation process—here’s what you need to know to be compliant. Basis for Revalidation Requirements In 2010 the Affordable Care
- [Ask Proactive - Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because the resident’s previous BIMS scores have been 14 or15. When I interact with the resident, I don’t observe any cognitive decline, and the staff report no concerns either. Is this BIMS coding correct?](https://proactiveltcexperts.com/ask-proactive-our-social-worker-attempted-to-complete-the-bims-with-a-resident-but-the-resident-refused-to-answer-the-questions-as-a-result-the-social-worker-coded-all-responses-in-c0200-0300-an/) - Q: Our social worker attempted to complete the BIMS with a resident, but the resident refused to answer the questions. As a result, the social worker coded all responses in C0200, 0300 and 0400 as “0” with a BIMS Summary Score of “00” at C0500. This seems odd because the resident’s previous BIMS scores have
- [LTC Advance Directives: Key to Resident-Centered Care](https://proactiveltcexperts.com/understanding-advance-directives-in-long-term-care-facilities-a-critical-component-of-resident-centered-care/) - LTC Advance Directives: Key to Resident-Centered Care As the population ages and more individuals transition into long-term care (LTC) facilities, ensuring personalized, dignified care becomes increasingly important.. One of the most essential tools in achieving this is the use of advance directives—legal documents that allow individuals to outline their preferences for medical care if they
- [Ask Proactive - My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening?](https://proactiveltcexperts.com/ask-proactive-my-facility-is-triggering-high-for-the-quality-measure-prevalence-of-behavior-symptoms-affecting-others-but-we-dont-have-many-behavioral-issues-in-our-population-why-is-thi/) - Q: My facility is triggering high for the Quality Measure: Prevalence of Behavior Symptoms Affecting Others, but we don’t have many behavioral issues in our population. Why is this happening? A: This measure may trigger if the most recent MDS is coded with a 1, 2, or 3 for behavior frequency on the
- [Refusal of Care & Non-Adherence to Care Plan](https://proactiveltcexperts.com/refusal-of-care-non-adherence-to-care-plan/) - Addressing Refusal of Care and Non-Adherence to Care Plans in Skilled Nursing Facilities: Strategies for Success Refusal of care and non-adherence to care plans by residents in Skilled Nursing Facilities (SNFs) present significant challenges for healthcare teams. When residents reject the care or therapies prescribed, it can lead to adverse health outcomes, increased risk of
- [Supportive Documentation for ADL Care, Functional Declines, & Restorative Nursing](https://proactiveltcexperts.com/supportive-documentation-for-adl-care-functional-declines-restorative-nursing/) - Nursing home regulations are designed to ensure that residents receive quality care while maintaining their dignity and independence. Two key regulations, F676 (Quality of Life) and F688 (Mobility), focus on monitoring a resident’s ability to perform Activities of Daily Living (ADLs) and implementing a restorative program when a decline in ADLs is identified. Understanding F676
- [Ask Proactive - I accidentally submitted a 5-Day assessment for Managed Care.  What steps should I take to correct the situation?](https://proactiveltcexperts.com/ask-proactive-i-accidentally-submitted-a-5-day-assessment-for-managed-care-what-steps-should-i-take-to-correct-the-situation/) - Q: I accidentally submitted a 5-Day assessment for Managed Care. What steps should I take to correct the situation? A: Updated information has been provided in the Final MDS 3.0 RAI October 2024 section 5.8 page 5-14 to clarify how facilities must take specific steps to correct erroneous assessments that were submitted
- [Ask Proactive - How should we handle staffing challenges during peak flu season?](https://proactiveltcexperts.com/ask-proactive-how-should-we-handle-staffing-challenges-during-peak-flu-season/) - Q: How should we handle staffing challenges during peak flu season? A: During peak flu season, having a robust staffing plan is essential. This includes cross-training staff to fill multiple roles, establishing partnerships with local staffing agencies for temporary support, and encouraging vaccination among staff to reduce illness rates. Additionally, promoting a culture
- [Falling Leaves, Pumpkin Spice and MDS Changes](https://proactiveltcexperts.com/mds-changes-and-pumpkin-spice/) - October 1st is right around the corner which means new MDS changes. While there are fewer changes as compared to 2023, this year brings several important updates. So, sit back with your pumpkin spice latte and read on for the key MDS update information you need to know… CMS Posted the MDS changes to the
- [Substance Use Disorders in LTC](https://proactiveltcexperts.com/substance-use-disorders-in-ltc/) - Addressing Substance Use Disorders in Long-Term Care: A Growing Need for Comprehensive Care As the population ages, long-term care (LTC) facilities are increasingly encountering residents with complex health needs, including Substance Use Disorders (SUDs). Once considered a condition primarily affecting younger individuals, SUDs are now becoming more prevalent among older adults. This shift presents new
- [Ask Proactive - Our facility is triggering the UTI QM, and we have identified that many of these are the result of the hospital diagnosing a UTI that does not meet our infection criteria. Do we have to code those on the MDS if they occur during the look-back period?](https://proactiveltcexperts.com/ask-proactive-our-facility-is-triggering-the-uti-qm-and-we-have-identified-that-many-of-these-are-the-result-of-the-hospital-diagnosing-a-uti-that-does-not-meet-our-infection-criteria-do-we-have-t/) - Q: Our facility is triggering the UTI QM, and we have identified that many of these are the result of the hospital diagnosing a UTI that does not meet our infection criteria. Do we have to code those on the MDS if they occur during the look-back period? A: The RAI manual, on
- [Ask Proactive - What are some effective strategies for improving staff engagement and retention in nursing homes?](https://proactiveltcexperts.com/ask-proactive-what-are-some-effective-strategies-for-improving-staff-engagement-and-retention-in-nursing-homes/) - Q: What are some effective strategies for improving staff engagement and retention in nursing homes? A: Improving staff engagement and retention is crucial for maintaining high-quality care in nursing homes. Here are some strategies: Offer Competitive Compensation and Benefits: Ensure that your salary and benefits packages are competitive with industry standards to attract
- [A Guide to Effective Care Plan Meetings](https://proactiveltcexperts.com/a-guide-to-effective-care-plan-meetings/) - Effective care plan meetings are crucial for delivering high-quality care in skilled nursing facilities. These meetings ensure that each resident receives personalized and comprehensive care tailored to their unique needs and circumstances. Care plan development relies on a detailed, interdisciplinary assessment of the resident’s problems, needs, and strengths, which are documented in the medical record
- [Ask Proactive - My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify.](https://proactiveltcexperts.com/ask-proactive-my-biller-is-requesting-a-hipps-code-for-a-medicare-resident-who-admitted-to-our-snf-and-then-transferred-to-an-assisted-living-facility-on-the-same-day-i-didnt-think-we-coul/) - Q: My biller is requesting a HIPPS code for a Medicare resident who admitted to our SNF and then transferred to an assisted living facility on the same day. I didn’t think we could bill for the day of discharge. Please clarify. A: Generally, the day of discharge, death, or day on which
- [Practical Tips to Avoid F695 Respiratory Care Deficiencies](https://proactiveltcexperts.com/practical-tips-to-avoid-f695-respiratory-care-deficiencies/) - F695 Respiratory Care was the 7th most cited deficiency in standard health surveys so far for the 2024 Fiscal Year, being cited in 21% of surveys. F695 mandates that facilities must ensure residents requiring respiratory care, such as oxygen therapy, respiratory treatments, tracheostomy care, tracheal suctioning and mechanical ventilation, receive it according to professional standards,
- [The Critical Role of Frontline Caregivers in Managing Resident Condition Changes](https://proactiveltcexperts.com/the-critical-role-of-frontline-caregivers-in-managing-resident-condition-changes/) - Frontline caregivers are instrumental to the delivery of optimal care practices for residents. Conversely, when changes in a resident's condition go unnoticed or are not communicated promptly by caregivers, there is a significant risk of deterioration. The timely recognition and management of these changes are crucial to maintaining high standards of care, ensuring compliance with
- [Ask Proactive - A new resident was admitted to our facility with an order for Mirtazapine 15mg every evening. There is no information in the admission paperwork regarding its use and the admitting nurse entered the order “for antidepressant.” Should N0415C2: High-Risk Drug Classes: Indication be coded “yes” or “no”?](https://proactiveltcexperts.com/ask-proactive-a-new-resident-was-admitted-to-our-facility-with-an-order-for-mirtazapine-15mg-every-evening-there-is-no-information-in-the-admission-paperwork-regarding-its-use-and-the-admitting-nur/) - Q: A new resident was admitted to our facility with an order for Mirtazapine 15mg every evening. There is no information in the admission paperwork regarding its use and the admitting nurse entered the order “for antidepressant.” Should N0415C2: High-Risk Drug Classes: Indication be coded “yes” or “no”? A: Based on the available
- [Enhancing Behavioral Healthcare Through Non-Pharmacological Approaches](https://proactiveltcexperts.com/enhancing-behavioral-healthcare-through-non-pharmacological-approaches/) - Behavioral health conditions, including dementia, depression, and anxiety, are common in and out of skilled nursing and long-term care facilities. While medications are often prescribed to manage these conditions, there is a growing recognition of the importance of non-pharmacological approaches. These methods focus on addressing the root causes of behavioral issues through holistic, person-centered care,
- [Ask Proactive - What should be the first reference for MDS/NAC or IDT members when searching for a diagnosis code?](https://proactiveltcexperts.com/ask-proactive-what-should-be-the-first-reference-for-mds-nac-or-idt-members-when-searching-for-a-diagnosis-code/) - Q: What should be the first reference for MDS/NAC or IDT members when searching for a diagnosis code? A: The ICD-10-CM Official Guidelines for Coding and Reporting (Guidelines) for the current fiscal year should always be the first reference consulted. These guidelines are updated twice a year, in October and April, and are
- [Nutrition and Hydration Refresher](https://proactiveltcexperts.com/nutrition-and-hydration-refresher/) - Maintaining adequate nutrition and hydration status is crucial to promoting quality of life and positive outcomes for each resident. Poor nutritional status can lead to adverse health effects, including decreased strength and functional abilities, depression, increased risk for falls, infections, pressure ulcers, delayed healing, prolonged recovery time and higher risk of rehospitalization. Interdisciplinary Approach SNFs
- [Ask Proactive - Do you have suggested strategies for integrating QAPI into the daily operations of a nursing home?](https://proactiveltcexperts.com/ask-proactive-do-you-have-suggested-strategies-for-integrating-qapi-into-the-daily-operations-of-a-nursing-home/) - Q: Do you have suggested strategies for integrating QAPI into the daily operations of a nursing home? A: Best practices for integrating QAPI into daily operations include embedding QAPI principles into the organizational culture, making quality improvement a routine part of all staff roles. Leadership should encourage continuous education and training on QAPI
- [The Lowdown on DON Oversight of MDS](https://proactiveltcexperts.com/the-lowdown-on-don-oversight-of-mds/) - In the fast day-to-day of managing nursing care and services, it’s easy for a a disconnect to develop between the Director of Nursing (DON) and the Minimum Data Set (MDS) Coordinator. This division is exacerbated when the DON is inexperienced in the MDS role, given that the MDS process is quite complex and driven by
- [Ask Proactive - Is there a specific assessment for determining a resident’s capacity to consent to sexual activity?](https://proactiveltcexperts.com/is-there-a-specific-assessment-for-determining-a-residents-capacity-to-consent-to-sexual-activity/) - Q: Is there a specific assessment for determining a resident’s capacity to consent to sexual activity? A: While you may find samples of assessments that are identified to be used for determining a resident’s capacity to consent to sexual activity, you will find that the majority of these do not address all of
- [Fiscal Year 2025 Skilled Nursing Facility Prospective Payment System Final Rule (CMS 1802-F)](https://proactiveltcexperts.com/fiscal-year-2025-skilled-nursing-facility-prospective-payment-system-final-rule-cms-1802-f/) - On July 31, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the final rule updating Medicare payment policies and rates for skilled nursing facilities (SNFs) under the Skilled Nursing Facility Prospective Payment System (SNF PPS) for fiscal year (FY) 2025. This annual update is required by law and includes significant changes aimed at
- [Ask Proactive - How can nursing home leadership effectively use Facility Assessment data to drive strategic planning and resource allocation?](https://proactiveltcexperts.com/ask-proactive-how-can-nursing-home-leadership-effectively-use-facility-assessment-data-to-drive-strategic-planning-and-resource-allocation/) - Q: How can nursing home leadership effectively use Facility Assessment data to drive strategic planning and resource allocation? A: Facility leadership can leverage Facility Assessment data to drive strategic planning and resource allocation by identifying trends and gaps in resident care needs and facility capabilities. This data helps prioritize areas requiring investment, such
- [F585 Grievance Process and Resolution](https://proactiveltcexperts.com/f585-grievance-process-and-resolution/) - F585 has been cited 580 times during the 2024 Fiscal year. An effective Grievance Process that is consistently carried out with timely complaint resolution reduces the risk of issues escalating. In this week’s blog, we examine the essential elements of an effective Grievance Process, steps to ensure compliance and examples of recent deficiencies…. Residents have
- [QAPI Expectations in Skilled Nursing Facilities](https://proactiveltcexperts.com/qapi-expectations-in-skilled-nursing-facilities/) - Quality Assurance and Performance Improvement (QAPI) is a vital component of maintaining and enhancing the quality of care in Skilled Nursing Facilities (SNFs). How can you move QAPI programming in your facility to the next level? QAPI is a comprehensive approach that integrates two crucial aspects of quality management: Quality Assurance (QA) and Performance Improvement
- [Ask Proactive - Can I code fluids received in the hospital in section K for a diagnosis of Hypovolemia?](https://proactiveltcexperts.com/ask-proactive-can-i-code-fluids-received-in-the-hospital-in-section-k-for-a-diagnosis-of-hypovolemia/) - Q: Can I code fluids received in the hospital in section K for a diagnosis of Hypovolemia? A: Fluids coded in K0520A1 do have to be for nutrition or hydration. Oftentimes we may not see that specific verbiage in the hospital notes. In cases where the diagnosis indicated the fluids were for hydration,
- [Housekeeping Insights and Disinfection for Infection Preventionists](https://proactiveltcexperts.com/housekeeping-insights-and-disinfection-for-infection-preventionists/) - In the world of healthcare, cleanliness isn't just about appearance—it's a critical component of infection control and prevention. Effective cleaning and disinfecting practices are essential to maintaining a safe and sanitary environment in skilled nursing, long-term care, and assisted living facilities. Here are some key insights and best practices for ensuring that your facility remains
- [Ask Proactive - Patient was admitted with a stage IV pressure ulcer that healed (fully epithelialized) and several months later reopened at the same site. How should this pressure ulcer be staged when it reopens?](https://proactiveltcexperts.com/ask-proactive-patient-was-admitted-with-a-stage-iv-pressure-ulcer-that-healed-fully-epithelialized-and-several-months-later-reopened-at-the-same-site-how-should-this-pressure-ulcer-be-staged-whe/) - Q: Patient was admitted with a stage IV pressure ulcer that healed (fully epithelialized) and several months later reopened at the same site. How should this pressure ulcer be staged when it reopens? A: According to the RAI Manual guidance for pressure ulcer staging, the accurate staging of ulcers requires a thorough review
- [Managing Long and Short Stay Pressure Ulcer/Injury Quality Measures](https://proactiveltcexperts.com/managing-long-and-short-stay-pressure-ulcer-injury-quality-measures/) - Pressure injuries, also known as pressure ulcers and bedsores, are a significant concern in nursing facilities, particularly among residents with limited mobility. The development of pressure injuries can be a reflection of the quality of care a resident receives, making it crucial for nursing facilities to monitor and improve their preventive measures. In this context,
- [Ask Proactive - We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative ambulation in the hallway. Therapy staff wore gowns and gloves while working with him in the therapy gym, but what should restorative nursing staff do in the hallway?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-on-enhanced-barrier-precautions-ebp-due-to-an-indwelling-catheter-that-has-completed-therapy-and-is-transferring-to-rnp-staff-will-be-providing-partial-moderate-a/) - Q: We have a resident on Enhanced Barrier Precautions (EBP) due to an indwelling catheter that has completed therapy and is transferring to RNP. Staff will be providing partial/moderate assistance, which will involve extended high contact, during restorative ambulation in the hallway. Therapy staff wore gowns and gloves while working with him in the therapy
- [F609 Reporting of Alleged Violations: Ensuring Timely and Accurate Reporting in Long-Term Care Facilities](https://proactiveltcexperts.com/f609-reporting-of-alleged-violations-ensuring-timely-and-accurate-reporting-in-long-term-care-facilities/) - Reporting alleged violations promptly is crucial for maintaining safety and compliance in long-term care facilities. Among the most frequently cited issues at the Immediate Jeopardy (IJ) level are those related to Abuse and Neglect. This article focuses on F609, one of the nine specific F tags, and provides practical tips to ensure timely and accurate
- [Ask Proactive - How does an interdisciplinary team contribute to effective discharge planning in healthcare?](https://proactiveltcexperts.com/ask-proactive-how-does-an-interdisciplinary-team-contribute-to-effective-discharge-planning-in-healthcare/) - Q: How does an interdisciplinary team contribute to effective discharge planning in healthcare? A: Discharge planning is a critical process in healthcare, involving an interdisciplinary team to ensure a smooth transition from one care setting to another. Here are the roles typically involved in discharge planning and their responsibilities: Physician/Primary Care Provider (PCP)
- [Ask Proactive - We have a Family Council starting in our facility. What is the facility’s responsibility to facilitate a successful Family Council?](https://proactiveltcexperts.com/ask-proactive-we-have-a-family-council-starting-in-our-facility-what-is-the-facilitys-responsibility-to-facilitate-a-successful-family-council-he-doesnt-have-copd-but-h/) - Q: We have a Family Council starting in our facility. What is the facility’s responsibility to facilitate a successful Family Council? A: Requirements for Family Councils in Medicare and Medicaid Certified Facilities Medicare and Medicaid certified facilities are required to support family councils by providing a meeting space, cooperating with council activities, and
- [Facility Assessment Tipsheet: Addressing Behavioral Health Needs](https://proactiveltcexperts.com/facility-assessment-tipsheet-addressing-behavioral-health-needs/) - CMS has issued updated guidance that surveyors will use to evaluate nursing home providers’ compliance with the expanded facility assessment requirements included in the minimum staffing rule, which become effective on August 8, 2024. Every nursing home provider must complete an updated facility assessment by this date. The facility assessment must include an evaluation of
- [Ask Proactive - We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives an inhaler to help with symptom management. Is it okay to mark at I6200 on his 5-day PPS assessment?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-who-has-a-progress-note-documenting-that-resident-requested-hob-to-be-elevated-because-when-lying-down-flat-he-cant-catch-his-breath-he-d/) - Q: We have a resident who has a progress note documenting that resident requested HOB to be elevated because when lying down flat he can’t “catch his breath.” He doesn’t have COPD but he does have pulmonary fibrosis which is listed on his hospital H&P and receives an inhaler to help with symptom management. Is
- [Enhanced Barrier Precautions—Are you in compliance?](https://proactiveltcexperts.com/enhanced-barrier-precautions-are-you-in-compliance/) - The Centers for Medicare & Medicaid Services (CMS) released QSO-24-08-NH in March 2024, the Memorandum pertaining to Enhanced Barrier Precautions (EBP) in Nursing Homes. While many facilities already had these precautions in place in some form based on CDC guidelines prior to March, they, along with those who had not yet implemented this program, may
- [Navigating Advance Directives and End-of-Life Care in Nursing Facilities](https://proactiveltcexperts.com/navigating-advance-directives-and-end-of-life-care-in-nursing-facilities/) - Few topics are as sensitive and crucial as end-of-life care. At the heart of this complex and emotionally charged subject are Advance Directives (ADs) – legal documents that spell out a person’s wishes regarding medical care and treatment when they can no longer communicate these wishes themselves. Understanding and implementing these directives is essential to
- [Ask Proactive - One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint replacement surgery but some of the available hospital documentation uses S72.141A Displaced intertrochanteric fracture of right femur, initial encounter for closed fracture. Which is the correct code?](https://proactiveltcexperts.com/ask-proactive-one-of-our-long-term-residents-fell-and-fractured-their-femur-requiring-a-hip-replacement-they-returned-to-our-facility-on-a-skilled-stay-the-idt-met-and-were-discussing-a-primary-di/) - Q: One of our long-term residents fell and fractured their femur requiring a hip replacement. They returned to our facility on a skilled stay. The IDT met and were discussing a primary diagnosis. Therapy believes we should use Z47.1 Aftercare following joint replacement surgery but some of the available hospital documentation uses S72.141A Displaced intertrochanteric
- [Ask Proactive - We have a patient who has achieved ambulation in the hallways at supervision level using a walker. Our new case manager is insistent that we discharge as soon as possible, or our services could be denied by Medicare. The patient wants to return to PLOF, independent ambulation, so her therapists do not feel a discharge is appropriate at this time. Would this claim be at risk for denial?](https://proactiveltcexperts.com/ask-proactive-we-have-a-patient-who-has-achieved-ambulation-in-the-hallways-at-supervision-level-using-a-walker-our-new-case-manager-is-insistent-that-we-discharge-as-soon-as-possible-or-our-servi/) - Q: We have a patient who has achieved ambulation in the hallways at supervision level using a walker. Our new case manager is insistent that we discharge as soon as possible, or our services could be denied by Medicare. The patient wants to return to PLOF, independent ambulation, so her therapists do not feel a
- [Avoiding the Most Commonly Cited Medication Errors](https://proactiveltcexperts.com/avoiding-the-most-commonly-cited-medication-errors/) - Recent CASPER data for Fiscal Year 2024 ranks deficiency F760, "Residents are Free of Significant Medication Errors," as 25th and F759, "Free of Medication Error Rate of 5% or More," as 27th. Let’s examine examples of these deficiencies along with an action plan based on best practices to avoid similar tags… Review of Important Definitions
- [Ask Proactive - What are the best practices to prevent a deficiency, especially an Immediate Jeopardy, related to CPR?](https://proactiveltcexperts.com/ask-proactive-what-are-the-best-practices-to-prevent-a-deficiency-especially-an-immediate-jeopardy-related-to-cpr/) - Q: What are the best practices to prevent a deficiency, especially an Immediate Jeopardy, related to CPR? A: One of the most critical components in preventing a deficiency related to CPR is communication. The facility must ensure that the resident’s admission documentation clearly identifies code status and/or Advance Directives. The designated code status
- [Minimum Staffing Rule’s Facility Assessment Mandate](https://proactiveltcexperts.com/minimum-staffing-rules-facility-assessment-mandate/) - On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS issued the Minimum Staffing Standards for Long-Term Care (LTC) Facilities and Medicaid Institutional Payment Transparency Reporting final rule. This final rule mandates the following minimum staffing hours per resident day (HPRD): 55 Registered Nurse (RN) 45 Nursing Aides (NA) 48 Total Nursing HPRD, which is an increase
- [Retiring Nurse Leaders—What’s your Plan?](https://proactiveltcexperts.com/retiring-nurse-leaders-whats-your-plan/) - Recently, a poll was posted inquiring about upcoming retirement plans for MDS Coordinators and Directors of Nursing. The poll was posted in a closed Facebook forum, The MDS Coordinators Discussion Group, hosted by Jim Kilburn which represents over 19,000 post-acute care nurse leaders. Around 300 responses were tabulated with eye-opening results. When asked “How many
- [Ask Proactive - What steps should be taken when a resident chooses not to comply with diet or fluid restrictions?](https://proactiveltcexperts.com/ask-proactive-what-steps-should-be-taken-when-a-resident-chooses-not-to-comply-with-diet-or-fluid-restrictions/) - Q: What steps should be taken when a resident chooses not to comply with diet or fluid restrictions? A: According to the State Operations Manual (SOM), under F553 ‘The Right to Participate in Planning Care,’ a resident has the right to select or refuse specific treatment options before the care plan is instituted,
- [Strengthening Nursing Home Oversight: A Review of Proposed Changes to Enforcement](https://proactiveltcexperts.com/strengthening-nursing-home-oversight-a-review-of-proposed-changes-to-enforcement/) - In the realm of healthcare, especially within nursing facilities, ensuring compliance with regulations is paramount to safeguarding the well-being of residents. Recently, the Centers for Medicare & Medicaid Services (CMS) proposed significant revisions to enforcement policies, particularly regarding Civil Money Penalties (CMPs). Let's delve into these proposed changes and understand their implications for nursing home
- [Ask Proactive - Is it best practice to have witnesses write their own statements for incidents or investigations or to write these statements for them?](https://proactiveltcexperts.com/ask-proactive-is-it-best-practice-to-have-witnesses-write-their-own-statements-for-incidents-or-investigations-or-to-write-these-statements-for-them/) - Q: Is it best practice to have witnesses write their own statements for incidents or investigations or to write these statements for them? A: Deciding whether to have witnesses write their own statements or not is going to depend on your specific state requirements, your facility policy, and the recommendations of your facility
- [Ask Proactive - I hear so much talk about drug diversion in healthcare, how would I know if it was happening in my facility?](https://proactiveltcexperts.com/ask-proactive-i-hear-so-much-talk-about-drug-diversion-in-healthcare-how-would-i-know-if-it-was-happening-in-my-facility/) - Q: I hear so much talk about drug diversion in healthcare, how would I know if it was happening in my facility? A: Healthcare professionals and institutions must remain vigilant for signs of drug diversion to safeguard patients and facilitate appropriate intervention for those involved in diversion. Below are examples of behaviors that
- [ICD.10 Corrections Issued Impacting PDPM](https://proactiveltcexperts.com/icd-10-corrections-issued-impacting-pdpm/) - CMS issued corrections to the FY 2024 SNF PPS Final Rule PDPM ICD-10 Mapping. The document, which was issued and effective April 10, 2024, makes corrections to technical errors that are applicable beginning 10/1/2023. This correction document can be accessed at the link below: Federal Register :: Medicare Program; Prospective Payment System and Consolidated Billing
- [Infection Control Highlight: Managing UTIs in Long-Term Care Facilities](https://proactiveltcexperts.com/infection-control-highlight-managing-utis-in-long-term-care-facilities/) - Infection control is a critical aspect of healthcare, especially in long-term care (LTC) facilities where residents are more vulnerable to infections like urinary tract infections (UTIs). UTIs are a common and often recurring issue in this setting, requiring vigilant management and prevention strategies to safeguard the health and well-being of residents. In this blog, we'll
- [Ask Proactive - I have a resident that was admitted Medicare part A on the 11th, discharged to the hospital on 13th and is returning today (22nd). Is her admission MDS due earlier because of the 04/11 admission date?](https://proactiveltcexperts.com/ask-proactive-i-have-a-resident-that-was-admitted-medicare-part-a-on-the-11th-discharged-to-the-hospital-on-13th-and-is-returning-today-22nd-is-her-admission-mds-due-earlier-because-of-the-04-11/) - Q: I have a resident that was admitted Medicare part A on the 11th, discharged to the hospital on 13th and is returning today (22nd). Is her admission MDS due earlier because of the 04/11 admission date? A: The admission assessment should be reinitiated with a new ARD and scheduled within 14 days
- [Auditor Insights: Easy Fixes to Skilled Charting Shortcomings](https://proactiveltcexperts.com/auditor-insights-easy-fixes-to-skilled-charting-shortcomings/) - Audits are on the rise! Skilled nursing facilities (SNFs) are at an all-time high when it comes to active medical review. From the SNF 5 Claim Probe and Educate and individual Medicare Advantage reviews, to recovery audit contractors (RACs) and Supplemental Medical Review Contractor (SMRC) audits – SNFs are increasingly on the radar to determine
- [Minimum Staffing Final Rule](https://proactiveltcexperts.com/minimum-staffing-final-rule/) - *Content in this post was corrected on 4/24/2024 at 11:11 Central Time. The HPRD of direct nurse aide care was changed from .45 to 2.45* On Monday, April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) unveiled a comprehensive 329-page final rule addressing staffing requirements for skilled nursing facilities. Key staffing requirements included
- [Top MDS Coding Misses and What It’s Costing Your Facility](https://proactiveltcexperts.com/top-mds-coding-misses-and-what-its-costing-your-facility/) - While MDS Coordinators consistently strive for accuracy, complying with the intricate coding instructions and details in the Resident Assessment Instrument User Manual, in addition to state-specific coding instructions is challenging. Unfortunately, MDS coding errors can often result in gaps in care provision and cost providers vital revenue. This week’s blog reviews two of the most
- [Ask Proactive - We just had an annual survey and received three F-Tags level D in SNF area. One of those was Infection Control. Should I anticipate a civil money penalty due to the Infection tag?](https://proactiveltcexperts.com/ask-proactive-we-just-had-an-annual-survey-and-received-three-f-tags-level-d-in-snf-area-one-of-those-was-infection-control-should-i-anticipate-a-civil-money-penalty-due-to-the-infection-tag/) - Q: We just had an annual survey and received three F-Tags level D in SNF area. One of those was Infection Control. Should I anticipate a civil money penalty due to the Infection tag? A: You will only receive the enhanced enforcement penalties if you receive both F880 & F887 at lower s/s
- [Ask Proactive - We just had an annual survey and received three F-Tags level D in SNF area. One of those was Infection Control. Should I anticipate a civil money penalty due to the Infection tag?](https://proactiveltcexperts.com/ask-proactive-we-just-had-annual-survey-received-three-f-tags-level-d-in-snf-area-one-of-those-was-infection-control-should-i-anticipate-a-civil-money-penalty-due-to-the-infection-tag/) - Q: We just had an annual survey and received three F-Tags level D in SNF area. One of those was Infection Control. Should I anticipate a civil money penalty due to the Infection tag? A: You will only receive the enhanced enforcement penalties if you receive both F880 & F887 at lower s/s
- [Strategies for Achieving Restorative Nursing Excellence](https://proactiveltcexperts.com/strategies-for-achieving-restorative-nursing-excellence/) - Skilled nursing facilities (SNFs) and nursing facilities (NFs) play a crucial role in supporting individuals with chronic illnesses, disabilities, or those needing extended care services. Among the essential programs within these facilities is the Restorative Nursing Program (RNP), which aims to enhance residents' quality of life by maintaining or improving their functional abilities and independence.
- [After the Survey: Tips On Writing an Effective Plan of Correction](https://proactiveltcexperts.com/after-the-survey-tips-on-writing-an-effective-plan-of-correction/) - Let’s delve into what a Plan of Correction (PoC) entails. According to, 42 CFR §488.401 a PoC is a plan developed by the facility and approved by either CMS or the survey agency. It outlines the actions the facility will take to rectify deficiencies and specifies the date by which those deficiencies will be corrected.
- [Ask Proactive - Is concussion related to fall considered a fall with major injury that would be coded in section JJ1900C of the MDS?](https://proactiveltcexperts.com/ask-proactive-is-concussion-related-to-fall-considered-a-fall-with-major-injury-that-would-be-coded-in-section-jj1900c-of-the-mds/) - Q: Is concussion related to fall considered a fall with major injury that would be coded In section JJ1900C of the MDS? A: The RAI Manual defines a fall with major injury as follows: Major injury: includes bone fractures, joint dislocations, closed head injury with altered consciousness, subdural hematoma. A concussion meets the
- [Ask Proactive - I had a resident admitted to our SNF under skilled care who has been diagnosed with HIV/AIDS, but the NTA points are not generating in the HIPPS code. Can you please explain why this is happening and what corrective action should be taken to ensure reimbursement is accurate?](https://proactiveltcexperts.com/i-had-a-resident-admitted-to-our-snf-under-skilled-care-who-has-been-diagnosed-with-hiv-aids-but-the-nta-points-are-not-generating-in-the-hipps-code-can-you-please-explain-why-this-is-happening-and/) - Q: I had a resident admitted to our SNF under skilled care who has been diagnosed with HIV/AIDS, but the NTA points are not generating in the HIPPS code. Can you please explain why this is happening and what corrective action should be taken to ensure reimbursement is accurate? A: To account for
- [Managing Elopement Risk in Nursing Homes](https://proactiveltcexperts.com/managing-elopement-risk-in-nursing-homes/) - Managing elopement risk is crucial for ensuring the safety and well-being of residents in nursing homes, particularly those with cognitive impairments. Elopement, defined as when a resident leaves the premises or a safe area without the facility’s knowledge and supervision, poses significant dangers such as exposure to extreme temperatures, dehydration, medical complications, and accidents. In
- [Top Survey Tags FY2024 & How to Avoid Them](https://proactiveltcexperts.com/department-specific-top-tags-how-to-avoid-them/) - According to CASPER Standard Survey data (3/17/24), over 25 thousand deficiencies have been cited thus far this fiscal year (FY), spanning 215 distinct F-tags. This article aims to scrutinize the primary deficiencies across five regulatory groups/facility departments and proposes strategies for their avoidance. Food and Nutrition Services F812 Food Procurement, Store/Prepare/Serve Sanitary continues to top
- [Ask Proactive - To ensure resident safety with beds and bedrails, how often should bed inspections be conducted and what should be checked?](https://proactiveltcexperts.com/ask-proactive-to-ensure-resident-safety-with-beds-and-bedrails-how-often-should-bed-inspections-be-conducted-and-what-should-be-checked/) - Q: To ensure resident safety with beds and bedrails, how often should bed inspections be conducted and what should be checked? A: As part of the preventive maintenance program, bed inspections should be conducted a minimum of every six months, and this should include the bed frames, mattresses, and rails. The bed inspection
- [Keys to Managing Survey in Process](https://proactiveltcexperts.com/keys-to-managing-survey-in-process/) - Navigating the intricacies of the survey process can seem difficult. However, with the right strategies, mindset, and preparedness plan your facility can emerge stronger and better equipped for success than ever before. In this week’s blog, we delve into the key aspects of managing the survey process to focus our teams on not only achieving
- [Ask Proactive - When coding IV fluids “while not a resident” in section K of the MDS for a resident who does not have a dehydration diagnosis what documentation would support that the IVFs were administered for nutrition/hydration?](https://proactiveltcexperts.com/ask-proactive-when-coding-iv-fluids-while-not-a-resident-in-section-k-of-the-mds-for-a-resident-who-does-not-have-a-dehydration-diagnosis-what-documentation-would-support-that-the/) - Q: When coding IV fluids “while not a resident” in section K of the MDS for a resident who does not have a dehydration diagnosis what documentation would support that the IVFs were administered for nutrition/hydration? A: The key to supporting the coding IV fluids in section K of the MDS is that
- [Ask Proactive - How does oral care impact the risk of death in a nursing home?](https://proactiveltcexperts.com/ask-proactive-how-does-oral-care-impact-the-risk-of-death-in-a-nursing-home/) - Q: How does oral care impact the risk of death in a nursing home? A: Aspiration pneumonia is a leading cause of death in nursing homes. Aspiration pneumonia occurs when a non-air substance (e.g. food, liquid, saliva) and bacteria from the mouth is inhaled and infects the lungs. Oral health, including consistent, effective
- [DON Success: Delegation of Duties](https://proactiveltcexperts.com/don-success-delegation-of-duties/) - As the acuity and complexity of long-term care residents has increased, the responsibilities of the Director of Nursing (DON) have also escalated significantly. The duties of the DON are not just clinical in nature, they also involve regulatory, reimbursement, and legal aspects of facility operations as well. It is virtually impossible for the DON to
- [Ask Proactive – What should be done if a PPS 5-Day assessment completed for Managed Care is submitted to CMS?](https://proactiveltcexperts.com/ask-proactive-what-should-be-done-if-a-pps-5-day-assessment-completed-for-managed-care-is-submitted-to-cms/) - 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 Medicare Advantage Plans. If a PPS assessment is incorrectly
- [Ask Proactive - How long does CMS’ Abuse Icon remain on Care Compare?](https://proactiveltcexperts.com/ask-proactive-how-long-does-cms-abuse-icon-remain-on-care-compare/) - Q: How long does CMS’ Abuse Icon remain on Care Compare? A: Criteria that identify a facility of non-compliance related to abuse, and placement of the Abuse Icon on Care Compare includes: Harm-level abuse citation in the most recent survey cycle: Facilities cited for abuse where residents were found to be harmed (Scope/Severity
- [Retaining Top-Notch MDS Staff—Tips for Supporting Your MDS Team](https://proactiveltcexperts.com/retaining-top-notch-mds-staff-tips-for-supporting-your-mds-team/) - In the ever-evolving landscape of healthcare, the retention of skilled and dedicated MDS (Minimum Data Set) staff is critical. MDS coordinators play a pivotal role in assessing patients' needs, maintaining compliance with regulations, and facilitating smooth communication between various healthcare professionals. Yet, amidst the dynamic healthcare landscape and competitive labor market, preserving top-tier MDS talent
- [Sharpening Pain Management Charting](https://proactiveltcexperts.com/sharpening-pain-management-charting/) - Pain is a significant issue for many nursing home residents that can negatively impact quality of life when not appropriately managed. Unrelieved pain can lead to a decline in the resident’s function, cognitive, mood, behavior, and psychosocial status. An effective pain management program focuses on improving quality of life by maintaining an optimal level of
- [Ask Proactive - We have a resident who was admitted to the nursing home on 2/4/24 and scheduled their MDS admission assessment with an ARD (assessment reference date) for 2/11/24. They elected to enroll in a hospice program on 2/9/24. We know a significant change MDS assessment needs to be completed when a resident elects hospice. Do we need to schedule a significant change MDS assessment in addition to their admission MDS assessment?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-who-was-admitted-to-the-nursing-home-on-2-4-24-and-scheduled-their-mds-admission-assessment-with-an-ard-assessment-reference-date-for-2-11-24-they-elected-to-enro/) - Q: We have a resident who was admitted to the nursing home on 2/4/24 and scheduled their MDS admission assessment with an ARD (assessment reference date) for 2/11/24. They elected to enroll in a hospice program on 2/9/24. We know a significant change MDS assessment needs to be completed when a resident elects hospice. Do
- [Upholding Standards: Investigating Abuse and Neglect in Nursing Homes](https://proactiveltcexperts.com/upholding-standards-investigating-abuse-and-neglect-in-nursing-homes/) - As leaders in the nursing home industry, ensuring the well-being and safety of residents is paramount. One of the most challenging aspects of this responsibility is investigating allegations of abuse and neglect within our facilities. In this article, we will explore the importance of thorough investigations, best practices for conducting them, and strategies for preventing
- [Ask Proactive - We have a lot of residents on Scheduled Toileting. I’m worried we won’t get credit for them during our next CMI validation. What will I need to show our review nurse to receive credit?](https://proactiveltcexperts.com/ask-proactive-we-have-a-lot-of-residents-on-scheduled-toileting-im-worried-we-wont-get-credit-for-them-during-our-next-cmi-validation-what-will-i-need-to-show-our-review-nurse-to/) - Q: We have a lot of residents on Scheduled Toileting. I’m worried we won’t get credit for them during our next CMI validation. What will I need to show our review nurse to receive credit? A: The RAI Manual MDS item H0200C, 'Current Toileting Program' (page H-6), outlines specific requirements that must be
- [Ask Proactive - When is it appropriate to use staff interviews on the MDS?](https://proactiveltcexperts.com/ask-proactive-when-is-it-appropriate-to-use-staff-interviews-on-the-mds/) - Q: When is it appropriate to use staff interviews on the MDS? A: For the four interviews on the MDS (BIMS, PHQ2/9, Activities, and Pain), direct resident input should be the primary approach as observations may be misleading. For instance, the RAI manual notes in its discussion of the BIMS that “Without an
- [Mastering Behavioral Health Documentation: Top 5 Tips for Skilled Nursing Facilities](https://proactiveltcexperts.com/mastering-behavioral-health-documentation-top-5-tips-for-skilled-nursing-facilities/) - Behavioral health issues in skilled nursing facilities (SNFs) require meticulous documentation to ensure proper care and compliance with regulations. Accurate documentation not only facilitates effective treatment but also helps in addressing legal and regulatory requirements. Here are the top five tips for SNFs to enhance their behavioral health documentation practices. Thorough Assessment and Evaluation: Comprehensive
- [Ask Proactive - As a new DON, what duties should I expect from the Medical Director?](https://proactiveltcexperts.com/ask-proactive-as-a-new-don-what-duties-should-i-expect-from-the-medical-director/) - Q: As a new DON, what duties should I expect from the Medical Director? A: The duties of the Medical Director are addressed in the CMS regulations as follows: F841 483.70(h) Medical director. 483.70(h)(1) The facility must designate a physician to serve as medical director. 483.70(h)(2) The medical director is responsible for— Implementation
- [ICD-10-CM Common Errors and How to Avoid Them](https://proactiveltcexperts.com/icd-10-cm-common-errors-and-how-to-avoid-them/) - PDPM coding and reimbursement success relies significantly on ICD-10 coding accuracy. In particular, the impact of ICD.10 coding on the clinical category, SLP, Nursing, and NTA comorbid diagnoses cannot be overstated; Medicare reimbursement for SNF services depends on accurate coding. Unfortunately, diagnosis coding is not a skill easily mastered on the job. In fact, the
- [Proactive serves on NARA expert Panel in DC](https://proactiveltcexperts.com/proactive-serves-on-nara-expert-panel-in-dc/) - NARA’s Spring Conference in Washington DC I was invited to NARA’s Spring Conference in Washington DC to join as an expert panelist during their Pre-Conference session. The expert topic was related to ICD-10-CM and the shift from a payment model that emphasizes volume based therapy to focus on patient characteristics, often captured through diagnosis coding.
- [Is Your Triple Check PDPM Ready?](https://proactiveltcexperts.com/is-your-triple-check-pdpm-ready/) - A strong Triple Check process requires a group effort The Triple Check process is an internal audit that ensures billing accuracy and compliance with regulatory guidelines prior to the submission of claims to Medicare and other payors. A strong Triple Check process requires a group effort from the Interdisciplinary team in order to validate care
- [How will you meet Trauma Informed Care standards?](https://proactiveltcexperts.com/how-will-you-meet-trauma-informed-care-standards/) - How will you meet Trauma Informed Care standards required under the Phase 3 Requirements of Participation (ROP)? Trauma-informed care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma informed care emphasizes physical, psychological and emotional safety for staff, families, and the residents
- [CDC/CMS Free Infection Preventionist Training Course](https://proactiveltcexperts.com/cdc-cms-free-infection-preventionist-training-course/) - Specialized Infection Prevention and Control Training for Nursing Home Staff On March 11, 2019, CMS announced that the Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available and can be accessed on CDC's TRAIN website (click here to visit). Effective November 28, 2019, Infection Preventionist Phase
- [Navigate the Requirements of Participation with Ease!](https://proactiveltcexperts.com/navigate-the-new-requirements-of-participation-with-ease/) - Let us ease the burden of interpretation and compliant implementation of the Final RoP, and help ensure that you are ready to meet the requirements with confidence. Proactive has a partnership plan to carry the burden of Phase 1-3 Requirements of Participation Readiness. Our experts guide RoP compliance readiness through remote review of existing facility
- [PDPM: Effective Systems and Coding of Section GG Recording Now Available!](https://proactiveltcexperts.com/pdpm-effective-systems-and-coding-of-section-gg-recording-now-available/) - This blog has been updated. Please visit the shop to download this recording. This 1.25 hour webinar focuses on effective systems for gathering data and documenting function to support coding decisions for the MDS 3.0 Section GG. The webinar includes a review of Section GG items used to determine PDPM function scores and how those
- [Time to Update Your Facility Assessment](https://proactiveltcexperts.com/time-to-update-your-facility-assessment/) - Pursuant to §483.70(e) (F838), each facility must conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies. The facility must review and update that assessment, as necessary, and at least annually. The assessment must be presented to surveyors during the annual
- [New! Draft Oct 2019 Item Sets](https://proactiveltcexperts.com/new-draft-oct-2019-item-sets/) - CMS has posted the draft version of the October 2019 MDS item sets which includes the draft Interim Payment Assessment. Draft item sets can be downloaded here. Need help with PDPM preparedness and training? Proactive can help! Click here fore more info!
- [CMS Releases Final Rule CY2019 Medicare Physician Fee Schedule](https://proactiveltcexperts.com/cms-releases-final-rule-cy2019-medicare-physician-fee-schedule/) - On November 1, CMS finalized proposals that impact payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019. CMS estimates that the conversation factor for CY2019 PFS will be $36.03 which is a slight increase from the CY 2019 PFS conversation factors
- [Emergency Preparedness](https://proactiveltcexperts.com/emergency-preparedness/) - Would you like an objective assessment of your Emergency Preparedness Plan? Health care providers and suppliers affected by the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers were required to comply and implement all regulations by November 15, 2017. Per CMS, the emergency preparedness requirements have a set of tags
- [Ask Proactive - Can you have an elopement event when the resident does not leave the facility, ex: found in the business office?](https://proactiveltcexperts.com/ask-proactive-can-you-have-an-elopement-event-when-the-resident-does-not-leave-the-facility-ex-found-in-the-business-office/) - Q: Can you have an elopement event when the resident does not leave the facility, ex: found in the business office? A: Yes, this situation could be considered an elopement. Per CMS, “A situation in which a resident leaves the premises or a safe area without the facility’s knowledge and supervision, if necessary,
- [Five Star Improvement Check Up for the MDS Department](https://proactiveltcexperts.com/five-star-improvement-check-up-for-the-mds-department/) - Providers focused on Five Star improvement often look to the MDS department as a driver of Five Star performance. Let’s examine the potential impact of the MDS on facility star ratings and consider key focus areas for coding accuracy… Before jumping to the conclusion that MDS is the root cause of five star trouble, first
- [Ask Proactive - How are A1005: Ethnicity, and A1010: Race supposed to be coded on an unplanned Discharge Assessment or Death in Facility Tracking Record?](https://proactiveltcexperts.com/ask-proactive-how-are-a1005-ethnicity-and-a1010-race-supposed-to-be-coded-on-an-unplanned-discharge-assessment-or-death-in-facility-tracking-record/) - Q: How are A1005: Ethnicity, and A1010: Race supposed to be coded on an unplanned Discharge Assessment or Death in Facility Tracking Record? A: As these are direct resident interview items the obvious concern is that the resident may not be asked in the instance of an unplanned discharge and certainly cannot respond
- [Ask Proactive - I pulled the Q4 2023 Facility Level Quality Measure report for my facility in January and noticed several measures are displayed as “I” for incomplete. Can you please explain why these measure calculations are shown as incomplete on my report?](https://proactiveltcexperts.com/ask-proactive-i-pulled-the-q4-2023-facility-level-quality-measure-report-for-my-facility-in-january-and-noticed-several-measures-are-displayed-as-i-for-incomplete-can-you-please-e/) - Q: I pulled the Q4 2023 Facility Level Quality Measure report for my facility in January and noticed several measures are displayed as “I” for incomplete including the following: Percent of Residents Whose Ability to Walk Independently Worsened Percent of Residents Whose Need for Help with Activities of Daily Living Has Increased Percent of Residents
- [DON’s New Year’s Resolution List](https://proactiveltcexperts.com/dons-new-years-resolution-list/) - With 2024 underway, it’s time to focus on what we would like to accomplish in the next 350 days remaining in the year. If you haven’t already created one, consider these goals for your DON New Year’s Resolution list. Be Survey ready 365 days a year. This is not as difficult to achieve as
- [Ask Proactive - I heard we don’t have to code urinary tract infection (UTI) in section I if it doesn’t meet the McGeers requirement, but my  director of nursing is telling me I do have to code it. Can you clarify?](https://proactiveltcexperts.com/ask-proactive-i-heard-we-dont-have-to-code-urinary-tract-infection-uti-in-section-i-if-it-doesnt-meet-the-mcgeers-requirement-but-my-director-of-nursing-is-telling-me-i-do-have/) - Q: I heard we don’t have to code urinary tract infection (UTI) in section I if it doesn’t meet the McGeers requirement, but my DON is telling me I do have to code it. Can you clarify? A: Urinary Tract Infections that do not meet evidence-based criteria such as McGeer, NHSN, or Loeb
- [Charting the Future: Top 10 Questions When Considering EHR Software Change](https://proactiveltcexperts.com/charting-the-future-top-10-questions-when-considering-ehr-software-change/) - In the ever-evolving landscape of healthcare, nursing facility providers are recognizing the significance of transitioning to advanced Electronic Health Record (EHR) software. This shift is driven by the need for streamlined operations, improved resident care, and enhanced compliance with industry standards. As nursing facility providers embark on the journey of changing their EHR software, it
- [Ask Proactive - After completing my baseline care plan, what should I include in my summary to be provided to the resident/representative?](https://proactiveltcexperts.com/ask-proactive-after-completing-my-baseline-care-plan-what-should-i-include-in-my-summary-to-be-provided-to-the-resident-representative/) - Q: After completing my baseline care plan, what should I include in my summary to be provided to the resident/representative? A: The facility must provide residents and their representatives, if applicable, with a written summary of the baseline care plan prior to the completion of the comprehensive care plan. This summary must include
- [Navigating Immediate Jeopardy: Top Citations in FY2023 for Nursing Facilities](https://proactiveltcexperts.com/navigating-immediate-jeopardy-top-citations-in-fy2023-for-nursing-facilities/) - Understanding Immediate Jeopardy Citations is crucial for ensuring the quality and safety of nursing facility environments. In Fiscal Year 2023, several citations took the spotlight, shedding light on areas demanding careful attention in the year ahead. Let's review the top five Immediate Jeopardy Citations and explore strategies for maintaining ongoing compliance. Immediate Jeopardy Citations signify
- [Proactive’s Top 10 Blogs of 2023](https://proactiveltcexperts.com/proactives-top-10-blogs-of-2023/) - As we close out 2023, let’s highlight the top ten most read articles from the past year covering topics that range from common MDS coding errors, avoiding deficiencies in Food and Nutrition Services, Medical Review risks, all the way to Care and Maintenance of the Maintenance Department… 10/1 Update to the Coding of Parkinson's Disease
- [MDS Changes Coming In 2024—What to Expect!](https://proactiveltcexperts.com/mds-changes-coming-in-2024-what-to-expect/) - During the December SNF Open Door Forum call, CMS announced their plan to release the MDS 1.19.1, which will be effective October 1, 2024. CMS has indicated the revisions will be minor and impact primarily the following 3 areas of the MDS: Section GG: Self-care and Mobility The removal for the discharge goal column from
- [Ask Proactive - Do the physicians have up to 30 days to see new admissions?](https://proactiveltcexperts.com/ask-proactive-do-the-physicians-have-up-to-30-days-to-see-new-admissions/) - Q: Do the physicians have up to 30 days to see new admissions? A: Yes, per guidance at §483.30(c) (F712) "In a SNF, the first physician visit (this includes the initial comprehensive visit) must be conducted within the first 30 days after admission, and then at 30 day intervals up until 90 days
- [Ask Proactive - How often do Advance Directives need to be reviewed?](https://proactiveltcexperts.com/ask-proactive-how-often-do-advance-directives-need-to-be-reviewed/) - Q: How often do Advance Directives need to be reviewed? A: It is considered best practice to review the resident’s Advance Directives with the resident and resident representative upon admission, in each Care Plan meeting, and with any significant change in the resident’s status. This will ensure that the facility team and resident/representative
- [The Vital Role of Supportive Documentation in Nursing Homes in Ensuring Quality Care and Compliance](https://proactiveltcexperts.com/the-vital-role-of-supportive-documentation-in-nursing-homes-in-ensuring-quality-care-and-compliance/) - Supportive documentation is the backbone of effective communication, quality care delivery, and regulatory compliance within nursing homes. In this blog, we'll delve into the significant aspects of effective charting and the requirements that must be met to ensure both resident well-being and legal compliance. The Significance of Supportive Documentation: Enhanced Communication and Continuity of Care:
- [10 Tips for Enhancing Customer Service in Nursing Homes](https://proactiveltcexperts.com/10-tips-for-enhancing-customer-service-in-nursing-homes/) - Excellent customer service is crucial in nursing homes where residents and their families entrust their care to the facility staff. Ensuring a positive and compassionate experience significantly impacts quality of care and contributes to the well-being of residents. Consumers’ perception of the care experience may be posted on social media –with potentially positive (or negative)
- [Ask Proactive - Immediate Jeopardy cited –now what?](https://proactiveltcexperts.com/ask-proactive-immediate-jeopardy-cited-now-what/) - Q: Immediate Jeopardy cited – now what? A: When a skilled nursing facility is cited with immediate jeopardy, it means that the facility is in violation of regulations to an extent that it poses a serious threat to the health and safety of its residents. Immediate jeopardy is a serious situation that requires
- [Ask Proactive - We are questioning the MDS/Care planning meeting schedule. When adding an extra OBRA to capture rehab or other clinical conditions for Case Mix, do we need a care plan review even though we may have had one recently?](https://proactiveltcexperts.com/ask-proactive-we-are-questioning-the-mds-care-planning-meeting-schedule-when-adding-an-extra-obra-to-capture-rehab-or-other-clinical-conditions-for-case-mix-do-we-need-a-care-plan-review-even-thou/) - Q: We are questioning the MDS/Care planning meeting schedule. When adding an extra OBRA to capture rehab or other clinical conditions for Case Mix, do we need a care plan review even though we may have had one recently? A: Per the State operations manual, F657. Pg 245 the requirement is for the
- [Long-Term Care Federal Monitoring Surveys](https://proactiveltcexperts.com/long-term-care-federal-monitoring-surveys/) - On November 20, 2023, CMS released Guidance for Federal Monitoring Surveys (FMS) which identifies the FY2024 and FY2025 focus concerns and guidance on how CMS staff will conduct FMS and communicates estimated FY2024-FY2025 required number of long-term care (LTC) FMS and Life Safety Code (LSC)/Emergency Preparedness (EP) surveys. CMS is required to conduct FMS of
- [SNF Meetings– UR & Triple Check Essentials](https://proactiveltcexperts.com/snf-meetings-ur-triple-check-essentials/) - SNF Meetings– UR & Triple Check Essentials According to a recent Agency Financial Report released by the Department of Health and Human Services (HHS), the primary reasons for SNF payment error include (1) missing or insufficient documentation to support the skilled coverage criteria requirements and (2) missing or insufficient documentation to support the required component(s)
- [Ask Proactive - For PBJ, where do we allocate NP hours?](https://proactiveltcexperts.com/ask-proactive-for-pbj-where-do-we-allocate-np-hours/) - Q: For PBJ, where do we allocate NP hours? A: If performing MD delegated duties report Job code 13 (see definitions below) Per the PBJ manual, Job Code 7 Registered Nurse hours include: Those persons licensed to practice as registered nurses in the State where the facility is located. Includes geriatric nurse practitioners
- [Ask Proactive - We have a resident who receives Haldol decanoate injections every 3 weeks. How is this coded in section N of the MDS?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-who-receives-haldol-decanoate-injections-every-3-weeks-how-is-this-coded-in-section-n-of-the-mds/) - Q: We have a resident who receives Haldol decanoate injections every 3 weeks. How is this coded in section N of the MDS? A: Haldol decanoate is a long-acting antipsychotic medication and the MDS 3.0 RAI User Manual provide the following guidance related to coding high risk medications in section N0415: Count long-acting
- [F565: Implementing Resident and Family Councils](https://proactiveltcexperts.com/f565-implementing-resident-and-family-councils/) - While residents and families are not required to organize a resident or family group in their facility, the F 565 regulation does stipulate the obligations of the facility when residents/families choose to exercise this right. F565 states “The resident has a right to organize and participate in resident groups in the facililty”. This can be
- [Ask Proactive - How will the 10/1/23 changes to the MDS impact the 5-Star Quality Measure rating for nursing facilities?](https://proactiveltcexperts.com/ask-proactive-how-will-the-10-1-23-changes-to-the-mds-impact-the-5-star-quality-measure-rating-for-nursing-facilities/) - Q: How will the 10/1/23 changes to the MDS impact the 5-Star Quality Measure rating for nursing facilities? A: On 9/20/23, CMS issued QSO-23-21-NH, which announced that CMS will replace some of the Quality Measures (QMs) used on Nursing Home Care Compare, in order to accommodate the elimination of Section G in the
- [10/1 Update to the Coding of Parkinson’s Disease](https://proactiveltcexperts.com/10-1-update-to-the-coding-of-parkinsons-disease/) - As of October 1, 2023, the code G20 is now obsolete and will likely reject on any billing to Medicaid, Medicare, or insurance companies. Prior to your November billing, you will want to update to the appropriate new codes to avoid delayed billing processes. This diagnosis is quite important to be accurately coded for PDPM
- [Outside the Box Staffing: Remote MDS](https://proactiveltcexperts.com/outside-the-box-staffing-remote-mds/) - On any given day, there are more than 1500 open MDS positions across the United States. With MDS staff feeling the ongoing pressure of staffing shortages, combined with the added stress of the October 1st MDS changes, many facilities are at significant risk of MDS turnover. With the Patient Driven Payment Model, Case Mix reimbursement, and
- [Ask Proactive - What do I need to know about the changes to Depression Screening in MDS Section D that were effective October 1, 2023?](https://proactiveltcexperts.com/ask-proactive-what-do-i-need-to-know-about-the-changes-to-depressions-screening-in-mds-section-d-that-were-effective-october-1-2023/) - Q: What do I need to know about the changes to Depression Screening in MDS Section D that were effective October 1, 2023? A: MDS Section D, “Resident Mood Interview,” which captures depression screening, changed from the full PHQ-9 (which includes 9 questions) to the PHQ-2 (which asks 2 initial questions). Based on
- [LTC Best Practices: F770-779 Labs & Other Diagnostic Services](https://proactiveltcexperts.com/ltc-best-practices-f770-779-labs-other-diagnostic-services/) - Consistent adherence to nursing home regulations is crucial for ensuring resident safety and well-being. In this blog, we overview of CMS Nursing Home Regulations F770-779, which cover laboratory and diagnostic services. We'll delve into the key compliance elements and share best practices to help you excel in this area. Overview of the Regulations F770 Laboratory
- [IQIES and CASPER Reports](https://proactiveltcexperts.com/iqies-and-casper-reports/) - Earlier this year CMS transitioned from QIES to IQIES for MDS submission and CASPER reporting access. This transition left some MDS coordinators confused about how to access reports that were previously made available through QIES. Available report types for each user are determined by the IQIES role assigned to the individual users. Permissions are determined
- [Ask Proactive - What can a Director of Nursing (DON) do to ensure an effective antibiotic stewardship program is in place?](https://proactiveltcexperts.com/ask-proactive-what-can-a-director-of-nursing-don-do-to-ensure-an-effective-antibiotic-stewardship-program-is-in-place/) - Q: What can a Director of Nursing (DON) do to ensure an effective antibiotic stewardship program is in place? A: The DON plays a significant role in establishing and maintaining an effective antibiotic stewardship program. Here are key strategies the DON can implement to ensure the success of such a program: Leadership Commitment:
- [Navigating Nursing Home Survey Trends Into the New Fiscal Year](https://proactiveltcexperts.com/navigating-nursing-home-survey-trends-into-the-new-fiscal-year/) - As a new fiscal year begins, it's the perfect time to dive into survey trends we've witnessed across the nation in the past year. These these trends can serve as a guide to preparations for upcoming surveys. For those eagerly awaiting the survey team's arrival, these insights will help you steer the ship through the
- [Ask Proactive - How can I ensure my care plan meetings are meeting the needs of the resident, responsible party and the IDT while being efficient and mindful of everyone’s time?](https://proactiveltcexperts.com/ask-proactive-how-can-i-ensure-my-care-plan-meetings-are-meeting-the-needs-of-the-resident-responsible-party-and-the-idt-while-being-efficient-and-mindful-of-everyones-time/) - Q: How can I ensure my care plan meetings are meeting the needs of the resident, responsible party and the IDT while being efficient and mindful of everyone’s time? A: Care planning is a critical aspect of patient-centered care and plays a pivotal role in ensuring that the healthcare needs and preferences of
- [Drug Regimen Review: Ensuring Medication Safety and SPADES Compliance](https://proactiveltcexperts.com/drug-regimen-review-ensuring-medication-safety-and-spades-compliance/) - In the complex landscape of geriatric healthcare, medication errors can significantly impact LTC resident health, safety and quality of life. Unfortunately, potential and actual adverse consequences related to medications are prevalent, often occurring during transitions in care. These adverse consequences can result in serious harm or even death, emergency department visits, and rehospitalizations. One vital
- [Ask Proactive - It has been 3 years since our facility’s last annual survey. What are the top Life Safety K tags that are being cited?](https://proactiveltcexperts.com/ask-proactive-it-has-been-3-years-since-our-facilitys-last-annual-survey-what-are-the-top-life-safety-k-tags-that-are-being-cited/) - Q: It has been 3 years since our facility’s last annual survey. What are the top Life Safety K tags that are being cited? A: The top 5 Life Safety K tags have been fairly consistent over the last few years and have primarily just changed in their ranking number. These include: K035
- [Ask Proactive - What is the best practice for Section GG documentation?](https://proactiveltcexperts.com/ask-proactive-what-is-the-best-practice-for-section-gg-documentation/) - Q: What is the best practice for Section GG documentation? A: As with most processes, the provider must determine the process that is most suitable for their facility policy, while also adhering to Federal and State requirements. According to a CMS FAQ Document, CMS does not impose specific documentation procedures, but that qualified
- [Caution! MDS Bumps in the Road with 10/1 Transition](https://proactiveltcexperts.com/caution-mds-bumps-in-the-road-with-10-1-transition/) - With the implementation of the MDS 3.0 v1.18.11 this past Sunday, October 1st, it may not be surprising that there have been a few bumps in the road. Software vendors continue to work diligently to address issues, but here are some transitional potholes that you may want to watch out for: PointClickCare (PCC): PCC is
- [Proactive LTC Consulting Strengthens Services Through Merger with Leading Transitions](https://proactiveltcexperts.com/proactive-ltc-consulting-strengthens-services-through-merger-with-leading-transitions/) - 10/3/2023 Proactive LTC Consulting Amie Martin 812-471-7777 info@proactiveltcexperts.com proactiveltcexperts.com FOR IMMEDIATE RELEASE PROACTIVE LTC CONSULTING STRENGTHENS SERVICES THROUGH MERGER WITH LEADING TRANSITIONS Evansville, IN – Proactive LTC Consulting (Proactive), a leading provider of nursing home support services, is proud to announce a merger with Leading Transitions Post Acute Care Consultation & Staffing (LTPAC). The
- [Compliance Rounding for Survey Readiness](https://proactiveltcexperts.com/compliance-rounding-for-survey-readiness/) - Is your facility survey ready? According to CASPER (9/17/23), nearly 12% of the nation’s LTC facilities have not had a recertification survey in over 24 months. The states with the highest percentages include: Kentucky – 76.3% Maryland – 73.3% Idaho – 67.9% Alabama – 55.1% Tennessee – 38.5% Nursing homes typically use the results of
- [Ask Proactive - When can I schedule MDS assessments that will have an ARD of 10/1 or after? The look-back period begins this week.](https://proactiveltcexperts.com/ask-proactive-when-can-i-schedule-mds-assessments-that-will-have-an-ard-of-10-1-or-after-the-look-back-period-begins-this-week/) - Q: When can I schedule MDS assessments that will have an ARD of 10/1 or after? The look-back period begins this week. A: This will depend on your software vendor who should let you know when the update has been made and when it is allowable to open assessments with an ARD in
- [Ask Proactive - How should you sanitize a glucometer when used for different residents?](https://proactiveltcexperts.com/ask-proactive-how-should-you-sanitize-a-glucometer-when-used-for-different-residents/) - Q: How should you sanitize a glucometer when used for different residents? A: To prevent the spread of pathogens among residents and to avoid a possible F880 citation, it’s vital to clean the glucometers both before and after each resident’s use. Blood glucose meters can become contaminated with blood and, if used for
- [Improving Resident Care & Reimbursement: The Role of the PHQ-2 TO 9© in Nursing Homes Under PDPM](https://proactiveltcexperts.com/improving-resident-care-reimbursement-the-role-of-the-phq-2-to-9-in-nursing-homes-under-pdpm/) - In the dynamic world of nursing home care, ensuring the well-being of residents while managing financial stability is a constant challenge. Today, we'll explore a valuable tool in this endeavor – the PHQ-2 TO 9© – and its pivotal role in both delivering quality care and influencing reimbursement under the Patient-Driven Payment Model (PDPM). Understanding
- [SNF Certification/Recertification Compliance Check Up](https://proactiveltcexperts.com/snf-certification-recertification-compliance-check-up/) - MACs have begun rolling out the mandated 5-Claim Probe and Educate audit and will eventually review claims for every eligible SNF in their jurisdiction. SNF certifications and recertifications are important elements of SNF Medicare stay compliance and will be considered as part of this review. In this blog, we'll delve into the essential aspects of
- [Ask Proactive - How long does the physician have to see new admissions?](https://proactiveltcexperts.com/ask-proactive-how-long-does-the-physician-have-to-see-new-admissions/) - Q: How long does the physician have to see new admissions? A: Per guidance at §483.30(c) (F712) "In a SNF, the first physician visit (this includes the initial comprehensive visit) must be conducted within the first 30 days after admission, and then at 30 day intervals up until 90 days after the admission
- [Ask Proactive - My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating?](https://proactiveltcexperts.com/ask-proactive-my-facility-has-been-selected-for-a-schizophrenia-audit-by-cms-how-will-be-results-of-this-audit-impact-our-facilitys-five-star-rating/) - Q: My facility has been selected for a Schizophrenia Audit by CMS. How will the results of this audit impact our facility’s Five Star rating? A: Inaccuracies identified through these audits impact QM ratings as follows: The overall QM and long-stay QM ratings are downgraded to one star for six months, which will
- [Proposed Minimum Staffing Standards for LTC Facilities – What You Need to Know](https://proactiveltcexperts.com/proposed-minimum-staffing-standards-for-ltc-facilities-what-you-need-to-know/) - The Centers for Medicare & Medicaid Services (CMS) issued the long-awaited Proposed Minimum Staffing Rule on 9/1/23 with the stated objective of seeking “to establish comprehensive nurse staffing requirements to hold nursing homes accountable for providing safe and high-quality care for the over 1.2 million residents receiving care in Medicare and Medicaid certified facilities each
- [Ask Proactive - We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission assessment, he indicated that he did not want to be resuscitated in the event of cardiac/respiratory arrest. Would staff still be required to perform CPR since there is no signed Advance Directive and Physician’s Order?](https://proactiveltcexperts.com/ask-proactive-we-had-a-resident-admit-over-the-weekend-he-is-his-own-responsible-party-his-admission-packet-had-only-been-partially-completed-he-did-not-have-an-advanced-directive-or-physician/) - Q: We had a resident admit over the weekend. He is his own responsible party. His admission packet had only been partially completed. He did not have an advanced directive or physician’s order indicating code status order. While completing the nursing admission assessment, he indicated that he did not want to be resuscitated in the
- [Meaningful Meetings in LTC](https://proactiveltcexperts.com/meaningful-meetings-in-ltc/) - How much of your time is spent in meetings? Depending on your role, time in meetings may take more time than any other task or responsibility you have. Do you sometimes wonder if all these meetings are even necessary (“Could this have been an email?”) Days are busy and staffing shortages contribute to the feeling
- [Missing the Boat Under Patient Driven Payment Model (PDPM)](https://proactiveltcexperts.com/missing-the-boat-under-patient-driven-payment-model-pdpm/) - PDPM has been in place for nearly four years, and with it came the shift from payment based on resource utilization to payment driven by patient characteristics and service provision. PDPM presents with many nuances and complexities that open the door to sinking reimbursement when systems for thorough and vigilant clinical review and data collection
- [Ask Proactive - While it is the resident’s right to refuse care, what are the responsibilities of the facility when this occurs?](https://proactiveltcexperts.com/while-it-is-the-residents-right-to-refuse-care-what-are-the-responsibilities-of-the-facility-when-this-occurs/) - Q: While it is the resident’s right to refuse care, what are the responsibilities of the facility when this occurs? A: As we see in the Federal Regulatory Grouping §483.10 Resident Rights, the resident absolutely has the right to refuse care. This is specified in §483.10(c)(6) The right to request, refuse, and/or discontinue treatment,
- [Infection Preventionist Essentials: Multidrug-Resistant Organisms in Nursing Homes](https://proactiveltcexperts.com/infection-preventionist-essentials-multidrug-resistant-organisms-in-nursing-homes/) - As nursing home professionals, you play a crucial role in caring for vulnerable residents and maintaining a safe and healthy environment. One of the most pressing challenges faced by healthcare facilities is the emergence and spread of multidrug-resistant organisms (MDROs). In this article, we will explore the essentials of infection prevention in nursing homes, focusing
- [Ask Proactive - What are some tips to determine if the completion of the optional Interim Payment Assessment (IPA) is appropriate to impact reimbursement?](https://proactiveltcexperts.com/ask-proactive-what-are-some-tips-to-determine-if-the-completion-of-the-optional-interim-payment-assessment-ipa-is-appropriate-to-impact-reimbursement/) - Q: What are some tips to determine if the completion of the optional Interim Payment Assessment (IPA) is appropriate to impact reimbursement? A: The IPA may be completed when a Medicare Part A beneficiary’s condition and/or the care and services provided change such that the current rate of reimbursement is lower than the rate
- [Ask Proactive - My facility is going through a Medicare UPIC review and received a significant number of denials followed by a demand letter requiring repayment. What are our options for appealing the decision and what is the interest rate that will apply if we aren’t able to immediately issue repayment?](https://proactiveltcexperts.com/ask-proactive-my-facility-is-going-through-a-medicare-upic-review-and-received-a-significant-number-of-denials-followed-by-a-demand-letter-requiring-repayment-what-are-our-options-for-appealing-the/) - Q: My facility is going through a Medicare UPIC review and received a significant number of denials followed by a demand letter requiring repayment. What are our options for appealing the decision and what is the interest rate that will apply if we aren’t able to immediately issue repayment? A: When there is an
- [QM Insights - Long Stay Weight Loss](https://proactiveltcexperts.com/qm-insights-long-stay-weight-loss/) - There are 3 primary facets to the effective management of the quality measure (QM) Percentage of Long Stay Residents Who Lose too Much Weight: 1. Understanding the ins and outs of the QM calculation2. Ensuring Correct MDS Coding of Weight and Weight Loss 3. Preventing Weight Loss in the Nursing Home Setting Understanding the Quality
- [Role of the HIPAA Privacy Officer in LTC](https://proactiveltcexperts.com/role-of-the-hipaa-privacy-officer-in-ltc/) - HIPAA (Health Insurance Portability and Accountability Act) plays a critical role in nursing homes by ensuring the protection and privacy of resident’s sensitive medical information. Nursing homes handle vast amounts of personal health data daily including medical records, treatment plans, and medication delivery records. HIPAA regulations mandate strict guidelines for how this information is collected,
- [Ask Proactive - Do you anticipate significant changes in capturing depression end-splits for the nursing CMGs with the October 1st change to PHQ-2 to 9 from PHQ-9?](https://proactiveltcexperts.com/ask-proactive-do-you-anticipate-significant-changes-in-capturing-depression-end-splits-for-the-nursing-cmgs-with-the-october-1st-change-to-phq-2-to-9-from-phq-9/) - Q: Do you anticipate significant changes in capturing depression end-splits for the nursing CMGs with the October 1st change to PHQ-2 to 9 from PHQ-9? A: You’re not alone in contemplating the impact of the coming changes to capturing the depression end-splits; this is certainly a concern for many providers. As you know, if
- [Enhancing Medication Error Prevention: Beyond the "6 Rights"](https://proactiveltcexperts.com/medication-error-prevention-more-than-just-the-6-rights/) - Medication administration staff are well-versed in the "6 Rights" of accurate medication administration: Right Resident Right Medication Right Dose Right Route Right Time Right Documentation While these "6 Rights" form the foundation of safe medication practices, it is essential to implement additional strategies to ensure the correct and safe administration of resident medications. By incorporating
- [Ask Proactive - Should facilities include MDS and nurse supervisors in the daily nurse staffing data that we are required to post?](https://proactiveltcexperts.com/ask-proactive-should-facilities-include-mds-and-nurse-supervisors-in-the-daily-nurse-staffing-data-that-we-are-required-to-post/) - Q: Should facilities include MDS and nurse supervisors in the daily nurse staffing data that we are required to post? A: The requirement for posting staffing information at F732, is for hours worked by licensed and unlicensed nursing staff directly responsible for resident care, so this does not include administrative nurses who do not
- [Action Plan for Oct. 1st MDS Changes](https://proactiveltcexperts.com/action-plan-for-oct-1st-mds-changes/) - The October 1st effective date of the revised MDS 3.0 item set (v1.18.11) is fast approaching. This updated version of the MDS brings with it many significant changes. The implications of these changes affect not just the completion of the MDS, but also will have a significant impact on the facility assessment and documentation practices,
- [Ask Proactive - How do you code a Kennedy ulcer in Section M of the MDS?](https://proactiveltcexperts.com/ask-proactive-how-do-you-code-a-kennedy-ulcer-in-section-m-of-the-mds/) - Q: How do you code a Kennedy ulcer in Section M of the MDS? A: A Kennedy terminal ulcer is not a pressure ulcer. It is believed to be caused by end-of-life organ failure, with skin being the largest organ of the human body. This does not meet any of the skin conditions listed
- [Care Area Assessments – What’s Changing in October?](https://proactiveltcexperts.com/care-area-assessments-whats-changing-in-october/) - The Care Area Assessment (CAA) process is one of three components of the Resident Assessment Instrument (RAI). Another component, the MDS, identifies actual or potential areas of concern, and the remainder of the RAI process supports efforts to further assess Care Area Triggers (CATs) in order to identify whether the findings represent a problem or
- [Ask Proactive - In the past, when there have been significant updates/revisions to the RAI Manual, there has been changeover in the MDS Staff in our facility. How do you recommend that we prepare should this occur again?](https://proactiveltcexperts.com/ask-proactive-in-the-past-when-there-have-been-significant-updates-revisions-to-the-rai-manual-there-has-been-changeover-in-the-mds-staff-in-our-facility-how-do-you-recommend-that-we-prepare-shou/) - Q: In the past, when there have been significant updates/revisions to the RAI Manual, there has been changeover in the MDS Staff in our facility. How do you recommend that we prepare should this occur again? A: While expecting change doesn’t make it any easier, it can inspire us to stay prepared for changes
- [Ask Proactive - How will the removal of section G affect my everyday workflow?](https://proactiveltcexperts.com/ask-proactive-how-will-the-removal-of-section-g-affect-my-everyday-workflow/) - Q: How will the removal of section G affect my everyday workflow? A: Section G has been removed from the federally required MDS item sets effective October 1, 2023. However, some states will continue to use section G information to complete an Optional State Assessment (OSA) and a few of the section G data
- [F740 Elements of an Effective Behavior Management Program for Nursing Facilities](https://proactiveltcexperts.com/f740-elements-of-an-effective-behavior-management-program-for-nursing-facilities/) - Elements of an Effective Behavior Management Program for Nursing Facilities Behavior management plays a crucial role in maintaining a safe and supportive environment for residents in nursing facilities. It involves strategies and interventions aimed at understanding and addressing challenging behaviors exhibited by older adults with cognitive impairments or mental health conditions. An effective behavior management
- [Care and Maintenance of the Maintenance Department](https://proactiveltcexperts.com/care-and-maintenance-of-the-maintenance-department/) - Maintenance Department staff are the spark plugs and oil of the facility engine. Without an operational physical plant and working equipment, the facility could not “drive” quality in all other departments. How effectively are you ensuring proper Care and Maintenance of the Maintenance Department? Consider these opportunities for keeping the Maintenance Department engine fired up
- [Update on SNF 5 Claim Probe Audit Initiated June 5th 2023](https://proactiveltcexperts.com/update-on-snf-5-claim-probe-audit-initiated-june-5th-2023/) - A new CMS web page is now available devoted to the SNF 5-Claim Probe and Educate audit initiated June 5, 2023 as part of the effort to lower the SNF payment error rate. The webpage includes additional information and FAQs on what to expect as the review has gotten underway in June and will affect
- [Ask Proactive - What medications should be considered for review as part of a gradual dose reduction program?](https://proactiveltcexperts.com/ask-proactive-what-medications-should-be-considered-for-review-as-part-of-a-gradual-dose-reduction-program/) - Q: What medications should be considered for review as part of a gradual dose reduction program? A: Gradual dose reduction (GDR) is a method used to reduce the dosage of a specific medication while closely monitoring the resident’s progress and potentially incorporating alternative intervention strategies. Phase 2 of the Requirements of Participation (ROPs), which
- [Understanding PDPM Group Therapy Changes and FREE Group Therapy Tip Sheet](https://proactiveltcexperts.com/understanding-pdpm-group-therapy-changes-and-free-group-therapy-tip-sheet/) - Greater flexibility is good news for SNFs Beginning 10/1, up to 25% of therapy may be provided as group and/or concurrent treatment per discipline. Greater flexibility in how care and services may be delivered to Medicare patients is good news for SNFs, but keep in mind that the 25% group/concurrent treatment is a ceiling and
- [Insights into Compliance: F712 Physician Services and Frequency of LTC/SNF Physician Visits](https://proactiveltcexperts.com/insights-into-compliance-f712-physician-services-and-frequency-of-ltc-snf-physician-visits/) - Physicians play a crucial role in supervising the care of residents in nursing facilities. Physician visits should be thorough and comprehensive, encompassing an evaluation of the resident’s condition, review of medications and treatments, and a review of the plan of care-- directing any necessary adjustments to ensure optimal management of residents’ health care. Review of
- [Ask Proactive - The new MDS data element A2123 asks about the Provision of Current Reconciled Medication List to the Resident at Discharge. How is the current reconciled medication list defined and what information should be included?](https://proactiveltcexperts.com/ask-proactive-the-new-mds-data-element-a2123-asks-about-the-provision-of-current-reconciled-medication-list-to-the-resident-at-discharge-how-is-the-current-reconciled-medication-list-defined-and-wh/) - Q: The new MDS data element A2123 asks about the Provision of Current Reconciled Medication List to the Resident at Discharge. How is the current reconciled medication list defined and what information should be included? A: This data element is one of the new Standardized Patient Assessment Data Elements (SPADEs) on the MDS effective
- [Restoring Restorative Nursing Programs—the Why, What and How of Restorative Success](https://proactiveltcexperts.com/restoring-restorative-nursing-programs-the-why-what-and-how-of-restorative-success/) - Dedication to robust restorative nursing programming will bring countless benefits to your residents, as well as improved facility outcomes. Designed to achieve and maintain optimal physical, mental, and psychosocial functioning, restorative nursing programs are central to health-related quality of life. Unfortunately, restorative nursing is often underutilized due to obstacles providers face in staffing and effectively
- [Ask Proactive - Do we need a discharge goal for every item in section GG?](https://proactiveltcexperts.com/ask-proactive-do-we-need-a-discharge-goal-for-every-item-in-section-gg/) - Q: Do we need a discharge goal for every item in section GG? A: For the SNF Quality Reporting Program (QRP), a minimum of one self-care or mobility discharge goal must be coded. However, facilities may choose to complete more than one self-care or mobility discharge goal(s). Identifying multiple goals helps to ensure that
- [Insights into Compliance: F684 Quality of Care Requirements and End of Life/Hospice Care](https://proactiveltcexperts.com/insights-into-compliance-f684-quality-of-care-requirements-and-end-of-life-hospice-care/) - Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents’ choices. The Intent of
- [Ask Proactive - My facility was just put on the Special Focus Facility (SFF) candidate list. Why were we selected and what should we expect?](https://proactiveltcexperts.com/ask-proactive-my-facility-was-just-put-on-the-special-focus-facility-sff-candidate-list-why-were-we-selected-and-what-should-we-expect/) - Q: My facility was just put on the Special Focus Facility (SFF) candidate list. Why were we selected and what should we expect? A: Candidacy for the SFF program is determined by performance on standard health and complaint surveys in the previous 3 years. CMS issues a list of SFF candidates monthly. In the
- [Ask Proactive - There is a resident in our facility that has frequent falls, and we are out of ideas for interventions. How can we update the care plan if we do not know what new interventions to add?](https://proactiveltcexperts.com/ask-proactive-are-nursing-facilities-who-do-not-accept-medicaid-as-a-payer-source-required-to-provide-residents-with-the-state-developed-notice-of-medicaid-rights-and-obligations-that-is-required-2/) - Q: There is a resident in our facility that has frequent falls, and we are out of ideas for interventions. How can we update the care plan if we do not know what new interventions to add? A: The first step to take after a fall occurs is completion of a thorough root cause
- [Big Changes Coming to the MDS 10/1—What You Need to Do Now](https://proactiveltcexperts.com/big-changes-coming-to-the-mds-10-1-what-you-need-to-do-now/) - You’ve likely heard that significant changes are coming to the MDS in October 2023. Here’s what you need to know in a nutshell and our recommended action steps to be prepared. An updated version of the MDS 3.0 (version 1.18.11) will be implemented effective October 1, 2023, and the changes are some of the most
- [Every SNF to Undergo 5 Claim Medicare Audit Starting June 5th](https://proactiveltcexperts.com/cms-mandated-all-snf-5-claim-review-probe-and-educate-starting-next-month/) - On May 4th, CMS issued Transmittal 12015 instructing MACs to perform a 5 claim probe and educate medical review on every SNF in their jurisdiction. A 15.1% SNF error rate in 2022 based on the Comprehensive Error Rate Testing (CERT) program is the catalyst for this action (see 2022 Improper Payment Data). SNFs had the
- [Ask Proactive - Our facility is being purchased by a new company. Does this affect the current patient’s MDS assessments and schedules? If so, how?](https://proactiveltcexperts.com/ask-proactive-our-facility-is-being-purchased-by-a-new-company-does-this-affect-the-current-patients-mds-assessments-and-schedules-if-so-how/) - Q: Our facility is being purchased by a new company. Does this affect the current patient’s MDS assessments and schedules? If so, how? A: If the CCN (CMS Certification Number) changes, then yes. Per RAI Chapter 2, pg. 2-5: There are two types of change in ownership (CHOW) transactions: The more common situation requires
- [Ask Proactive - Are nursing facilities, who do not accept Medicaid as a payer source, required to provide residents with the State-developed notice of Medicaid rights and obligations that is required at F572 (§483.10(g)(16))?](https://proactiveltcexperts.com/ask-proactive-are-nursing-facilities-who-do-not-accept-medicaid-as-a-payer-source-required-to-provide-residents-with-the-state-developed-notice-of-medicaid-rights-and-obligations-that-is-required/) - Q: Are nursing facilities, who do not accept Medicaid as a payer source, required to provide residents with the State-developed notice of Medicaid rights and obligations that is required at F572 (§483.10(g)(16))? A: Yes, All nursing facilities that are Medicaid and/or Medicare certified are required to provide residents with a notice of Medicaid rights.
- [Housekeeping Essentials in LTC](https://proactiveltcexperts.com/housekeeping-essentials-in-ltc/) - Has anyone heard the phrase, “smells like a nursing home”? Unfortunately, along with the microorganisms that cause unpleasant odors potentially dangerous virus, bacteria and mold may be present with the potential to cause the vulnerable nursing home resident population illness or much worse. Housekeeping is an essential part of maintaining a clean, safe, comfortable environment
- [Ask Proactive - Now that the COVID-19 Public Health Emergency (PHE) has ended, what Infection Control precautions are facilities required to follow?](https://proactiveltcexperts.com/ask-proactive-now-that-the-covid-19-public-health-emergency-phe-has-ended-what-infection-control-precautions-are-facilities-required-to-follow/) - Q: Now that the COVID-19 Public Health Emergency (PHE) has ended, what Infection Control precautions are facilities required to follow? A: The recommendations in the CDC Guidance, Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, continue to apply after the end of the PHE. The guidelines
- [Food and Nutrition Services: Top Deficiencies and How to Avoid Them](https://proactiveltcexperts.com/food-and-nutrition-services-top-deficiencies-and-how-to-avoid-them/) - F812 Food Procurement, Store/Prepare/Serve-Sanitary is ranked as the most frequently cited deficiency in Standard Surveys so far for the 2023 fiscal year (CASPER 5/7/23). F812 has been cited in 39% of these surveys. No other dietary tags rank in the top 25, although some have resulted in immediate jeopardy citations. Understanding the Regulatory Requirements and
- [Mitigating Risk to Prevent LTC Litigation](https://proactiveltcexperts.com/mitigating-risk-to-prevent-ltc-litigation/) - Nursing home settlements involving abuse or neglect in the United States are estimated at an average of $400,000.00 when the case settles out of court (What is the Average Settlement for Nursing Home Neglect? (sgklawyers.com). If the case proceeds to a court trial, the payout can reach upwards of $1 million or more (Id.) Depending
- [Ask Proactive - If we have a new admission on or prior to May 11th using the QHS waiver, what happens when they require a hospital stay?](https://proactiveltcexperts.com/ask-proactive-if-we-have-a-new-admission-on-or-prior-to-may-11th-using-the-qhs-waiver-what-happens-when-they-require-a-hospital-stay/) - Q: If we have a new admission on or prior to May 11th using the QHS waiver, what happens when they require a hospital stay? A: John Kane addressed this during the Open Door Forum (ODF) on March 2nd. The full transcript for this ODF is located under the Skilled Nursing Facility (SNF)/Long Term
- [Insights into Compliance: F675-F680 Quality of Life Requirements](https://proactiveltcexperts.com/insights-into-compliance-f675-f680-quality-of-life-requirements/) - Quality of life is a fundamental principle that applies to all care and services provided to nursing facility residents. The Quality of Life regulatory requirements at 483.24 (F675-F680) cover Quality of Life, Activities of Daily living, CPR, and activities. F677, ADL Care for Dependent Residents, is the most commonly cited Quality of Life requirement. Last
- [Ask Proactive - Why is daily charting necessary and how do you tackle compliance with Medicare A charting?](https://proactiveltcexperts.com/ask-proactive-why-is-daily-charting-necessary-and-how-do-you-tackle-compliance-with-medicare-a-charting/) - Q: Why is daily charting necessary and how do you tackle compliance with Medicare A charting? A: Documentation is an important part of providing resident care, it is a means to facilitate communication among the healthcare team, allowing for collaboration and informed decision making. Documentation is central to Quality of Care, serving as a
- [F578 Resident’s Rights- Advance Directives](https://proactiveltcexperts.com/residents-rights-related-to-medical-decision-making-and-advance-care-planning/) - Advance Directive and resident’s rights related to medical decision making are addressed in the surveyor guidance under F578. Understanding how the guidance defines both advance directives and advanced care planning is critical to complying with the regulations: Advance care planning is a process of communication between individuals and their healthcare agents to understand, reflect on, discuss,
- [Facility Assessment Tool - Now Available!](https://proactiveltcexperts.com/facility-assessment-tool-now-available/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Nursing facilities are required to complete a comprehensive Facility Assessment by November 28, 2017 as part of the Phase 2 Requirements of Participation (RoP.) The assessment must be presented to surveyors during the annual survey
- [Is Your Staff Prepared for the  New Long Term Care Survey Process?](https://proactiveltcexperts.com/is-your-staff-prepared-for-the-new-long-term-care-survey-process/) - LTC facilities in all states began a new computer-based survey process on November 28, 2017 for standard surveys. This new process incorporates new survey procedures, new survey forms, new F-tags, and 41 new and updated critical element pathways. 3 part Survey Process: Initial Pool Process - Interviews, Observations & Limited Record Review Sample Selection - 70%
- [SNF ICD.10 Coding: Integrating SNF Coding Systems In Preparation for PDPM](https://proactiveltcexperts.com/snf-icd-10-coding-integrating-snf-coding-systems-in-preparation-for-pdpm/) - November 13 + December 10, 2018 9:30 AM-3:30 PM (Eastern Time) SNF ICD.10 Coding: Integrating SNF Coding Systems In Preparation for PDPM This course will review common challenges skilled nursing facilities face regarding ICD-10 coding and provide best practices for accurate diagnosis coding across the interdisciplinary team. Participants will learn about common coding errors seen
- [PDPM—How Will You Fare Under the New Reimbursement Model?](https://proactiveltcexperts.com/pdpm-how-will-you-fare-under-the-new-reimbursement-model/) - CMS issued the final rule for Fiscal Year (FY) 2019 SNF Prospective Payment System (PPS) announcing that the Patient-Driven Payment Model (PDPM) will take effect October 1st, 2019, replacing the current PPS RUGs-IV model. How will your facility fare under PDPM? Reimbursement Under PDPM: PDPM completely replaces RUGs IV and focuses on resident clinical characteristics
- [Ask Proactive - Does Cultural Competence include gender identity and sexual orientation?](https://proactiveltcexperts.com/ask-proactive-does-cultural-competence-include-gender-identity-and-sexual-orientation/) - Q: Does Cultural Competence include gender identity and sexual orientation? A: Attitudes toward sexuality in general and toward sexual identity or orientation are culturally defined. Gender identity and sexual orientation can be categorized as cross-cutting cultural issues that are important in defining the cultural orientations of many. According to the Substance Abuse and Mental
- [Therapy Department Report Card](https://proactiveltcexperts.com/therapy-department-report-card/) - A thriving therapy department can have a tremendous impact on nursing home care culture, quality outcomes, and the bottom line. Whether your facility has an in-house or contract therapy program, rehabilitation services should continually contribute to resident well-being, develop functional potential, and integrate with the interdisciplinary team for operational success. Consider these key areas when
- [Ask Proactive - Is there a certain amount of time allowed before an RN needs to complete a resident fall follow-up? Also, what should a fall follow-up entail?](https://proactiveltcexperts.com/ask-proactive-is-there-a-certain-amount-of-time-allowed-before-an-rn-needs-to-complete-a-resident-fall-follow-up-also-what-should-a-fall-follow-up-entail/) - Q: Is there a certain amount of time allowed before an RN needs to complete a resident fall follow-up? Also, what should a fall follow-up entail? A: While there is no specified time frame for RN assessment, guidance tells us the proper actions following a fall include: Ascertaining if there were injuries, and providing
- [Ask Proactive - What actions need to be taken in preparation for the end of the Public Health Emergency (PHE)?](https://proactiveltcexperts.com/ask-proactive-what-actions-need-to-be-taken-in-preparation-for-the-end-of-the-public-health-emergency-phe/) - Q: What actions need to be taken in preparation for the end of the Public Health Emergency (PHE)? A: The COVID-19 national emergency was declared on March 13, 2020. As a result of this, several blanket waivers were put into place. Additions and modifications have been made since the implementation of the 1135 waivers.
- [New SNF PEPPER Now Available: Do you have outliers that may trigger medical review?](https://proactiveltcexperts.com/new-snf-pepper-now-available-do-you-have-outliers-that-may-trigger-medical-review/) - The Q4FY22 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2022 is now available for download. Follow these steps to access your PEPPER and analyze any outlier billing patterns that may signal Medicare overpayment medical review risk for your facility. About PEPPER PEPPER is
- [Drug Diversion Prevention—Are You Doing Enough?](https://proactiveltcexperts.com/drug-diversion-prevention-are-you-doing-enough/) - Drug diversion in a nursing home can have serious consequences and pose a risk to resident and staff health and safety. Facilities and their nursing staff are expected to be the gatekeepers of medications as a key component of ensuring quality care. Effective medication management includes mechanisms for storing, administering, and maintaining accurate documentation of
- [Proactive Director Comments on CMS Infection Control Enforcement Memorandum for McKnights](https://proactiveltcexperts.com/proactive-director-comments-on-cms-infection-control-enforcement/) - Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPC, Director of Regulatory Services, comments on CMS Infection Control enforcement memorandum QSO-23-10-NH for McKnights Long Term Care News CMS Announces Strengthened Enhanced Enforcement for Infection Control Deficiencies On March 30, 2023 CMS announced more aggressive enforcement action for facilities with infection control deficiencies, including greater
- [Ask Proactive - When a resident who has a feeding tube for nutrition is receiving speech therapy and has orders for a pureed diet/thickened liquid trials at lunch during therapy sessions, should this be coded on the MDS as a mechanically altered diet in section K0510?](https://proactiveltcexperts.com/ask-proactive-when-a-resident-who-has-a-feeding-tube-for-nutrition-is-receiving-speech-therapy-and-has-orders-for-pureed-diet-thickened-liquid-trials-at-lunch-during-therapy-sessions-should-this-be/) - Q: When a resident who has a feeding tube for nutrition is receiving speech therapy and has orders for a pureed diet/thickened liquid trials at lunch during therapy sessions, should this be coded on the MDS as a mechanically altered diet in section K0510? A: Mechanically altered diet should be coded on the MDS,
- [5 Things to Do Now to Improve Care Plan Processes](https://proactiveltcexperts.com/5-things-to-do-now-to-improve-care-plan-processes/) - Deficient practices related to care planning continue to be a frequently cited issue for providers. Effective care planning can be challenging and requires an IDT approach to ensure effective systems that will lead to better resident outcomes, as well as survey readiness. Here are 5 things you should do now to improve care plan processes:
- [Post-Pandemic Nursing Home Infection Preventionist Priorities](https://proactiveltcexperts.com/post-pandemic-nursing-home-infection-preventionist-priorities/) - An effective Infection Preventionists plays the part of guardian, detective, and scientist as they lead facility efforts in preventing and controlling infections through a robust Infection Prevention and Control (IPC) program. As facilities move beyond the COVID era, applying lessons learned and sustaining these key functions diligently is the priority. The purpose of an IPC
- [Ask Proactive - If a skilled or private pay resident is sent out to the hospital and the resident’s representative does not want to pay to hold the bed, is this an allowable discharge?](https://proactiveltcexperts.com/ask-proactive-if-a-skilled-or-private-pay-resident-is-sent-out-to-the-hospital-and-the-residents-representative-does-not-want-to-pay-to-hold-the-bed-is-this-an-allowable-discharge/) - Q: If a skilled or private pay resident is sent out to the hospital and the resident’s representative does not want to pay to hold the bed, is this an allowable discharge? A: No, you must permit them to readmit to the next available bed if your facility can still meet the needs of
- [Are You Prepared for Dementia Care Behavioral Health Requirements?](https://proactiveltcexperts.com/are-you-prepared-for-dementia-care-behavioral-health-requirements/) - Blog post and article by Eleisha Wilkes, RN, RAC-CT "Behavioral health services are an important component of fostering quality of life for that population we serve. As stated in the new Requirements of Participation, behavioral health encompasses a resident's whole emotional and mental well-being which includes, but is not limited to, the prevention and treatment
- [Department of Justice Launching Nursing Home Task Force](https://proactiveltcexperts.com/department-of-justice-launching-nursing-home-task-force/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. On March 30, 2016, the Department of Justice announced the launch of 10 regional Elder Justice Task Forces to coordinate and enhance efforts to investigate accusations of improper nursing home care of seniors. The Task
- [SNF RAC Review Activity Announced Following CMS Release of 2013 Provider Billing Data](https://proactiveltcexperts.com/snf-rac-review-activity-announced-following-cms-release-of-2013-provider-billing-data/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Indiana had the highest average standardized Medicare payment in 2013, followed by Texas and California, according to The Skilled Nursing Facility Utilization and Payment Public Use File, released March 9, 2016. The national average length
- [Comprehensive Care for Joint Replacement (CJR) Model Overview](https://proactiveltcexperts.com/comprehensive-care-for-joint-replacement-cjr-model-overview/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. The most common type of inpatient surgery for Medicare beneficiaries is the hip and knee replacement with the average Medicare expenditure for surgery, hospitalization, and recovery ranging from $16,500 to $33,000 across geographic areas. This
- [Payroll-Based Journal (PBJ) Staffing Data Submission](https://proactiveltcexperts.com/payroll-based-journal-pbj-staffing-data-submission/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. In an effort to promote greater accountability for long-term care facilities, the Affordable Care Act requires facilities to electronically submit direct care staffing information based on payroll and other auditable data. To meet this requirement,
- [Preview Data Available for New Quality Measures](https://proactiveltcexperts.com/preview-data-available-for-new-quality-measures/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. The Five Star Preview Reports were available through the CMS QIES System on April 20th. Beginning with this update, each nursing home is able to review data from the new quality measures that will be
- [Five Star Preview Reports](https://proactiveltcexperts.com/five-star-preview-reports/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Five Star Preview Reports Now Available The Five Star Preview Reports became available on July 21st. Nursing Home Compare will update with June’s Five Star data on July 27, 2016. New Claims Based & MDS
- [August 6, 2016 Final Rule](https://proactiveltcexperts.com/august-6-2016-final-rule/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2017, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and SNF Payment Models Research On August 6, 2016, CMS released a
- [HIPAA Privacy, Security and Breach Notification Audits Underway](https://proactiveltcexperts.com/hippa-privacy-security-and-breach-notification-audits-underway/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. The HHS Office for Civil Rights (OCR) began the latest phase of audits of covered entities and their business associates in July 2016. The 2016 Phase 2 HIPAA Audit Program reviews the policies and procedures
- [Section GG: Key Concepts for Successful Implementation](https://proactiveltcexperts.com/section-gg-key-concepts-for-successful-implementation/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. On October 1, 2016, completion of section GG (Functional Abilities and Goals) will be required as part of the admission (Start of SNF PPS Stay) and Discharge assessment (End of SNF PPS Stay) for all
- [Countdown to Section GG Begins! Get Answers to FAQ Here!](https://proactiveltcexperts.com/countdown-to-section-gg-begins-get-answers-to-faq-here/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Seasons are changing, and so are the MDS 3.0 rules! The start of FY2017 is quickly approaching with the accompanying MDS 3.0 changes effective 10/1. Unfortunately, much confusion related to coding the new Section GG
- [Breaking News! Conditions of Participation Final Rule Released](https://proactiveltcexperts.com/breaking-news-conditions-of-participation-final-rule-released/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. CMS has released the public inspection version of the SNF Conditions of Participation Final Rule. Proactive will be reviewing the update of the public inspection version of the final rule in detail and sharing recommendations
- [New Coding System: 2017 Evaluation Codes for PT/OT Webinar Recording Now Available](https://proactiveltcexperts.com/new-coding-system-2017-evaluation-codes-for-pt-ot-webinar-recording-now-available/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Did you miss the webinar? Don’t worry, the recording is now available! This course gives a description of methodology consistent with CMS and payment reform efforts which has led to reform in evaluation reporting to
- [New SNF Medical Review Activity Tied to COT OMRA Outliers](https://proactiveltcexperts.com/new-snf-medical-review-activity-tied-to-cot-omra-outliers/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. A sharp increase in the number of SNF Part A Post-Pay ADRs (Additional Documentation Requests) was noted in late December for claims with 2015 dates of service. The new medical review activity is being conducted
- [DOJ’s Fraud Section Issues New Guidance on Compliance Programs: Questions You Should Be Asking](https://proactiveltcexperts.com/dojs-fraud-section-issues-new-guidance-on-compliance-programs-questions-you-should-be-asking/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. The Fraud Section of the U.S. Department of Justice published the first formal guidance since the new administration took office. It includes a list of sample questions used to evaluate Corporate Compliance Program effectiveness: Evaluation
- [KY PT Regulation Update](https://proactiveltcexperts.com/ky-pt-regulation-update/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Two Changes to KY Physical Therapy Practice Act As of June 2, 2017, the Kentucky Board of Physical Therapy set forth changes according to 201 KAR 22:053, the administrative regulation which sets forth ethical standards
- [SNF Pepper: Compliance Action Plan](https://proactiveltcexperts.com/snf-pepper-compliance-action-plan/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. You’ve Taken the First Step and Downloaded Your SNF PEPPER Report Now what? Unfortunately, many facilities fail to glean the full risk assessment and management potential available through effective use of SNF PEPPER data, which
- [Proactive Medical Review Clinical & Reimbursement Experts in Post-Acute Care](https://proactiveltcexperts.com/proactive-medical-review-clinical-reimbursement-experts-in-post-acute-care/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Medical Review Preparedness & Response Efforts to reduce Medicare fraud and abuse have escalated, including expanded auditing of medical records and billing trends by governmental agencies and contractors. The administrative and financial implications of these
- [Medical Review Changes: Target Probe and Educate](https://proactiveltcexperts.com/medical-review-changes-target-educate-and-probe-tpe/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. CMS has announced plans to expand the targeted probe approach to medical review to all MACs (Medicare Administrative Contractors.) TPE includes processes for communication and education with providers that has been shown to help reduce
- [The New Survey Process - What To Expect](https://proactiveltcexperts.com/the-new-survey-process-what-to-expect/) - The New Survey Process Is Here... What You Need To Know Effective November 28, 2017, the new long term care survey process began. This new process combined the strengths from both the traditional survey process as well as the Quality Indicator Survey (QIS) to form the new process that is intended to identify concerns in
- [The New Survey Process: What Has Changed?](https://proactiveltcexperts.com/the-new-survey-process-what-has-changed/) - March 15, 2018 9:00 AM – 3:30 PM (Eastern Time) On November 28, 2017 all states began a brand new computer-based survey process for LTC facilities. This coincides with the implementation of Phase 2 of new Requirements of Participation and a newly revised State Operations Manual. Combined, this massive overhaul incorporates new survey procedures, new
- [Medicare Part B Therapy Caps Permanently Repealed!](https://proactiveltcexperts.com/medicare-part-b-therapy-caps-permanently-repealed/) - Medicare Part B therapy caps have been permanently repealed as part of the bipartisan budget deal passed last week and signed by President Trump on Friday, 2/9/18. The repeal will be retroactive to January 1, 2018, but claims over $2010.00 (OT or PT/SLP combined) will continue to require the KX modifier as an attestation of
- [Emergency Preparedness Requirements](https://proactiveltcexperts.com/emergency-preparedness-requirements/) - Are you Prepared for an Emergency? Health care providers and suppliers affected by the final rule Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers were required to comply and implement all regulations by November 15, 2017. Per CMS, the emergency preparedness requirements will have a set of tags that will be used
- [Prepare Your Staff For Survey](https://proactiveltcexperts.com/prepare-your-staff-for-survey-march-6-2018/) - Join us in April for training focused on the essentials you need to be prepared for the New Survey Process! The New Long Term Care Survey Process What to Expect: On November 28, 2017 all states began a brand new computer-based survey process for LTC facilities. This new process incorporates new survey procedures, new survey
- [CMS Five-Star Quality Rating System](https://proactiveltcexperts.com/cms-five-star-quality-rating-system/) - Health Inspection Changes On 11/24/2017, in S&C 18-04-NH, CMS announced upcoming changes to the Health Inspection domain of the Five-Star Quality Rating System. In this memo, CMS announced that they will hold constant the current health inspection star ratings on the Nursing Home Compare (NHC) website for any surveys occurring between November 28, 2017 and
- [Transitioning to PBJ Staffing Measures](https://proactiveltcexperts.com/transitioning-to-pbj-staffing-measures/) - Are You Ready? In April 2018, CMS will begin using the PBJ data to calculate staffing measures which will be posted on Nursing Home Compare and used in the Five Star Quality System. Staffing measures and staffing star ratings will be calculated based on the data for the 2017 Calendar Quarter 4 that was submitted
- [SNF Competency Tool Kits-Now Available!](https://proactiveltcexperts.com/snf-competency-tool-kits-now-available/) - Meeting RoP Staff Competency Requirements The regulation at F-tag 726 states that nursing facilities must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. Proactive has developed Competency
- [Section GG Proposed Updates](https://proactiveltcexperts.com/section-gg-propsed-updates/) - The proposed changes to section GG of the Minimum Data Set (MDS) anticipated on October 1, 2018 will require increased collaboration between therapy and nursing to appropriately fulfill coding requirements. Section GG was implemented in response to the IMPACT Act (Improving Medicare Post-Acute Care Transformation Act) with the goal of measuring patient care delivery in
- [Update on CMS/Jimmo Case and What it Means for Your Therapy Program](https://proactiveltcexperts.com/update-on-cms-jimmo-case-and-what-it-means-for-your-therapy-program-2/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. On February 1st, a Vermont U.S. District Court Judge filed a decision ordering CMS to implement a Corrective Action Plan for improved education related to skilled therapy and nursing service coverage required to maintain health
- [The New Survey Process Is Here—What You Need to Know](https://proactiveltcexperts.com/the-new-survey-process-is-here-what-you-need-to-know/) - Effective November 28, 2017, the new long term care survey process began. This new process combined the strengths from both the traditional survey process as well as the Quality Indicator Survey (QIS) to form the new process that is intended to identify concerns in a more efficient manner. Similar to the QIS survey process, the
- [Facility Assessment Compliance Made Easy](https://proactiveltcexperts.com/facility-assessment-compliance-made-easy/) - This post has been modified or updated. Learn more about our services here or shop our tools and resources here. Nursing facilities are required to complete a comprehensive Facility Assessment by November 28, 2017 as part of the Phase 2 Requirements of Participation (RoP.) The assessment must be presented to surveyors during the annual survey
- [Ohio Exception Reviews are Coming – Are You Prepared?](https://proactiveltcexperts.com/ohio-exception-reviews-are-coming-are-you-prepared/) - The Ohio Department of Medicaid (ODM) has awarded Myers and Stauffer with the contract to conduct exception reviews. "Exception review" is a review of minimum data set (MDS) assessment data. The purpose of an exception review is to identify any patterns or trends related to resident assessments submitted that could result in inaccurate case mix
- [WEBINAR: How Hot is your PEPPER Report?](https://proactiveltcexperts.com/how-hot-is-your-pepper-report/) - UPDATE!! THE LIVE WEBINAR HAS ENDED. CLICK HERE FOR RECORDING DETAILS. SNF PEPPER Now Available - Implement an Effective Response in Preparation for Government Audits The Q4FY17 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2017 is now available for download through the PEPPER
- [Ask Proactive - We have a resident who we are skilling related to a recent femur fracture. The principal diagnosis is S72.22XD, which maps to the  Non-Surgical Orthopedic/Musculoskeletal Clinical Category, but it states “May be Eligible for One of the Two Orthopedic Surgery Categories”. How do we determine if it is eligible for one of the Orthopedic Surgery categories?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-who-we-are-skilling-related-to-a-recent-femur-fracture-the-principal-diagnosis-is-s72-22xd-which-maps-to-the-non-surgical-orthopedic-musculoskeletal-clinical-cate/) - Q: We have a resident who we are skilling related to a recent femur fracture. The principal diagnosis is S72.22XD, which maps to the Non-Surgical Orthopedic/Musculoskeletal Clinical Category, but it states “May be Eligible for One of the Two Orthopedic Surgery Categories”. How do we determine if it is eligible for one of the Orthopedic
- [Winning at PDPM](https://proactiveltcexperts.com/winning-at-pdpm/) - Resident conditions and resource needs drive reimbursement under the Patient-Driven Payment Model (PDPM). Successful facilities have developed systems to effectively recognize and capture the differences among residents, particularly in the utilization of resources. Does your process include these key action steps to facilitate winning at PDPM? Since 2019, SNFs have been working to achieve payment
- [Transitioning from QIES to iQIES for MDS Submission](https://proactiveltcexperts.com/transitioning-from-qies-to-iqies-for-mds-submission/) - To comply with federal security mandates, the Centers for Medicare & Medicaid Services (CMS) has initiated new security requirements for access control to CMS Quality Systems through Remote Identity Proofing (RIDP) via the Healthcare Quality Information System (HCQIS) Access, Roles and Profile Management (HARP) system. To gain access, all current and future provider users are required
- [Ask Proactive - For the Quality Measure “Percent of Residents Who Newly Received an Antipsychotic Medication (SS),” is the initial assessment used in the calculation always an Admission or 5-Day?](https://proactiveltcexperts.com/ask-proactive-for-the-quality-measure-percent-of-residents-who-newly-received-an-antipsychotic-medication-ss-is-the-initial-assessment-used-in-the-calculation-always-an-admissio/) - Q: For the Quality Measure “Percent of Residents Who Newly Received an Antipsychotic Medication (SS),” is the initial assessment used in the calculation always an Admission or 5-Day? A: For this measure, the initial assessment is the first assessment completed after the Entry Tracking Record. In some situations, a Discharge assessment may be the
- [Social Services PDPM Impact](https://proactiveltcexperts.com/social-services-pdpm-impact/) - The Social Service department plays a significant role in daily nursing facility operations. From patient care planning, patient adjustment to facility admission, discharge planning, engaging with family/representatives, and beyond, social service staff members wear multiple hats and hold key responsibilities in facilitating success for both the patient and the facility. Among an extensive list of
- [Skilled Nursing Facility Value-Based Purchasing Program (SNF VBP)](https://proactiveltcexperts.com/skilled-nursing-facility-value-based-purchasing-program-snf-vbp/) - The SNF VBP program encourages SNFs to improve the quality of care provided to Medicare beneficiaries by awarding incentive payments to SNFs based on their performance in the area of reducing unplanned hospital readmissions. Currently, the SNF VBP program utilizes the SNF 30-day All-Cause Readmission Measure (SNFRM) to evaluate the risk standardized readmission rate of
- [Ask Proactive - We have a resident on Enhanced Barrier Precautions who will be staying at our facility long term. Are there criteria for discontinuing these precautions at some point?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-on-enhanced-barrier-precautions-who-will-be-staying-at-our-facility-long-term-are-there-criteria-for-discontinuing-these-precautions-at-some-point/) - Q: We have a resident on Enhanced Barrier Precautions who will be staying at our facility long-term. Are there criteria for discontinuing these precautions at some point? A: It depends on why the Enhanced Barrier Precautions (EBP) were implemented. For residents colonized with a novel or targeted MDRO, the CDC intends EBP to be
- [Assessing Resident Capacity to Consent to Sexual Activity](https://proactiveltcexperts.com/assessing-resident-capacity-to-consent-to-sexual-activity/) - The updated abuse guidance issued on June 29, 2022, stresses that facilities must take steps to ensure residents are protected from abuse, including evaluating whether the resident has the capacity to consent to sexual activity. To understand how to appropriately evaluate a resident’s capacity to consent, you must first understand the definition of capacity. According
- [Ask Proactive - We have a physician who has requested that all patients be seen in her office rather than on-site at the facility. Will this satisfy the physician visit requirements?](https://proactiveltcexperts.com/ask-proactive-we-have-a-physician-who-has-requested-that-all-patients-be-seen-in-her-office-rather-than-on-site-at-the-facility-will-this-satisfy-the-physician-visit-requirements/) - Q: We have a physician who has requested that all patients be seen in her office rather than on-site at the facility. Will this satisfy the physician visit requirements? A: The regulations do not specifically address a location requirement; however, according to the State Operations Manual: It is expected that visits will occur at
- [Ask Proactive - We have a patient with a stage IV pressure injury to the ankle that is being treated with a wound vac, which is changed 3x/week. Does this meet the criteria for skilled coverage under Medicare Part A in the SNF?](https://proactiveltcexperts.com/ask-proactive-we-have-a-patient-with-a-stage-iv-pressure-injury-to-the-ankle-that-is-being-treated-with-a-wound-vac-which-is-changed-3x-week-does-this-meet-the-criteria-for-skilled-coverage-under/) - Q: We have a patient with a stage IV pressure injury to the ankle that is being treated with a wound vac, which is changed 3x/week. Does this meet the criteria for skilled coverage under Medicare Part A in the SNF? A: The Medicare Benefit Manual Chapter 8 section 30.3 provides the following examples
- [Ins and Outs of F582 Medicaid/Medicare Coverage/Liability Notice](https://proactiveltcexperts.com/f582-medicaid-medicare-coverage-liability-notice-understanding-the-ins-and-outs-of-f-tag-582/) - Medicare beneficiaries in a SNF have rights and safeguards with regard to financial liability and appeal of the denial of Medicare services. Providers are required to inform beneficiaries of their financial liability and their appeal rights in writing by issuing specific notices. Is your facility consistently meeting the requirements of F582 related to Medicaid and
- [Ask Proactive - Our facility has several residents that require the use of a mechanical lift for transfers. What needs to be included in staff education/training?](https://proactiveltcexperts.com/ask-proactive-our-facility-has-several-residents-that-require-the-use-of-a-mechanical-lift-for-transfers-what-needs-to-be-included-in-staff-education-training/) - Q: Our facility has several residents that require the use of a mechanical lift for transfers. What needs to be included in staff education/training? A: Mechanical lifts are designed to provide safe and easy transfers. When used correctly, they minimize the risk of injury for both staff and resident; however, improper use of a
- [Becoming a Dynamic DON](https://proactiveltcexperts.com/becoming-a-dynamic-don/) - Fulfilling the Director of Nursing (DON) role in a skilled nursing facility is not an easy challenge. In addition to an extensive list of formal responsibilities and job duties, those who are truly successful in the role have tremendous grit, a sense of purpose, and a list of intangible qualities that could be used to
- [Respecting the Crime Scene](https://proactiveltcexperts.com/respecting-the-crime-scene/) - Every incident, whether it involves a crime, an accident, or a natural disaster, leaves traces of evidence at the scene. The goal of every investigation is to correctly identify the facts, reconstruct the events and deduce what occurred. When possible illegal activity is identified, the “crime scene” can be one of the most important sources
- [Start Here for PDPM Reimbursement Accuracy](https://proactiveltcexperts.com/start-here-for-pdpm-reimbursement-accuracy/) - Even though SNFs have collectively seen higher reimbursement rates under the Patient-Driven Payment Model compared to the previous RUG IV payment model, data shows that there is still room for improvement for most facilities in terms of ensuring accurate revenue under the new payment model. While the PDPM is based on clinical characteristic of an
- [Ask Proactive - Can you clarify the abuse reporting requirements in relation to what must be reported within 2 hours and what types of incidents do we have 24 hours to report?](https://proactiveltcexperts.com/ask-proactive-can-you-clarify-the-abuse-reporting-requirements-in-relation-to-what-must-be-reported-within-2-hours-and-what-types-of-incidents-do-we-have-24-hours-to-report/) - Q: Can you clarify the abuse reporting requirements in relation to what must be reported within 2 hours and what types of incidents do we have 24 hours to report? A: All alleged violations for abuse, neglect, exploitation or mistreatment, including injuries of unknow origin and misappropriation of property, as well as the results
- [Ask Proactive - Is it appropriate to skill every resident that tests positive for COVID-19? Does the waiver allow us to skill "in place" any resident who tests positive?](https://proactiveltcexperts.com/ask-proactive-im-a-new-mds-nurse-and-i-am-getting-pressure-to-skill-every-resident-we-have-that-tests-positive-for-covid-does-the-waiver-allow-us-to-skill-each-resident-who-is-positive/) - Q: Is it appropriate to skill every resident that tests positive for COVID-19? Does the waiver allow us to skill any resident who tests positive? A: There has been quite a bit of confusion surrounding the use of the waivers, especially when it comes to current long-term care residents and the ability to admit
- [Survey School in Session](https://proactiveltcexperts.com/survey-school-in-session/) - Curious about survey trends so far this year? Let’s take a look at current trends in citations and late surveys. Average Number of Deficiencies The national average number of deficiencies cited during annual surveys is currently 7. Utah’s average number of deficiencies is 19.8, which is the highest in the nation. Alaska and Mississippi have
- [5-Star Staffing Rating Simplified](https://proactiveltcexperts.com/5-star-staffing-rating-simplified/) - Multiple studies show evidence of a strong correlation between nursing home staffing levels and quality of care.[i] Federal law requires sufficient staffing levels to safely meet the care needs of residents. As facilities deal with significant staffing challenges nationwide, it is critical to understand how staffing levels will impact your 5-Star Rating. Here’s what you
- [Ask Proactive - I understand that CMS will be conducting audits of schizophrenia coding in the MDS data and potentially adjusting the long-stay residents who are receiving antipsychotic drugs QM ratings when inaccurate coding is found. What are the criteria for diagnosing Schizophrenia?](https://proactiveltcexperts.com/i-understand-that-cms-will-be-conducting-audits-of-schizophrenia-coding-in-the-mds-data-and-potentially-adjusting-the-long-stay-residents-who-are-receiving-antipsychotic-drugs-qm-ratings-when-inaccura/) - Q: I understand that CMS will be conducting audits of schizophrenia coding in the MDS data and potentially adjusting the long-stay residents who are receiving antipsychotic drugs QM ratings when inaccurate coding is found. What are the criteria for diagnosing Schizophrenia? A: The DSM-5 outlines 5 primary criteria for diagnosing schizophrenia: The patient must exhibit 2
- [Ask Proactive - How can the facility comply with administering nebulizer treatment without needing to stay with the resident during administration for a resident who will keep nebulizer on?](https://proactiveltcexperts.com/ask-proactive-what-can-facility-do-to-be-in-compliance-with-administering-nebulizer-treatment-without-needing-to-stay-with-the-resident-during-administration-for-a-resident-who-will-keep-nebulizer-o/) - Q: How can the facility comply with administering nebulizer treatment without needing to stay with the resident during administration for a resident who will keep nebulizer on? A: In order to support that the resident is able to self-administer a nebulizer treatment after set-up, it would be best practice to complete a medication self-administration
- [Mission Possible – SNF Department Head Briefing](https://proactiveltcexperts.com/snf-department-head-briefing/) - John F. Kennedy once said, “Leadership and learning are indispensable to each other.” Are your facility’s leaders, whether new or seasoned, receiving ongoing training to best perform their duties and lead their team? A recent study on why healthcare workers quit their job, lists working conditions in the top 5 catalysts for leaving. One of
- [Mentoring Your DON for 5-Star Success](https://proactiveltcexperts.com/mentoring-your-don-for-5-star-success/) - The 5-Star Quality Rating System was created by CMS in 2008. Today, almost 15 years later, we still see confusion and a lack of understanding of the 5-Star domains, how they are calculated, and how the DON can best lead the facility in improving the 5-Star rating. Does your facility employ these strategies to manage
- [Critical Risks for 2023 Audits](https://proactiveltcexperts.com/critical-risks-for-2023-audits/) - The New Year calls for new beginnings and fresh starts! With increasingly sophisticated data analytics, regulatory enforcement of required Compliance and Ethics Programs (CEP) effective October 2022, and President Biden’s nursing home reform, providers must focus audit priorities on critical areas of industry and facility risk. In this week’s blog, we explore hot button risk
- [Ask Proactive - How will the Facility Assessment be used during the survey process?](https://proactiveltcexperts.com/ask-proactive-what-is-the-difference-between-an-ipa-and-a-significant-change-assessment-2/) - Q: How will the Facility Assessment be used during the survey process? A: During your annual survey, you will be required to provide the survey team a copy of your completed Facility Assessment within four hours of them entering your facility. If systemic care concerns are identified that are related to your planning, surveyors
- [Overcoming the Administrator Doldrums](https://proactiveltcexperts.com/overcoming-the-administrator-doldrums-research-proven-steps-to-realize-2023-resolutions-for-your-facility/) - If your day started with a 2am phone call about a busted pipe or resident-to-resident altercation, you might be an administrator. If you enjoy daily visits to your office doorway from octogenarians with stories to tell (and sometimes lost laundry), you might be an administrator. If in a single shift you're hugged, cussed, fulfilled and
- [The Ins and Outs of Remote MDS Completion: Perspectives from a Remote MDS Pro](https://proactiveltcexperts.com/the-ins-and-outs-of-remote-mds-completion-an-interview-with-a-remote-mds-pro/) - The COVID-19 Public Health Emergency brought with it many changes and challenges for long-term care facilities. In many cases, staffing became critically low due to employees leaving permanently or temporarily because of intermittent illnesses and quarantines. Facilities fortunate enough to maintain MDS staff often relied on them to fill open positions on the floor in
- [Ask Proactive - What is the difference between an IPA and a Significant Change Assessment?](https://proactiveltcexperts.com/ask-proactive-what-is-the-difference-between-an-ipa-and-a-significant-change-assessment/) - Q: What is the difference between an IPA and a Significant Change Assessment? A: The IPA, which is completed for payment purposes under PDPM is often confused with the SCSA, which is a clinical assessment. The OBRA SCSA is required to be completed when there is a significant decline or improvement in the resident’s
- [Ask Proactive - The Registered Dietitian in my building has documented malnutrition on a new admission. I want to ensure I receive the 1 NTA point for malnutrition. Can I use the Dietician’s documentation to code Malnutrition in I5600? Will coding malnutrition in I5600 capture the NTA point?](https://proactiveltcexperts.com/ask-proactive-the-registered-dietitian-in-my-building-has-documented-malnutrition-on-a-new-admission-i-want-to-ensure-i-receive-the-1-nta-point-for-malnutrition-can-i-use-the-dieticians-d/) - Q: The Registered Dietitian in my building has documented malnutrition on a new admission. I want to ensure I receive the 1 NTA point for malnutrition. Can I use the Dietician’s documentation to code Malnutrition in I5600? Will coding malnutrition in I5600 capture the NTA point? A: To be able to code a diagnosis
- [Ask Proactive - What are the top non-compensation focused nurse retention strategies for front line nurse managers?](https://proactiveltcexperts.com/ask-proactive-what-are-the-top-non-compensation-focused-nurse-retention-strategies-for-front-line-nurse-managers/) - Q: What are the top non-compensation focused nurse retention strategies for front line nurse managers? A: According to research published in the Journal of Gerontological Nursing, {45(11), 11-19} which was used to develop an evidence-based nurse retention practice guideline, the three non-wage related areas nurse managers should focus their efforts to enhance job satisfaction
- [MDS to Transition to iQIES](https://proactiveltcexperts.com/mds-to-transition-to-iqies/) - As previously announced, CMS will be migrating MDS submission and reporting to the internet Quality Improvement and Evaluation System (iQIES) in early 2023. CMS has not yet established the go-live date for the transition. The iQIES portal is available at https://iqies.cms.gov/ and will soon be the new interface for MDS submission and reporting, replacing the
- [Overcoming Behavioral Care Planning Pitfalls](https://proactiveltcexperts.com/overcoming-behavioral-care-planning-pitfalls/) - Behavioral health can be one of the most complex aspects of long term care. Thoughtful and personalized care planning is key to both proactive preventative strategies and an effective response to challenging behaviors. This week’s blog breaks down the critical components of a successful behavioral health care plan… Overview of Behaviors Section E of the
- [Ask Proactive - Did the ICD-10 codes for Dementia recently change?](https://proactiveltcexperts.com/ask-proactive-did-the-icd-10-codes-for-dementia-recently-change/) - Q: Did the ICD-10 codes for Dementia recently change? A: Yes, the FY 2023 ICD-10 updates (effective 10/01/22) include updated codes that provide greater specificity based on severity and behavioral symptoms present. The ICD-10-CM now classifies dementia on the basis of the etiology (F01-Vascular Dementia; F02- Dementia in other diseases, such as Alzheimer’s; F03-unspecified
- [ABCs of an Effective Skilled Nursing Note](https://proactiveltcexperts.com/abcs-of-an-effective-skilled-nursing-note/) - According to the Patient-Driven Payment Model (PDPM), skilled nursing facilities (SNFs) are required to have documentation in the medical record that will allow a medical reviewer, in the case of an additional documentation request (ADR), to determine that Medicare Part A skilled services were provided and that those services were reasonable and necessary. This requirement
- [Ask Proactive - We do not currently have an MDS Coordinator and it will be some time before the new one can start. Who can complete the MDS; does it have to be a nurse?](https://proactiveltcexperts.com/ask-proactive-we-do-not-currently-have-an-mds-coordinator-and-it-will-be-some-time-before-the-new-one-can-start-who-can-complete-the-mds-does-it-have-to-be-a-nurse/) - Q: We do not currently have an MDS Coordinator and it will be some time before the new one can start. Who can complete the MDS; does it have to be a nurse? A: Each facility self-determines its policies and procedures for patient documentation practices and completing the assessments in compliance with state and
- [Tips for Successful IDR/IIDR](https://proactiveltcexperts.com/tips-for-successful-idr-iidr/) - The IDR process gives nursing homes one informal opportunity to dispute cited deficiencies after any survey of Federal requirements for participation. Facilities are also provided the opportunity to request and participate in an Independent IDR if CMS imposes civil money penalties against the facility and these penalties are subject to being collected and placed in
- [After the Survey: Developing a Plan of Correction](https://proactiveltcexperts.com/after-the-survey-developing-a-plan-of-correction/) - A plan of correction (POC) is a plan developed by the facility and approved by CMS or the state survey agency that clearly describes the actions the facility will take to correct deficiencies cited during a survey and specifies the date by which those deficiencies will be corrected. Consider these tips when developing your POC:
- [Ask Proactive - I have a Medicare Part A resident that went home for a visit and stayed overnight. Do I need to complete MDS assessments for an interrupted stay?](https://proactiveltcexperts.com/ask-proactive-i-have-a-medicare-part-a-resident-that-went-home-for-a-visit-and-stayed-overnight-do-i-need-to-complete-mds-assessments-for-an-interrupted-stay/) - Q: I have a Medicare Part A resident that went home for a visit and stayed overnight. Do I need to complete MDS assessments for an interrupted stay? A: Unless your State has a different policy, a Leave of Absence (LOA) which includes a temporary home visit of at least one night does not
- [Cleaning and Disinfection for the Infection Preventionist](https://proactiveltcexperts.com/cleaning-and-disinfection-for-the-infection-preventionist/) - A recent study found that over 90% of high-touch surfaces in Long Term Care facilities were contaminated with potential sources of infectious disease spread. (American Journal of Infection Control) Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high contamination levels. Is your facility meeting requirements
- [Ask Proactive - SNF Certification/Recertification](https://proactiveltcexperts.com/ask-proactive-snf-certification-recertification/) - Q: We recently received the outcome of our TPE audit. The MAC denied even with our delayed certifications for the skilled stays. We thought this was an accepted process if the SNF certification / recertifications were late. How can we dispute the determination? A: According to Pub. 100-01, Medicare General Information, Eligibility, and Entitlement
- [Ask Proactive - Your obligation to report concerns](https://proactiveltcexperts.com/ask-proactive-does-the-abn-have-to-be-issued-when-therapy-ends/) - Q: I am a floor nurse and have a concern about a coworker’s practices at work. When I am on the medication cart that she normally works, I find many medications that still have blisters packs that are full, and unopened inhalers, eye drops, etc. She and I are friends outside of work and I
- [Survey Ready! F895 LTC Compliance and Ethics Program Requirements](https://proactiveltcexperts.com/survey-ready-f895-ltc-compliance-and-ethics-program-requirements/) - Oversight, Outbreaks, Overpayments…Oh My! It seems the LTC industry has no shortage of potential pitfalls knocking at the door. October 24, 2022 has come and gone, with the long-awaited phase 3 surveyor interpretive guidance now in effect for LTC providers. This week’s blog reviews F895 Compliance and Ethics Program (CEP) Requirements and considers the steps
- [Key Steps to 5 Star Rating: Mock Survey](https://proactiveltcexperts.com/key-steps-to-5-star-rating-mock-survey/) - Key Steps to a Nursing Home 5 Star Rating. SNF & Long Term Care (LTC) Mock Surveys. Contact us to schedule a mock survey. 5️⃣⭐
- [Ask Proactive - Does the ABN Have to be Issued When Therapy Ends?](https://proactiveltcexperts.com/when-someone-is-still-on-med-a-benefits-and-the-therapy-team-reduces-or-ends-one-type-of-therapy-but-not-all-types-does-the-abn-need-to-be-given-each-time/) - Q: When someone is still on Med A benefits and the therapy team reduces or ends one type of therapy but not all types, does the ABN need to be given each time? A: The notices aren’t required when therapy reduces or ends services, but rather when the SNF determines the beneficiary no longer
- [Revisions to Special Focus Facility (SFF) Program](https://proactiveltcexperts.com/revisions-to-special-focus-facility-sff-program/) - On Oct. 21, 2022, CMS issued QSO-23-01-NH, announcing revisions to the Special Focus Facility (SFF) program with an emphasis on improving the quality of care that residents living in SFF receive. The changes to the program aim to address facilities that remain in the SFF program for too long and those with “yo-yo” noncompliance after
- [Survey Enforcement Remedies: Directed In-Service Training](https://proactiveltcexperts.com/survey-enforcement-remedies-directed-in-service-training/) - Q: My facility just completed our annual survey and is in denial of payment until a Directed In-Service training is completed. What is a Directed In-Service training and how do we ensure compliance? A: Directed In-service training is one of the enforcement actions that may be imposed as a remedy in accordance with 42
- [Avoiding Deficiencies at F758 – Psychotropic Drugs](https://proactiveltcexperts.com/avoiding-deficiencies-at-f758-psychotropic-drugs/) - The prevalence of psychotropic drugs in nursing homes has increased in recent years in part due to the worsening of emotional and behavioral disorders exacerbated by the restrictive measures of the COVID-19 pandemic.[1] Consequently, F758 Psychotropic Drugs is one of the top 10 areas cited for deficient practice in the nation. F758 Psychotropic Drugs [2]
- [F699 Trauma-Informed Care](https://proactiveltcexperts.com/f699-trauma-informed-care/) - F699 Trauma-informed Care is one of the many areas with changes to the LTC Survey process effective October 24th -- is your facility prepared? According to SAMHSA - Substance Abuse and Mental Health Services Administration seventy percent of adults in the United States have experienced some type of trauma. Notably, there is a direct correlation
- [Ask Proactive – How much is the ALJ Appeal Amount in Controversy for 2023?](https://proactiveltcexperts.com/ask-proactive-how-much-is-the-alj-appeal-amount-in-controversy-for-2023/) - Q: How much is the ALJ Appeal Amount in Controversy for 2023? A: The amount in controversy (AIC) threshold amount for Medicare ALJ appeals will continue to be $180.00 for CY2023 and the AIC for Judicial Review will increase to $1850.00 Learn more Angie Hamer, RN, RAC-CT Clinical Consultant Learn more about the rest
- [LTC Infection Prevention & Control Outbreak Management—Start Here!](https://proactiveltcexperts.com/outbreak-management-start-here/) - Infection surveillance is critical in long term care. It enables the effective Infection Preventionist to monitor facility trends and act proactively in response to potential outbreaks. CMS states that The facility must establish a system for surveillance based upon national standards of practice and the facility assessment, including the resident population and the services and
- [F895 Compliance and Ethics Programs](https://proactiveltcexperts.com/updated-covid-19-guidance-key-takeaways-2/) - Revised long term care surveyor guidance for F895 Compliance and Ethics Programs was released June 29, 2022. CMS will begin enforcing F895 on October 24, 2022 and has released specific surveyor guidance and updates to Appendix PP to guide preparations. Effective compliance and ethics programs need to accomplish three primary goals Prevent, detect, and correct
- [Ask Proactive – The Medicare and Medicaid Services (CMS) updated the surveyor guidance found in Appendix PP of the State Operations Manual on June 29, 2022. Surveyors will use critical element (CE) pathways to aid in the investigation of many of the federal tags. When will the new guidance begin?](https://proactiveltcexperts.com/ask-proactive-the-medicare-and-medicaid-services-cms-updated-the-surveyor-guidance-found-in-appendix-pp-of-the-state-operations-manual-on-june-29-2022-surveyors-will-use-critical-element/) - Q: The Medicare and Medicaid Services (CMS) updated the surveyor guidance found in Appendix PP of the State Operations Manual on June 29, 2022. Surveyors will use critical element (CE) pathways to aid in the investigation of many of the federal tags. When will the new guidance begin? A: Noncompliance with QAPI, trauma-informed care, and
- [Updated COVID-19 Guidance-Key Takeaways](https://proactiveltcexperts.com/updated-covid-19-guidance-key-takeaways/) - Over the past week, CMS and CDC issued updated guidance related to COVID-19. On September 23, 2022, CMS updated the QSO memos 20-38-NH related to nursing home testing requirements and 20-39-NH related to nursing home visitation. Key changes/additions to the CMS guidance include: Routine testing of asymptomatic staff is no longer recommended but may be
- [New Requirements Binding Arbitration Agreements](https://proactiveltcexperts.com/new-requirements-binding-arbitration-agreements/) - On July 18, 2019, CMS finalized new requirements related to binding arbitration agreements that went into effect on September 16, 2019. The requirements prohibit LTC facilities from requiring residents to sign binding arbitration agreements as a condition of admission to the facility, or as a requirement to continue to receive care at that facility. The
- [F686 Pressure Ulcers—Where Facilities Go Wrong](https://proactiveltcexperts.com/where-facilities-go-wrong-when-it-comes-to-wounds/) - In Appendix PP of the State Operations Manual, Tag F686 for Treatment/Services to Prevent/Heal Pressure Ulcers outlines the following requirements: 483.25(b)(1) Pressure ulcers. Based on the comprehensive assessment of a resident, the facility must ensure that—(i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure
- [Percent of Residents Who Made Improvements in Function](https://proactiveltcexperts.com/percent-of-residents-who-made-improvements-in-function/) - Q: Percent of Residents Who Made Improvements in Function – My facility generally performs very well in this Quality Measure but we have recently seen fewer residents triggering and a decline in our percentage. Most of our short-term residents are discharging to the community and therapy reports that residents are improving. What should I be
- [Staff Development Checkup: F880 Infection Prevention and Control Training Essentials](https://proactiveltcexperts.com/staff-development-checkup-f880-infection-prevention-and-control-training-essentials/) - Staff must be informed and competent in following proper infection control practices. Systems for educating team members and for ensuring that they understand and apply the information properly while performing their job duties is essential. In 2022, 4027 facilities were surveyed with a total of 5776 deficiencies related to F-Tag 880 Infection Control. Many of
- [MDS Completion: Death During Therapeutic Leave](https://proactiveltcexperts.com/mds-completion-death-during-therapeutic-leave/) - Q: I have a resident who went home this past week to spend a few hours with family. While on her therapeutic leave she expired. Do I complete a Discharge Return Not Anticipated assessment or death in facility? A: A Death in Facility assessment would be completed. RAI Manual pg 2-10 states Death in Facility
- [Long Term Care Mock Survey Considerations: A Study in Survey Readiness](https://proactiveltcexperts.com/mock-survey-considerations-a-case-study-in-survey-readiness/) - Is your nursing facility survey ready? Are you up to date with all of the upcoming regulatory changes effective in October 2022? Preparation for the annual recertification survey should be ongoing, with a formal mock survey process several months prior to the facility’s survey window so that a proper corrective action plan can be prioritized,
- [Ask Proactive – Our therapy contract company recently notified us that their therapy staff will no longer be able to help cover nurse aide / CNA responsibilities. We don’t agree with this. The regulation did not change and there hasn’t been recent activity with waiver updates. Please help.](https://proactiveltcexperts.com/ask-proactive-our-therapy-contract-company-recently-notified-us-that-their-therapy-staff-will-no-longer-be-able-to-help-cover-nurse-aide-cna-responsibilities-we-dont-agree-with-t/) - Q: Our therapy contract company recently notified us that their therapy staff will no longer be able to help cover nurse aide / CNA responsibilities. We don’t agree with this. The regulation did not change and there hasn’t been recent activity with waiver updates. Please help. A: We have seen some fairly recent updates (April
- [LTC Requirements of Participation Update: Admission, Transfer and Discharge Rights](https://proactiveltcexperts.com/ltc-requirements-of-participation-update-admission-transfer-and-discharge-rights/) - On June 29, 2022, CMS issued QSO-22-19-NH, announcing the release of new Interpretive Guidance for Phase 3 requirements, which went into effect November 28, 2019, as well as revisions to Phase 2 guidance. Surveyors will begin using this guidance to identify noncompliance on October 24, 2022. While all the new regulations and guidance related to Admission,
- [Medicare A PPS and MDS Essentials for the DON](https://proactiveltcexperts.com/medicare-a-pps-and-mds-essentials-for-the-don/) - If you are currently a Director of Nursing or are considering taking on that role, you understand that clinical knowledge is only one ingredient in the recipe that makes an effective nurse leader. Among numerous responsibilities, the challenging role of DON includes leadership, oversight, and integration of other individuals and departments responsible for completing complex
- [Ask Proactive – I understand SNFs will be transitioning from using QIES to IQIES for transmission of assessment data in early 2023.  What steps should providers take to prepare for this transition?](https://proactiveltcexperts.com/ask-proactive-i-understand-snfs-will-be-transitioning-from-using-qies-to-iqies-for-transmission-of-assessment-data-in-early-2023-what-steps-should-providers-take-to-prepare-for-this-transi/) - Q: I understand SNFs will be transitioning from using QIES to IQIES for transmission of assessment data in early 2023. What steps should providers take to prepare for this transition? A: Although the MDS submission and reporting functionality in IQIES will not be available until January 2023, each provider should prepare now by assigning at
- [Will the FY 2023 SNF final rule change how CMS defines the COVID-19 population?](https://proactiveltcexperts.com/will-the-fy-2023-snf-final-rule-change-how-cms-defines-the-covid-19-population/) - Q: Will the FY 2023 SNF final rule change how CMS defines the COVID-19 population? A: For the FY 2023 SNF final rule, CMS defines the COVID-19 population to include the following: Stays that have the interim COVID-19 code B97.29 from January 1, 2020 to March 31, 2020 or The new COVID-19 code U07.1 from April
- [Revised LTC Surveyor Guidance—Prepare for Oct. 24th Survey Updates](https://proactiveltcexperts.com/revised-ltc-surveyor-guidance/) - On June 29, 2022, CMS issued QSO-22-19-NH, announcing the release of new Interpretive Guidance for Phase 3 requirements, which went into effect November 28, 2019, as well as revisions to Phase 2 guidance. Surveyors will begin using this guidance to identify noncompliance on October 24, 2022. Significant revisions to the guidance include: Revisions to the
- [Avoiding F695 Respiratory/Trach Care and Suctioning Tags](https://proactiveltcexperts.com/survey-success-avoiding-f695-respiratory-trach-care-and-suctioning/) - F695 Respiratory care, including tracheostomy care and tracheal suctioning, is one of the top 10 areas cited most often in nursing homes. This regulation states that the facility must ensure that a resident who needs respiratory care, including tracheostomy care and tracheal suctioning, is provided such care, consistent with professional standards of practice, the comprehensive
- [Ask Proactive – Claim Denial Based on ICD10 Coding](https://proactiveltcexperts.com/ask-proactive-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/) - 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) as the ICD10 codes. This has never been a problem before.
- [Ready for Survey?](https://proactiveltcexperts.com/ready-for-survey/) - Now that annual surveys have resumed, long-term care facilities should be prepared for the first Annual survey they may have had in a very long time. Consider completing a survey readiness checklist as part of your facility’s self-evaluation. Use this sample checklist as a template to begin your review…. Consider reviewing these high-risk areas for
- [MDS to Transition to iQIES - Action Required!](https://proactiveltcexperts.com/mds-to-transition-to-iqies-action-required/) - CMS will be migrating MDS submission and reporting to the internet Quality Improvement and Evaluation System (iQIES) in early 2023. The iQIES portal is available at https://iqies.cms.gov/ and will soon be the new interface for MDS submission and reporting, replacing the current Assessment Submission and Processing (ASAP) and the Certification and Survey Provider Enhanced Reports
- [Ask Proactive – Can a resident requiring the CDC updated “Enhanced Barrier Precautions” be coded in Section O0100M for Isolation or Quarantine?](https://proactiveltcexperts.com/ask-proactive-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-t-2/) - 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 in Section O0100M. The EBP do not restrict residents to their rooms
- [QAPI Efficacy: From Plan to Sustained Improvement](https://proactiveltcexperts.com/qapi-efficacy-from-plan-to-sustained-improvement/) - Nursing homes are required to develop, implement, and maintain an effective, comprehensive, and data-driven Quality Assurance & Performance Improvement (QAPI) program to improve the quality of life and quality of care delivered to residents. Establishing an effective QAPI program is more than meeting the regulatory mandate to develop a written QAPI plan. All members of
- [Proactive Summary - FY 2023 SNF Final Payment Rule](https://proactiveltcexperts.com/proactive-summary-fy-2023-snf-final-payment-rule/) - 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) 2023. In addition, the final rule includes updates for the SNF Quality Reporting Program
- [Ask Proactive – 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 I do?](https://proactiveltcexperts.com/ask-proactive-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-t/) - 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 I do? A: If a resident
- [Risk Management Strategies for the DON](https://proactiveltcexperts.com/risk-management-strategies-for-the-don/) - The word “Risk” is referenced in the CMS State Operations Manual - Appendix PP 524 times. Clearly Risk Management is a critical area of focus for the Director of Nursing and the nursing department. According to the article Clinical Areas of Liability: Risk Management Concerns in Long- Term Care in the January 2005 Annals for
- [Detecting the Root Cause of Infection Events](https://proactiveltcexperts.com/detecting-the-root-cause-of-infection-events/) - Federal regulations require the facility Infection Preventionist (IP) to be a participant on the facility’s Quality Assessment and Assurance (QAA) committee and report on the Infection Prevention and Control Program (IPCP) and on incidents (e.g., healthcare-associated infections (HAIs)) identified under the program on a regular basis. Reporting may include, but is not limited to, facility
- [Update: SNF Qualifying Hospital Stay (QHS), Benefit Period Waivers and Medical Review Preparedness](https://proactiveltcexperts.com/update-snf-qualifying-hospital-stay-qhs-benefit-period-waivers-and-medical-review-preparedness-2/) - Effective July 15, 2022, HHS Secretary extended the PHE, the new expiration date being October 13, 2022. CMS continues to recognize that disruptions arising from a PHE can affect coverage under the SNF benefit: Prevent a patient from having the 3-day inpatient QHS Disrupt the process of ending the patient’s current benefit period and renewing
- [Ask Proactive – 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?](https://proactiveltcexperts.com/ask-proactive-what-happens-in-the-mds-department-when-a-building-is-being-purchased-by-a-new-company-a-colleague-mentioned-that-since-its-a-new-npi-number-we-may-need-to-complete/) - 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 ownership transactions. The more common
- [July 2022 Important New Revisions to 5 Star Methodology Expected to Penalize Up to 16% of Providers](https://proactiveltcexperts.com/july-2022-important-new-revisions-to-5-star-methodology-expected-to-penalize-up-to-16-of-providers/) - For facilities that have relied upon the strength of their staffing rating to drive the overall Five Star rating, the new guidance effective with the July 2022 refresh is estimated to negatively impact 10-16% of providers, according to a July 11 McKnight’s report (7/11 Marselas.) Changes to the Methodology for the Overall Quality Rating Effective
- [Avoiding Top 10 Deficiencies: F677 - ADL Care Provided for Dependent Residents](https://proactiveltcexperts.com/quick-list-of-significant-revisions-to-ltc-surveyor-guidance-effective-october-24th-2/) - F677 ADL care provided for dependent residents is one of the top 10 areas cited for deficient practice in the nation. This regulation states that a resident who is unable to carry out activities of daily living should receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene. How do we
- [Quick List of Significant Revisions to LTC Surveyor Guidance Effective October 24th](https://proactiveltcexperts.com/quick-list-of-significant-revisions-to-ltc-surveyor-guidance-effective-october-24th/) - On June 29, 2022, CMS issued QSO-22-19-NH, announcing the release of new Interpretive Guidance for Phase 3 requirements, which went into effect November 28, 2019, and revisions to Phase 2 guidance. Surveyors will begin using this guidance to identify noncompliance on October 24, 2022. Significant revisions to the guidance include: Revisions to the guidance for
- [Ask Proactive – 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?](https://proactiveltcexperts.com/ask-proactive-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/) - 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 patient is being isolated alone in a separate room due to
- [Antibiotic Stewardship](https://proactiveltcexperts.com/antibiotic-stewardship/) - Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority. Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics in a year (Luong &
- [Perfecting the Care Planning Process: CAAs](https://proactiveltcexperts.com/perfecting-the-care-planning-process-caas/) - The Care Areas Assessment (CAA) process is the framework for decision-making after the MDS assessment has been completed, and serves as the link between the MDS and the Care Plan. The CAA process helps the interdisciplinary team evaluate the resident holistically, and to identify strengths, weaknesses, and comorbidities that will potentially impact the resident’s function,
- [Ask Proactive – We recently received a letter from our MAC informing us of findings on the Comparative Billing Report (CBR) of SNF Short-Stays for PT / PT and NTA services. Our facility triggered greater than the 90th percentile as compared to our state and jurisdiction related to claims with PT/OT Short-Stays (0-20 days LOS). Wondering if we need to complete a self-audit?  Have you seen this? What should be our next steps?](https://proactiveltcexperts.com/ask-proactive-we-recently-received-a-letter-from-our-mac-informing-us-they-had-concluded-a-comparative-billing-report-cbr-of-snf-short-stays-for-pt-pt-and-nta-services-our-facility-trig/) - Q: We recently received a letter from our MAC informing us of findings on the Comparative Billing Report (CBR) of SNF Short-Stays for PT / PT and NTA services. Our facility triggered greater than the 90th percentile as compared to our state and jurisdiction related to claims with PT/OT Short-Stays (0-20 days LOS). Wondering if
- [Ask Proactive – Unacceptable Primary Diagnoses](https://proactiveltcexperts.com/ask-proactive-our-medicare-part-a-claim-was-rejected-due-to-principal-diagnosis-is-an-unacceptable-diagnosis-correct-and-resubmit-rekey-the-principal-diagnosis-coded-on/) - Q: Our Medicare Part A claim was rejected due to “principal diagnosis is an unacceptable diagnosis. Correct and resubmit/rekey”. The principal diagnosis coded on the Medicare claim and in section I0020B of the Medicare 5-day MDS is B95.62 (MRSA infection as the cause of diseases classified elsewhere). For PDPM, this code is not a return
- [How will a Recession Impact Your Facility?](https://proactiveltcexperts.com/how-will-a-recession-impact-your-facility/) - As most facilities continue to focus efforts on recovering from the impact of the pandemic, the potential of an economic recession threatens to present the next major provider challenge. With increasing inflation, climbing interest rates, stock market declines, supply chain issues, and ongoing labor shortages there is increasing talk of a coming recession. What might
- [Ask Proactive – I’m a new DON at a skilled nursing facility and the team meeting procedures don’t appear to help the facility manage the resident or team’s needs. What items should I be sure we cover to make these meetings both efficient and effective for the team?](https://proactiveltcexperts.com/ask-proactive-im-a-new-don-at-a-skilled-nursing-facility-and-the-team-meeting-procedures-dont-appear-to-help-the-facility-manage-the-resident-or-teams-needs-what/) - Q: I’m a new DON at a skilled nursing facility and the team meeting procedures don’t appear to help the facility manage the resident or team’s needs. What items should I be sure we cover to make these meetings both efficient and effective for the team?I A: Ensuring clinical meetings are both effective and efficient
- [Ask Proactive – If someone uses a lift for transfers, how should I code G0300E, Surface-to-Surface Transfer (Transfer between bed and chair or wheelchair)?](https://proactiveltcexperts.com/ask-proactive-under-f761-what-needs-to-be-included-on-the-label-of-multi-dose-products-that-are-pulled-from-the-e-kit-brought-from-home-or-brought-from-the-hospital-2/) - Q: If someone uses a lift for transfers, how should I code G0300E, Surface-to-Surface Transfer (Transfer between bed and chair or wheelchair)? A: The RAI Manual states “If a lift device (a mechanical device that is completely operated by another person) is used, and this mechanical device is being used because the resident requires staff
- [Clinical Meetings: Is Your Team Hitting the Mark?](https://proactiveltcexperts.com/pdpm-isolation-and-supportive-documentation-2/) - With staff pressed on every side, ensuring clinical meetings are an effective use of time and resources is essential. Strong meeting processes can facilitate key objectives are met related to clinical quality, MDS assessment accuracy, risk management, and reimbursement. Facility processes should include an ongoing review of the need for skilled level of care, care
- [Ask Proactive – Under F761, what needs to be included on the label of multi-dose products that are pulled from the E-kit, brought from home or brought from the hospital?](https://proactiveltcexperts.com/ask-proactive-under-f761-what-needs-to-be-included-on-the-label-of-multi-dose-products-that-are-pulled-from-the-e-kit-brought-from-home-or-brought-from-the-hospital/) - Q: Under F761, what needs to be included on the label of multi-dose products that are pulled from the E-kit, brought from home or brought from the hospital? A: Multi-use products should be labeled with: The original manufacturer’s or pharmacy-applied label indicating the medication name; Strength; Quantity; Accessory instructions; Lot number Expiration date when applicable.
- [PDPM Isolation and Supportive Documentation](https://proactiveltcexperts.com/pdpm-isolation-and-supportive-documentation/) - Under the Patient Driven Payment Model (PDPM), resident characteristics are used to classify Medicare residents into payment groups. One of these characteristics is isolation due to an active infection. Being coded for infection isolation can have a significant impact on the Medicare payment rate for a resident’s SNF stay. The increase in a SNF resident’s
- [Ask Proactive – I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation?](https://proactiveltcexperts.com/ask-proactive-i-have-a-resident-who-was-skilled-under-part-a-services-who-was-discharged-but-remained-in-the-facility-they-were-subsequently-picked-up-under-part-a-services-again-would-the/) - Q: I have a resident who was skilled under Part A services who was discharged but remained in the facility. They were subsequently picked up under Part A services again. Would the interrupted stay rules apply to this situation? A: Possibly, but timing matters. An interrupted Stay is a Medicare Part A SNF stay in
- [Survey Ready! Staff Development & Competency Essentials](https://proactiveltcexperts.com/staff-development-planning/) - As states are working to catch up on annual recertification surveys across the nation, now is a good time to review and update your education calendar for the upcoming year. During annual surveys in 2022, surveyors will be paying additional attention to compliance with the requirements for F-726 sufficient and competent staff, which states: “The
- [Avoiding F656 Care Planning Deficiencies](https://proactiveltcexperts.com/avoiding-f656-care-planning-deficiencies/) - F656 Develop/implement comprehensive care plans is the #5 most cited deficiency nationally. This week’s blog examines what you need to know about the regulatory requirements related to F656 and how to avoid issues commonly cited by surveyors. There are five standard steps in the nursing process which guide the development of the nursing care plan:
- [Ask Proactive – Let's say I have a resident fall with injury on January 1st. How many days have to pass before it will drop off and not count against us as far as our 5-star rating?](https://proactiveltcexperts.com/ask-proactive-lets-say-i-have-a-resident-fall-with-injury-on-january-1st-how-many-days-have-to-pass-before-it-will-drop-off-and-not-count-against-us-as-far-as-our-5-star-rating/) - Q: Let's say I have a resident fall with injury on January 1st. How many days have to pass before it will drop off and not count against us as far as our 5-star rating? A: The fall with major injury will be included in the QM % for the quarter if it was coded
- [Medicare Compliance: Avoiding Common Errors on SNF Certification/Recertification](https://proactiveltcexperts.com/responding-to-an-allegation-of-abuse-3/) - 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 documentation for Physician’s Certifications/Recertifications accounted for over 35% of errors contributing to improper payments. Likewise, SNF certification/recertification accuracy
- [Ask Proactive – I conducted the pain interview with a resident recently and they stated that they have ‘almost constant’ pain and rated it as ‘moderate’. I reviewed the chart and the resident has PRN analgesic available, but never requests it, and the Q shift Pain monitoring on the MAR indicates no pain during the look back period. How should I address this on the MDS?](https://proactiveltcexperts.com/ask-proactive-i-conducted-the-pain-interview-with-a-resident-recently-and-they-stated-that-they-have-almost-constant-pain-and-rated-it-as-moderate-i-revi/) - Q: I conducted the pain interview with a resident recently and they stated that they have ‘almost constant’ pain and rated it as ‘moderate’. I reviewed the chart and the resident has PRN analgesic available, but never requests it, and the Q shift Pain monitoring on the MAR indicates no pain during the look back
- [Ask Proactive – A Medicare patient was admitted to our SNF in the morning and went home AMA later that same afternoon.  What MDS assessments need to be completed?](https://proactiveltcexperts.com/ask-proactive-a-medicare-patient-was-admitted-to-our-snf-in-the-morning-and-went-home-ama-later-that-same-afternoon-what-mds-assessments-need-to-be-completed/) - Q: A Medicare patient was admitted to our SNF in the morning and went home AMA later that same afternoon. What MDS assessments need to be completed? A: The Entry record and the unplanned discharge return not anticipated are required to be completed. In addition, since the patient was admitted and discharged prior to midnight
- [Responding to an Allegation of Abuse](https://proactiveltcexperts.com/responding-to-an-allegation-of-abuse-2/) - There are few things that can wake up a nursing home administrator faster than a phone call in the middle of the night from their facility reporting an allegation of abuse. Federal regulations require nursing facilities to promptly report any allegation of abuse, within 2 hours. This week’s blog reviews the critical action steps that
- [Avoiding the #4 Top Citation – F689 Free of Accident Hazards/Supervision/Devices](https://proactiveltcexperts.com/avoidingf689/) - F689 is the fourth most cited deficiency in standard surveys and the first most cited in complaint surveys so far during the 2022 Fiscal Year according to CASPER data as of 4/17/22. F689 has been cited a total of 2,010 times during standard and complaint surveys 7% cited at Severity Level 4 (Immediate Jeopardy) 3%
- [Growing MDS Experts On Your Team](https://proactiveltcexperts.com/become-an-mds-mastermind/) - With staffing challenges and ongoing industry changes looming, it can be difficult to maintain a focus on MDS accuracy despite the considerable implications for care planning, QMs and reimbursement. Some facilities have needed to rely on their MDS Coordinator(s) to fulfill different or additional responsibilities, and many have experienced increased turnover in the MDS/RAC role.
- [Ask Proactive – Can you please clarify if we can skill our patient returning to the facility following a 3 day qualifying stay at a psychiatric hospital? We have a new RAI Nurse who is hesitant to skill.](https://proactiveltcexperts.com/ask-proactive-can-you-please-clarify-if-we-can-skill-our-patient-returning-to-the-facility-following-a-3-day-qualifying-stay-at-a-psychiatric-hospital-we-have-a-new-rai-nurse-who-is-hesitan/) - Q: Can you please clarify if we can skill our patient returning to the facility following a 3-day qualifying stay at a psychiatric hospital? We have a new RAI Nurse who is hesitant to skill. A: CMS speaks to skilled days following a psych stay in Chapter 8 of the Medicare Benefit Policy Manual, Section
- [Ask Proactive – A nursing home resident rose out of his wheelchair, walked 2 steps, and stated “I am too weak to move any further" as staff noticed his knees beginning to buckle. Two aides assisted him onto his roommate’s bed. Is this considered a fall?](https://proactiveltcexperts.com/ask-proactive-our-medical-director-has-been-conducting-most-of-his-visits-via-telehealth-is-there-a-date-when-physicians-will-have-to-return-to-in-person-visits/) - Q: A nursing home resident rose out of his wheelchair, walked 2 steps, and stated “I am too weak to move any further" as staff noticed his knees beginning to buckle. Two aides assisted him onto his roommate’s bed. Is this considered a fall? A: Yes, this is an intercepted fall. The resident would have
- [2022 5-Star Rating System Changes](https://proactiveltcexperts.com/2022-5-star-rating-system-changes/) - Effective with the April 2022 Five-Star refresh, CMS is now implementing the planned, regular increases to the Quality Measure (QM) rating thresholds, that were originally announced to begin in 2019 but were delayed due to the public health emergency. With the April 2022 update, the QM rating thresholds were increased by one-half of the average
- [The Ins and Outs of Immediate Jeopardy](https://proactiveltcexperts.com/immediate-jeopardy/) - There are few things that raise the alarm quicker during a facility survey than the mention of possible Immediate Jeopardy. This level of deficiency scope and severity has a significant impact on the facility staff and residents in the present and going into the future for a minimum of 3 years as part of the
- [Infection Preventionist Essentials: Infectious Diseases Common in Post-Acute Care Setting](https://proactiveltcexperts.com/infection-preventionist-essentials-infectious-diseases-common-in-post-acute-care-setting/) - Long Term Care facilities present unique infection prevention risks. Communal living environments, in general, provide an excellent breeding ground for bacteria and viruses with closed ventilation systems, regular use of common bathing facilities and shared dining areas. Residents with dementia and other conditions may have a limited ability to perform proper hand hygiene and cough
- [SNF PEPPER Available: Do you have outliers that may trigger medical review?](https://proactiveltcexperts.com/snf-pepper-available-do-you-have-outliers-that-may-trigger-medical-review/) - 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 patterns that may signal medical review risk. About PEPPER PEPPER is an educational tool that summarizes
- [Ask Proactive – My facility considers October through March as “flu season.” Does this mean flu season is officially over for MDS Section O coding purposes?](https://proactiveltcexperts.com/ask-proactive-my-facility-considers-october-through-march-as-flu-season-does-this-mean-flu-season-is-officially-over-for-mds-section-o-coding-purposes/) - Q: My facility considers October through March as “flu season.” Does this mean flu season is officially over for MDS Section O coding purposes? A: It’s best not to restrict yourself to specific date ranges for influenza vaccination seasons and reporting periods. According to the RAI: Influenza can occur at any time, but most
- [Ask Proactive – A resident went out to the ER, and while he was there, he received IV medication. Can I count that as ‘IV Medication while a resident’ under O0100H2?](https://proactiveltcexperts.com/ask-proactive-a-resident-went-out-to-the-er-and-while-he-was-there-he-received-iv-medication-can-i-count-that-as-iv-medication-while-a-resident-under-o0100h2/) - Q: A resident went out to the ER, and while he was there, he received IV medication. Can I count that as ‘IV Medication while a resident’ under O0100H2? A: If the resident was not admitted to the hospital, then he would be considered a resident of the facility while in ER and you
- [MDS 3.0 Refresh: Mastering the Art of Coding Accuracy](https://proactiveltcexperts.com/2022-medical-review-in-full-swing-2/) - Compliance, Accuracy, Quality. These are words we’ve heard over and over in long-term care. They are part of our everyday regulatory landscape and are essential to MDS data integrity. Despite two years under our belts operating under the PDPM payment model, data shows there is still room for improvement for accurate coding and reimbursement. While
- [Ask Proactive – What are some best practices for residents who refuse care?](https://proactiveltcexperts.com/ask-proactive-what-are-some-best-practices-for-residents-who-refuse-care/) - Q: What are some best practices for residents who refuse care? A: In the CMS State Operations Manual – Appendix PP in F 578 §483.10(c)(6), (c)(8), (g)(12) CMS has provided guidance regarding resident refusals: While the resident also has the right to refuse any treatment or services, the resident’s refusal does not absolve facility
- [2022 Medical Review in Full Swing](https://proactiveltcexperts.com/2022-medical-review-in-full-swing/) - While nursing homes across the nation are seeing a significant decline in COVID-19 cases, providers are reporting a sharp increase in medical review. The most prominent activity includes RAC (Recovery Auditors Contractor) reviews and TPE (Targeted Probe & Educate) reviews from the MACs (Medicare Administrative Contractors). Nursing homes can monitor active topics posted by their
- [Ask Proactive – I’ve assumed a new role that requires me to audit our compliance with reporting to NHSN. The instructions for completion of the LTCF COVID-19 module are not clear in some areas. For example, we are the designated COVID-19 unit amongst two sister facilities. If the patient acquires COVID in my sister facility, then transfers to my facility, and passes away due to the infection, do I have to count this as a resident COVID death in my facility?](https://proactiveltcexperts.com/ask-proactive-ive-assumed-a-new-role-that-requires-me-to-audit-our-compliance-with-reporting-to-nhsn-the-instructions-for-completion-of-the-ltcf-covid-19-module-are-not-clear-in-so/) - Q: I’ve assumed a new role that requires me to audit our compliance with reporting to NHSN. The instructions for completion of the LTCF COVID-19 module are not clear in some areas. For example, we are the designated COVID-19 unit amongst two sister facilities. If the patient acquires COVID in my sister facility, then transfers
- [F761 Label/Store Drugs & Biologicals](https://proactiveltcexperts.com/f761-label-store-drugs-biologicals/) - F 761 Label/Store Drugs & Biologicals is consistently a “Top 10” deficiency. Compliance with F761 is complicated by the vast number of medications and related supplies that facilities must utilize each day, along with the multiple places they must be stored, including medication carts and med rooms. Another cause of problems is the frequent interruptions
- [Ask Proactive – Are the resident quarantine requirements the same for residents who are unvaccinated and those who are vaccinated, but have not received a booster?](https://proactiveltcexperts.com/ask-proactive-are-the-resident-quarantine-requirements-the-same-for-residents-who-are-unvaccinated-and-those-who-are-vaccinated-but-have-not-received-a-booster/) - Q: Are the resident quarantine requirements the same for residents who are unvaccinated and those who are vaccinated, but have not received a booster? A: Yes, Based on updated guidance released by the CDC on Feb. 2, 2022: CDC now recommends quarantining residents who have close contact with an infected person if the resident is
- [Ask Proactive – A resident was admitted with a pressure injury (PI) that was unstageable because it was covered with slough and eschar. I coded it on the admission MDS under M0300F(Unstageable Pressure Ulcers Related to Slough and/or Eschar). I’m now doing a quarterly and the slough has been debrided, but there is still a lot of eschar. Do I still code it as unstageable on the MDS?](https://proactiveltcexperts.com/ask-proactive-a-resident-was-admitted-with-a-pressure-injury-pi-that-was-unstageable-because-it-was-covered-with-slough-and-eschar-i-coded-it-on-the-admission-mds-under-m0300funstageable/) - Q: A resident was admitted with a pressure injury (PI) that was unstageable because it was covered with slough and eschar. I coded it on the admission MDS under M0300F(Unstageable Pressure Ulcers Related to Slough and/or Eschar). I’m now doing a quarterly and the slough has been debrided, but there is still a lot of
- [Ask Proactive – We have a patient who received a skilled stay (34 days) using the spell of illness waiver (related to positive COVID condition and clinical needs). She just returned from the hospital outside her 30-day window, but still has 38 days remaining in the benefit period. Can we skill her again? How many times can we use the waiver for a patient?](https://proactiveltcexperts.com/ask-proactive-we-have-a-patient-who-received-a-skilled-stay-34-days-using-the-spell-of-illness-waiver-related-to-positive-covid-condition-and-clinical-needs-she-just-returned-from-the-h/) - Q: We have a patient who received a skilled stay (34 days) using the spell of illness waiver (related to positive COVID condition and clinical needs). She just returned from the hospital outside her 30-day window, but still has 38 days remaining in the benefit period. Can we skill her again? How many times can
- [Biden Announces Nursing Home Reforms](https://proactiveltcexperts.com/biden-announces-nursing-home-reforms/) - Biden’s March 1st State of the Union speech included a promise to bring Nursing Home Industry Reforms including minimum staffing requirements, enhanced nursing home oversight, and greater transparency of facility ownership with a focus on private equity firms. The White House shared a fact sheet outlining a vision “to improve quality of care and quality
- [Avoiding the #2 Survey Tag: F812 Food Procurement](https://proactiveltcexperts.com/avoiding-the-2-survey-tag-f812-food-procurement/) - Based on 2021 Survey Data, F-Tag 812: Food Procurement was the second most cited deficiency on annual surveys and the 5th most cited overall. So far, in 2022, it has been the #1 deficiency cited on annual survey and the 4th most cited overall. (Source: S&C's Quality, Certification and Oversight Reports (QCOR)) The State Operations
- [Guidance on Precautions for Unvaccinated Staff](https://proactiveltcexperts.com/implementing-additional-precautions-for-unvaccinated-staff-with-medical-religious-exemptions/) - According to CMS, facilities are required to “ensure that staff who are not yet fully vaccinated, or who have a pending or been granted an exemption, or who have a temporary delay as recommended by the CDC, adhere to additional precautions that are intended to mitigate the spread of COVID-19”. (CMS QSO 22-11-ALL). In this
- [Care Planning for Fall Prevention](https://proactiveltcexperts.com/care-planning-for-fall-prevention/) - Falls in nursing homes are an unfortunate, yet common occurrence. Studies show that approximately half of nursing home residents in the United States fall each year, and a 2014 report by the Office of the Inspector General found that nearly 10% of adverse events experienced by Medicare skilled nursing facility residents were falls resulting in
- [Ask Proactive – Under the NHSN Data Reporting, who is included in contracted and vendor HCP (healthcare personnel) for vaccination reporting?](https://proactiveltcexperts.com/ask-proactive-under-the-nhsn-data-reporting-who-is-included-in-contracted-and-vendor-hcp-healthcare-personnel-for-vaccination-reporting/) - Q: Under the NHSN Data Reporting, who is included in contracted and vendor HCP (healthcare personnel) for vaccination reporting? A: After the NHSN COVID-19 Vaccination Team held webinars in November 2021 that reviewed frequently asked questions (FAQs) and data entry for the COVID-19 Vaccination Modules, they clarified their guidance regarding how to report COVID-19 vaccination
- [Top Vulnerabilities in SNF Infection Prevention and Control Programs](https://proactiveltcexperts.com/top-vulnerabilities-in-snf-infection-prevention-and-control-programs/) - Is your facility at risk for one of the top vulnerabilities in SNF IPC programs? With the ongoing COVID-19 public health emergency, CMS has made Infection Prevention and Control programs (IPC) a significant focus of survey efforts. Surveys are bringing to light many shortcomings in facility IPC programs. In 2021, over 40% of nursing facilities
- [Ask Proactive – What happens if a patient receives more than 25% of therapy in a concurrent/group setting?](https://proactiveltcexperts.com/ask-proactive-what-happens-if-a-patient-receives-more-than-25-of-therapy-in-a-concurrent-group-setting/) - Q: What happens if a patient receives more than 25% of therapy in a concurrent/group setting? A: The provider will receive a warning edit on the validation report that will inform them that they have exceeded the 25% limit. The edit will state: “The total number of group and/or concurrent minutes for one or more
- [Understanding the CMS Vaccine Mandate and Compliance with F888](https://proactiveltcexperts.com/understanding-the-cms-vaccine-mandate-and-compliance-with-f888/) - BACKGROUND On November 5, 2021, CMS published an interim final rule with comment period, entitled “Medicare and Medicaid Programs; Omnibus COVID-19 health Care Staff Vaccination.” This IFC revised the infection control requirements, adding a staff vaccination mandate for health care facilities participating in the Medicare and Medicaid programs. This week’s blog takes a deep dive
- [Vaccine Mandate To-Do List with Compliance Dates](https://proactiveltcexperts.com/vaccine-mandate-to-do-list-with-compliance-dates/) - With the Supreme Court vaccine mandate decision, state surveyors (and/or CMS) will soon begin enforcing COVID-19 vaccine requirements under F888. The mandate covers all Medicare certified health care facilities under the Medicare & Medicaid requirements of participation. It does not cover Assisted Living Communities or SNFs that are neither Medicare nor Medicaid certified. There are
- [Ask Proactive – Since the Discharge MDS does not have a HIPPS code, do we have to do the BIMS/PHQ-9 interviews at DC?](https://proactiveltcexperts.com/ask-proactive-since-the-discharge-mds-does-not-have-a-hipps-code-do-we-have-to-do-the-bims-phq-9-interviews-at-dc/) - Q: Since the Discharge MDS does not have a HIPPS code, do we have to do the BIMS/PHQ-9 interviews at DC? A: Although the discharge assessment is not required for reimbursement purposes, it is required for regulatory compliance. RAI guidelines (pp. C-1-2) state that the interviews must be completed except for unplanned DC from a
- [The Primary Diagnoses Under PDPM: How to Avoid Common Mistakes](https://proactiveltcexperts.com/the-primary-diagnoses-under-pdpm-how-to-avoid-common-mistakes/) - Since the inception of PDPM, selecting the Primary Diagnosis has been a challenge for MDS/RAI coordinators. Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B largely determines reimbursement for the entire Medicare stay unless an Interim Payment Assessment (IPA) is necessary. It is essential to build strong processes and
- [A Fresh Look at Fall Prevention](https://proactiveltcexperts.com/a-fresh-look-at-fall-prevention/) - It probably comes as no surprise that falls are the number one cause of injury for seniors, the leading cause of hospital admissions for nursing home residents, and the top issue prompting facility lawsuits. The average facility fall-related cost is $17,000.00. Half of all residents fall annually and 1 in 3 of those who fall
- [Ask Proactive – I’ve just received an old findings letter from our recent RAC audit. Unfortunately, it looks like our time for open discussion has expired. What should we do next?](https://proactiveltcexperts.com/ask-proactive-ive-just-received-an-old-findings-letter-from-our-recent-rac-audit-unfortunately-it-looks-like-our-time-for-open-discussion-has-expired-what-should-we-do-next/) - Q: I’ve just received an old findings letter from our recent RAC audit. Unfortunately, it looks like our time for open discussion has expired. What should we do next? A: A phone call to the customer service number listed on the letter may prove successful. If not, the RAC will forward the denied claim(s) to
- [Ask Proactive – Should discontinued and/or revised policies still be maintained by the facility?](https://proactiveltcexperts.com/ask-proactive-should-discontinued-and-or-revised-policies-still-be-maintained-by-the-facility/) - Q: Should discontinued and/or revised policies still be maintained by the facility? A: It is always best to check with your facility legal counsel for their guidance on what documents, other than resident care records, should be maintained, where to maintain them and for how long. It is usually recommended that you keep discontinued and/or
- [Top Tips to Improve Skilled Documentation](https://proactiveltcexperts.com/top-tips-to-improve-skilled-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 order to make an appropriate judgement on whether or not
- [PDPM Insights: Are You Leaving Money on the Table?](https://proactiveltcexperts.com/are-you-leaving-money-on-the-table/) - To ensure accurate coding of all PDPM clinical conditions and comorbidities, it is essential to review the medical record prior to the 5-day MDS ARD. This chart review process is important to identify the need for gaps which may require additional supporting documentation to capture the most appropriate Medicare reimbursement for the conditions treated and
- [Ask Proactive – What do I do if a resident is admitted Med A and then has an unplanned discharge or death in facility prior to the 5 Day MDS being opened/created?](https://proactiveltcexperts.com/ask-proactive-what-do-i-do-if-a-resident-is-admitted-med-a-and-then-has-an-unplanned-discharge-or-death-in-facility-prior-to-the-5day-mds-being-opened-created/) - Q: What do I do if a resident is admitted Med A and then has an unplanned discharge or death in facility prior to the 5 Day MDS being opened/created? A: This would be considered a Missed PPS Assessment. The facility would be liable and would not be able to Medicare A for the
- [Updated CDC Guidance: Managing Staff with COVID-19 Infection or Exposure](https://proactiveltcexperts.com/updated-cdc-guidance-managing-staff-with-covid-19-infection-or-exposure/) - On Dec. 23, the CDC released updated Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2 and Strategies to Mitigate Healthcare Personnel Staffing Shortages. Key points included in the revised guidance include: In general, asymptomatic staff who have had a higher-risk exposure do not require work restriction if they have received
- [Essentials of the 12/28/21 CMS Vaccine Mandate Enforcement Memo](https://proactiveltcexperts.com/essentials-of-the-12-28-21-cms-vaccine-mandate-enforcement-memo/) - On Dec. 28, CMS released QSO-22-07-ALL Guidance for the Interim Final Rule that was released on Nov. 5, 2021 that established requirements regarding COVID-19 vaccine immunization of staff. The guidance and survey procedures included in this memo currently does not apply to the following states, who are part of lawsuits that continue to have injunctions:
- [Day in the Life of the Effective Infection Preventionst](https://proactiveltcexperts.com/day-in-the-life-of-the-effective-infection-preventionst/) - With COVID Cases on the rise again, and now 3 different COVID variants identified, COVID prevention and management is a primary focus of the Infection Preventionist (IP). However, COVID is only one of many infection related issues challenging our IP professionals today. Flu and cold season is underway, long term care visitation is now fully
- [Ask Proactive – I’m confused about the Interrupted Stay. If a Medicare A resident discharges home and then returns to the SNF two days later due to inability to care for themselves at home, is this an interrupted stay? The discharge was planned and their return was not anticipated.](https://proactiveltcexperts.com/ask-proactive-im-confused-about-the-interrupted-stay-if-a-medicare-a-resident-discharges-home-and-then-returns-to-the-snf-two-days-later-due-to-inability-to-care-for-themselves-at/) - Q: I’m confused about the Interrupted Stay. If a Medicare A resident discharges home and then returns to the SNF two days later due to inability to care for themselves at home, is this an interrupted stay? The discharge was planned and their return was not anticipated. A: This scenario can be an interrupted
- [Ask Proactive – Who is qualified to provide Restorative Aide training?](https://proactiveltcexperts.com/ask-proactive-who-is-qualified-to-provide-restorative-aide-training/) - Q: Who is qualified to provide Restorative Aide training? A: Recommend that a therapist or nurse performs the training. It would be best practice to have the therapist provide the training or have the therapist train the nurse, and then the nurse trains the CNA/RNA. The RAI Manual nor F726 specifies who provides the
- [2022 Staff Development Planning](https://proactiveltcexperts.com/2022-staff-development-planning/) - As we move into a new year, it’s a great time to review and update your 2022 education plan. According to QSO-22-02-ALL issued last month, during annual surveys in 2022, surveyors will be paying additional attention to compliance with the requirements for F-726 sufficient and competent staff, which states: “The facility must have sufficient nursing
- [Survey Management: Drafting Effective Plans of Correction](https://proactiveltcexperts.com/effective-plans-of-correction/) - 42 CFR §488.401 defines a Plan of Correction (PoC) as a plan developed by the facility and approved by CMS or the survey agency that describes the actions the facility will take to correct deficiencies and specifies the date by which those deficiencies will be corrected. The facility should not wait until the survey has
- [Ask Proactive – What happens if a patient receives more than 25 percent of their therapy in a concurrent/group setting?](https://proactiveltcexperts.com/ask-proactive-what-happens-if-a-patient-receives-more-than-25-percent-of-their-therapy-in-a-concurrent-group-setting/) - Q: What happens if a patient receives more than 25 percent of their therapy in a concurrent/group setting? A: The provider will receive a warning edit on the validation report that will inform them that they have exceeded the 25% limit. The edit will state: “The total number of group and/or concurrent minutes for
- [Standards of Care: Indwelling Catheter Use](https://proactiveltcexperts.com/standards-of-care-indwelling-catheter-use/) - Overview of F690 F690 indicates that an indwelling catheter should not be inserted unless clinically indicated and removal should occur as soon as possible. Providers and nursing staff should assess risks to avoid complications, such as CAUTI (Catheter Associated Urinary Tract Infection), sepsis and others, related to ongoing use of the catheter. Additionally, a resident
- [Ask Proactive – Our facility has had a couple claims come back with incorrect ICD 10 codes (i.e. Depression F32.9, cough r05 and low back pain m54.5). I notice that they have new digits added. Is there a resource to find new ICD-10 code changes?](https://proactiveltcexperts.com/ask-proactive-our-facility-has-had-a-couple-claims-come-back-with-incorrect-icd-10-codes-i-e-depression-f32-9-cough-r05-and-low-back-pain-m54-5-i-notice-that-they-have-new-digits-added/) - Q: Our facility has had a couple claims come back with incorrect ICD 10 codes (i.e. Depression F32.9, cough r05 and low back pain m54.5). I notice that they have new digits added. Is there a resource to find new ICD-10 code changes? A: Each year, in October, ICD-10-CM code updates occur. The 2022
- [Standards of Care: Incontinence](https://proactiveltcexperts.com/incontinence/) - Urinary incontinence is a common symptom among residents of long-term care facilities but is frequently left untreated, resulting in a high incidence of falls among other problems. Incontinence is one of the leading reasons for placement of older adults into institutionalized care. Although its prevalence increases with age, incontinence is not considered a normal part
- [Ask Proactive – We have a current patient receiving rehabilitation following a stroke. Her family signed her out for their Thanksgiving holiday meal, but kept her out overnight and didn’t return until the following evening. Her family is already asking how long they can have her out for attending their Christmas celebrations. We’re questioning if she can remain skilled if her family is able to care for her outside our SNF.](https://proactiveltcexperts.com/ask-proactive-we-have-a-current-patient-receiving-rehabilitation-following-a-stroke-her-family-signed-her-out-for-their-thanksgiving-holiday-meal-but-kept-her-out-overnight-and-didn/) - Q: We have a current patient receiving rehabilitation following a stroke. Her family signed her out for their Thanksgiving holiday meal, but kept her out overnight and didn’t return until the following evening. Her family is already asking how long they can have her out for attending their Christmas celebrations. We’re questioning if she can
- [Ask Proactive – How does a death impact the MDS assessment schedule? We had a resident that was here under Medicare A and the ARD for the PPS 5-day and Admission assessment was scheduled for the 8th day of the stay. She, unfortunately, passed away on the ARD. Do I still need to complete the 5-day/Admission?](https://proactiveltcexperts.com/ask-proactive-how-does-a-death-impact-the-mds-assessment-schedule-we-had-a-resident-that-was-here-under-medicare-a-and-the-ard-for-the-pps-5-day-and-admission-assessment-was-scheduled-for-t/) - Q: How does a death impact the MDS assessment schedule? We had a resident that was here under Medicare A and the ARD for the PPS 5-day and Admission assessment was scheduled for the 8th day of the stay. She, unfortunately, passed away on the ARD. Do I still need to complete the 5-day/Admission?
- [Regulatory Update: COVID-19 Survey Activities & Increased Oversight in Nursing Homes](https://proactiveltcexperts.com/regulatory-update-covid-19-survey-activities-increased-oversight-in-nursing-homes/) - On Nov. 12, 2021, CMS issued a memo regarding changes to COVID-19 Survey Activities and Increased Oversight in Nursing Homes. Key changes to the survey process announced in this memo include: CMS is rescinding the requirement to conduct focused infection control (FIC) surveys within 3-5 days of a COVID-19 outbreak, but survey agencies (SA) may
- [OIG Updates the Health Care Fraud Self-Disclosure Protocol](https://proactiveltcexperts.com/oig-updates-the-health-care-fraud-self-disclosure-protocol/) - The Department of Health and Human Services Office of Inspector General released an update to the Health Care Fraud Self-Disclosure Protocol (SDP). The SDP can be used by health care providers, suppliers, or other individuals or entities subject to Civil Monetary Penalties to voluntarily disclose self-discovered evidence of potential fraud. The revised version incorporates legal
- [Vaccine Mandate Policy Consideration Checklist](https://proactiveltcexperts.com/vaccine-mandate-policy-consideration-checklist/) - As your team prepares to comply with the vaccine mandate in response to CMS’ Interim Final Rule, consider this checklist to assess whether your vaccination policy addresses all requirements. Access the checklist… COVID-19 Vaccine Mandate Policy Checklist Does the policy and procedure include the following: Process facility will use for obtaining the vaccination Will
- [Ask Proactive – What services can be included as respiratory therapy on the MDS in Section O?](https://proactiveltcexperts.com/ask-proactive-what-services-can-be-included-as-respiratory-therapy-on-the-mds-in-section-o/) - Q: What services can be included as respiratory therapy on the MDS in Section O? A: The RAI manual defines Respiratory therapy (on page A-19 of Appendix A) as the following: Services that are provided by a qualified professional (defined as respiratory therapists or a respiratory nurse). “Respiratory therapy services are for the assessment,
- [Nutrition, Hydration and Weight Loss](https://proactiveltcexperts.com/nutrition-hydration-and-weight-loss/) - Maintaining adequate nutritional/hydration status and prevention of weight loss in LTC residents can be challenging. According to AMDA data, 50-60% of LTC residents experience weight changes and 12% are chronically undernourished (based on BMI). Learn more about the requirements of F692, key resident risk factors that should be monitored and strategies for effective facility processes
- [Ask Proactive – How should the SNF count total volume, mode, and type of therapy in section O of the MDS for purposes of the discharge assessment when a patient’s stay included one or more interrupted stays?](https://proactiveltcexperts.com/ask-proactive-how-should-the-snf-count-total-volume-mode-and-type-of-therapy-in-section-o-of-the-mds-for-purposes-of-the-discharge-assessment-when-a-patients-stay-included-one-or/) - Q: How should the SNF count total volume, mode, and type of therapy in section O of the MDS for purposes of the discharge assessment when a patient’s stay included one or more interrupted stays? A: SNFs should report the therapies furnished since the beginning of the Part A stay, including all parts of
- [Long Stay Quality Measures: System Strategies and Tips for Accuracy](https://proactiveltcexperts.com/long-stay-quality-measures-system-strategies-and-tips-for-accuracy/) - Quality Measures (QMs), have set the standards for SNF/LTC QA focus. QM ratings objectively assess the quality of care a skilled nursing facility provides compared to peers and play a key role in the facility selection process for the resident, their family, physicians, social workers, and discharge planners. ACOs, bundled payment providers, and insurance companies
- [Ask Proactive – What changes were made to the 5-Star Rating System in the October update to the 5-Star Technical Users’ Guide?](https://proactiveltcexperts.com/ask-proactive-what-changes-were-made-to-the-5-star-rating-system-in-the-october-update-to-the-5-star-technical-users-guide/) - Q: What changes were made to the 5-Star Rating System in the October update to the 5-Star Technical Users’ Guide? A: The 5-Star Users’ Guide was updated on 10/27/2021 with minor revisions made to the Quality Measure Rating. The changes include: The "Rate of successful return to home and community from a SNF" measure
- [Ask Proactive – We’re in the process of updating our patient discharge survey. With anticipated new CMS quality measures based on the patient or family’s interpretation of the quality of care received, what questions do you recommend including?](https://proactiveltcexperts.com/ask-proactive-were-in-the-process-of-updating-our-patient-discharge-survey-with-anticipated-new-cms-quality-measures-based-on-the-patient-or-familys-interpretation-of-the/) - Q: We’re in the process of updating our patient discharge survey. With anticipated new CMS quality measures based on the patient or family’s interpretation of the quality of care received, what questions do you recommend including? A: The SNF FY2022 Proposed Rule included two measures that will be solely based on the patient and/or
- [COVID Litigation](https://proactiveltcexperts.com/covid-litigation/) - As the COVID-19 pandemic swept through the nation in early 2020, one fact that became clear to us all was that the elderly population, especially those residing in nursing facilities, were disproportionately impacted. Around 140,000 residents and staff of nursing facilities have died from COVID-19 and there have been over 1.3 million confirmed resident/staff cases
- [Ask Proactive – I know that the 48-hour Baseline Care plan must be completed within 48 hours, but what is required to be addressed in this care plan?](https://proactiveltcexperts.com/ask-proactive-i-know-that-the-48-hour-baseline-care-plan-must-be-completed-within-48-hours-but-what-is-required-to-be-addressed-in-this-care-plan/) - Q: I know that the 48-hour Baseline Care plan must be completed within 48 hours, but what is required to be addressed in this care plan? A: In Appendix PP of the State Operations Manual, F 655 Baseline Care Plan has the following requirements: “The facility must develop and implement a baseline care plan
- [Ensuring CMI Accuracy: Don’t Miss Out on These Easy Fixes](https://proactiveltcexperts.com/ensuring-cmi-accuracy-dont-miss-out-on-these-easy-fixes/) - Are your processes achieving accurate CMI reimbursement for the care that your staff delivers? The case mix index is intended to reflect the type of residents being treated and the level of care required. Therefore, it is important to ensure that procedures are in place to identify, document, and code the conditions present and services
- [Hospice & End of Life Services in Nursing Homes](https://proactiveltcexperts.com/hospice-end-of-life-services-in-nursing-homes/) - Caring for patients nearing the end of life or in the advanced stage of a serious illness should address needs in the areas of physical comfort and practical life tasks, as well as spiritual and emotional needs. This blog overviews Hospice and Palliative Care services in nursing homes, and discusses common oversight and deficiency risks
- [Ask Proactive – If a new admission was diagnosed and treated for a UTI prior to admission, but there is not sufficient documentation to determine that UTI criteria (McGeer's) was met, do I code it in Section I?](https://proactiveltcexperts.com/ask-proactive-if-a-new-admission-was-diagnosed-and-treated-for-a-uti-prior-to-admission-but-there-is-not-sufficient-documentation-to-determine-that-uti-criteria-mcgeers-was-met-do-i-co/) - Q: If a new admission was diagnosed and treated for a UTI prior to admission, but there is not sufficient documentation to determine that UTI criteria (McGeer's) was met, do I code it in Section I? A: In the case of UTI diagnosis within 30 days of the admission ARD, UTI evidence-based criteria does
- [The Relationship Between the Standards of Care (SoC) and a Wrongful Death](https://proactiveltcexperts.com/the-relationship-between-the-standards-of-care-soc-and-a-wrongful-death/) - Wrongful death claims pose a significant concern for healthcare facilities. In a 2019 review of claims, roughly half of fall-related claims involved a death and 62% of closed claims involved death related to pressure injury with total payments related to pressure injury allegations averaging $246, 386.00 (Excelas, 2019). How can your facility ensure that the
- [Ask Proactive – Can you code restorative programs in section O that are completed while performing ADL care? For example, can you code AROM when a resident is lifting their arms & legs while bathing & dressing?](https://proactiveltcexperts.com/ask-proactive-can-you-code-restorative-programs-in-section-o-that-are-completed-while-performing-adl-care-for-example-can-you-code-arom-when-a-resident-is-lifting-their-arms-legs-while-b/) - Q: Can you code restorative programs in section O that are completed while performing ADL care? For example, can you code AROM when a resident is lifting their arms & legs while bathing & dressing? A: No. For both active and passive range of motion, the RAI Manual states that movement by a resident
- [Ask Proactive – Since there are no changes to the MDS Item Set for this FY, am I able to open/schedule October assessments now without worry?](https://proactiveltcexperts.com/ask-proactive-since-there-are-no-changes-to-the-mds-item-set-for-this-fy-am-i-able-to-open-schedule-october-assessments-now-without-worry/) - Q: Since there are no changes to the MDS Item Set for this FY, am I able to open/schedule October assessments now without worry? A: While it is true that there are no CMS directed changes to the MDS Item Sets for FY 2022, it would still be prudent to validate the RUG/PDPM version
- [Medical Review: Preparing for TPE Audits](https://proactiveltcexperts.com/medical-review-preparing-for-tpe-audits/) - The Centers for Medicare & Medicaid Services (CMS) indicated in an August 2021 MLNConnects newsletter that the targeted probe and educate (TPE) program would resume ending the temporary suspension since in place since March 2020 due to the COVID-19 public health emergency (PHE). While an exact date for resumption was not provided, some Medicare Administrative
- [Leading Through Chaos](https://proactiveltcexperts.com/leading-through-chaos/) - “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 experience, history has shown that some of the greatest
- [Ask Proactive – For the goals you do not set in Section GG, should you use a dash or an “09” Not Applicable? Won’t dashes affect the QRP?](https://proactiveltcexperts.com/ask-proactive-is-the-monoclonal-antibody-infusion-considered-an-iv-med-for-mds-coding-purposes-2/) - Q: For the goals you do not set in Section GG, should you use a dash or an “09” Not Applicable? Won’t dashes affect the QRP? A: A dash may be used in column 2 of section GG for any goals that are not set, and not affect the QRP as long as at
- [F689 Accident Hazards/Supervision/Devices](https://proactiveltcexperts.com/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 from B to L, with the majority (1,858) cited at the D level
- [SNF Waiver Clarification Issued & Medical Review Anticipated](https://proactiveltcexperts.com/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 clarified the following: “these emergency measures don’t waive or change any other existing
- [Ask Proactive – What changes are being made to ICD-10-CM guidelines or codes for FY2022 that impact nursing facilities?](https://proactiveltcexperts.com/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, we were directed to code depression (unspecified) to F32.9, Major depressive
- [Ask Proactive – Is the monoclonal antibody infusion considered an IV med for MDS coding purposes?](https://proactiveltcexperts.com/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. Monoclonal antibodies, do not fall under transfusions, which are only
- [Addressing Pain - The “Fifth Vital Sign”](https://proactiveltcexperts.com/are-you-addressing-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). Based on this information, it is critical that we are
- [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?](https://proactiveltcexperts.com/ask-proactive-our-facility-would-like-to-start-a-process-for-assessing-post-covid-patients-to-determine-if-they-would-benefit-from-restorative-nursing-programs-this-will-be-for-those-pati/) - 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 complete the assessment and implement the program, but how do you suggest
- [Targeted Probe and Educate (TPE) Medical Review Restarting](https://proactiveltcexperts.com/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 overpayments, or with unusual billing practices compared to peers, and/ or
- [Predicting PDPM Reimbursement](https://proactiveltcexperts.com/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 Identifying reimbursement potential and the need for supporting documentation related to key clinical conditions and
- [Guest Blog: Strategies Nurse Leaders Can Take Regarding the New Vaccination Mandate](https://proactiveltcexperts.com/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 Medicaid funding. The exact guidance and compliance requirements are expected in September. Although this
- [Simplifying Interpretive Guidance for F656 Comprehensive Care Plans](https://proactiveltcexperts.com/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 of the person-centered care plan. Think of the care plan as a road map
- [Ask Proactive – Do Items V0200C1 and V0200C2. Signature of Person Completing Care Plan Decision and Date Signed have to be signed by an RN?](https://proactiveltcexperts.com/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 care planning decision-making. The person signing does
- [F761 Label/Store Drugs and Biologicals](https://proactiveltcexperts.com/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 used in the facility must be labeled in accordance with currently accepted professional principles, and include the appropriate
- [Ask Proactive – Should therapists conduct initial evaluations upon readmission of a patient in an interrupted stay under the Interrupted Stay Policy?](https://proactiveltcexperts.com/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 criteria defined by the Interrupted Stay Policy. Therefore, a stay is considered
- [Unpacking the FY22 SNF PPS Medicare Final Rule](https://proactiveltcexperts.com/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 mapping under the Patient Driven Payment Model (PDPM), and updates to both the SNF Quality Reporting
- [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?](https://proactiveltcexperts.com/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 incisions, skin grafts or drainage sites.” Additionally, the manual notes
- [CMS Returns to Per-Day CMPs](https://proactiveltcexperts.com/cms-returns-to-per-day-cmps/) - On July 28, 2021, CMS issued a memo stating that they are removing the guidance they issued in 2017 that instructed CMS Locations to impose civil monetary penalties (CMPs) for prior noncompliance solely on a per-instance basis. CMS states they will now retain the discretion to impose a per-day CMP where appropriate to address specific
- [CY2022 Medicare Part B Proposed Rule Impact to LTC Therapy Departments](https://proactiveltcexperts.com/cy2022-medicare-part-b-proposed-rule-impact-to-ltc-therapy-departments/) - Last month, CMS released the “Medicare Part B” CY 2022 Medicare Physician Fee Schedule (PFS) Proposed Rule outlining proposed changes which would take effect January 1, 2022. This proposed rule only applies to traditional Medicare and not Medicare Advantage plans. The 804-page document includes proposed therapy pay cuts, a therapist assistant differential, and updates to
- [Ask Proactive – Are there going to be any MDS Updates in October?](https://proactiveltcexperts.com/ask-proactive-are-there-going-to-be-any-mds-updates-in-october/) - Q: Are there going to be any MDS Updates in October? A: Updates are not expected. The CMS PHE Tip Sheet provides the following: The Center for Medicare and Medicaid Services (CMS) posted an update on May 8, 2020 announcing the delayed release of updated versions of the Minimum Data Set (MDS) needed to
- [Census Development 101: First Impression Focused Tours](https://proactiveltcexperts.com/census-development-101-first-impression-focused-tours/) - It takes 27 seconds to make a first impression.[i] How is your facility fostering a positive impression as visitors enter the property, open your front door and wait in the lobby before a tour? The front entrance and lobby should be one of the most appealing areas of the nursing home to reflect the consistent
- [Ask Proactive – With most facilities awaiting their annual survey after waiting 15 months to 2 years without one, what are some tips for things to double check to make sure they are prepared?](https://proactiveltcexperts.com/ask-proactive-with-most-facilities-awaiting-their-annual-survey-after-waiting-15-months-to-2-years-without-one-what-are-some-tips-for-things-to-double-check-to-make-sure-they-are-prepared/) - Q: With most facilities awaiting their annual survey after waiting 15 months to 2 years without one, what are some tips for things to double-check to make sure they are prepared? A: Answer: One of the most important things to do is to make sure you have all of the Entrance Information prepared and
- [Telehealth’s Impact on Short Stay Emergency Department Visit QMs](https://proactiveltcexperts.com/has-telehealth-impacted-your-cms-quality-measures-regarding-emergency-department-visits/) - Nationally, telehealth appears to have had a positive impact on the CMS Quality Measures regarding Emergency Department (ED) Visits—has your facility shown improvement in this area? In March 2020, following the declaration of the COVID-19 public health emergency, CMS and CDC guidelines restricted hospital stays and emergency department (ED) transfers. As a result, Telehealth usage
- [Ask Proactive – How is the patient classified under PDPM if neither the BIMS nor the CPS staff assessment is completed to determine cognitive level?](https://proactiveltcexperts.com/ask-proactive-how-is-the-patient-classified-under-pdpm-if-neither-the-bims-nor-the-cps-staff-assessment-is-completed-to-determine-cognitive-level/) - Q: How is the patient classified under PDPM if neither the BIMS nor the CPS staff assessment is completed to determine cognitive level? A: If neither the BIMS nor the staff assessment is completed, a patient will be classified under PDPM as if the patient were “cognitively intact.” In other words, even if the
- [The Current State of Recertification Surveys Across the Nation](https://proactiveltcexperts.com/the-current-state-of-recertification-surveys-across-the-nation/) - Wondering when surveyors will be at your facility for your annual survey? You’re not alone. This past year has been anything but normal in terms of survey activities. Let’s take a look at the current state of recertification surveys occurring across the nation and data on trends on the most cited deficiencies. Based on survey
- [Ask Proactive – We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare Part A for this while she remains on Hospice?](https://proactiveltcexperts.com/ask-proactive-we-have-a-resident-using-hospice-services-for-end-stage-renal-disease-that-fell-and-broke-her-hip-she-had-a-3-day-hospital-stay-for-orif-prior-to-the-fall-she-was-ambulatory/) - Q: We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare Part A for this while she remains
- [Ask Proactive – Do citations received during Focused Infection Control Surveys impact my Five-Star rating?](https://proactiveltcexperts.com/ask-proactive-do-citations-received-during-focused-infection-control-surveys-impact-my-five-star-rating/) - Q: Do citations received during Focused Infection Control Surveys impact my Five-Star rating? A: Yes, focused infection control surveys are included in the rating calculation, with citations from these surveys counting towards the total weighted health inspection score (similar to how complaint survey citations are counted). Complaint inspections and focused infection control surveys are assigned
- [Ask Proactive – How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code?](https://proactiveltcexperts.com/ask-proactive-how-do-i-appropriately-code-a-periprosthetic-fracture-should-i-use-an-m-or-s-icd-10-code/) - Q: How do I appropriately code a periprosthetic fracture? Should I use an M or S ICD-10 code? A: Fractures result from trauma or injury or a pathological condition. With a periprosthetic fracture, two ICD-10 codes would be utilized. One code would include the underlying condition and the other would include the specific type of
- [Internal Investigations](https://proactiveltcexperts.com/internal-investigations/) - When you became a long-term care Administrator or Director of Nursing you probably didn’t envision that you would also wear the hat of a detective. In today’s long-term care environment, being able to conduct a thorough internal investigation is a critical strength for all administrative staff. From the report of a missing item, an accident
- [Part 2: Ready, Set, Medical Review-Preparing for PDPM Audits](https://proactiveltcexperts.com/part-2-ready-set-medical-review-preparing-for-pdpm-audits/) - The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020 this past August, but according to a June 3, 2021 announcement may now officially begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will restart later per MLN Connects
- [Ask Proactive – 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 comorbidity conditions COPD and Pulmonary Fibrosis. Now they have denied at the medical review because our MDS HIPPS code (KAPD1) did not match the plan’s approved HIPPS code (KAPF1). We billed as was approved, not what was MDS generated. Is there any way to overturn these decisions? We haven’t had luck so far.](https://proactiveltcexperts.com/ask-proactive-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-ge/) - 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 comorbidity conditions COPD and Pulmonary Fibrosis. Now they have denied at
- [Fall Prevention: Fall Risk Assessment Tools](https://proactiveltcexperts.com/fall-prevention-fall-risk-assessment-tools/) - While often preventable, falls continue to be the leading cause of both fatal and nonfatal injuries in older adults. Per the Centers for Disease Control and Prevention, each year, a typical nursing home with 100 beds reports 100 to 200 falls, with even more falls going unreported. Between half and three-quarters of nursing home residents
- [Ask Proactive – 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 still complete the PPS 5-day for billing?](https://proactiveltcexperts.com/ask-proactive-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-th/) - 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 still complete the PPS 5-day for billing? A: Per RAI pg.
- [Part 1: Ready, Set, Medical Review Resumes](https://proactiveltcexperts.com/part-1-ready-set-medical-review-resumes/) - The MACs officially resumed post-payment medical review of items and services with dates of service prior to March 2020, but may now officially begin conducting post-payment medical reviews for later dates of service. The Targeted Probe and Educate program will restart later per MLN Connects of June 3, 2021. As you prepare for the likely
- [Ins and Outs of Skilled Maintenance Therapy](https://proactiveltcexperts.com/ins-and-outs-of-skilled-maintenance-therapy/) - Skilled maintenance therapy has long been a service offering available for use in long-term care, yet this programming continues to be the source of confusion for many providers. ”Maintenance Therapy”, is often requested by patients and their representatives/families with the understanding that their loved one can continue receiving therapy to maintain function, or to prevent
- [Ask Proactive – 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?](https://proactiveltcexperts.com/ask-proactive-do-any-two-restorative-nursing-programs-count-toward-the-cmi-component-for-medicaid-case-mix/) - 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, when an employer asks employees whether they have obtained the COVID-19
- [Ask Proactive – Can a resident be on both restorative and therapy at the same time?](https://proactiveltcexperts.com/ask-proactive-can-a-resident-be-on-both-restorative-and-therapy-at-the-same-time/) - Q: Can a resident be on both restorative and therapy at the same time? A: Yes. Facilities may elect to have licensed rehabilitation professionals perform skilled therapeutic interventions that constitute a high level of complexity, or train aides in individualized programming for restorative / maintenance services. For example, the PT may address higher level
- [Pandemic Aftermath: Resident Depression](https://proactiveltcexperts.com/pandemic-aftermath-resident-depression/) - To manage COVID-19 transmission among residents, nursing facilities had to enforce social distancing between residents, their family and friends, and in certain circumstances, even residents and caregivers. The extended quarantine caused social isolation with adverse effects such as depression, loneliness, and anxiety. Prior to the pandemic, researchers estimate 30% of nursing home residents suffered from
- [Ask Proactive – We are implementing the use of Paid Feeding Assistants. Once our staff completes the state-approved training program, do we need to do anything else?](https://proactiveltcexperts.com/ask-proactive-we-are-implementing-the-use-of-paid-feeding-assistants-once-our-staff-completes-the-state-approved-training-program-do-we-need-to-do-anything-else/) - Q: We are implementing the use of Paid Feeding Assistants. Once our staff completes the state-approved training program, do we need to do anything else? A: Training is only 1 of the 3 components of the Paid Feeding Assistants federal regulation. Supervision and Resident Selection Criteria are also required. Paid feeding assistants must work
- [Driving Excellence Through SNF QAPI](https://proactiveltcexperts.com/snf-qapi-program/) - QAPI programs help to solidify strong processes for identifying and prioritizing problems and opportunities, and sustaining progress on quality objectives long term. QAPI work plans target organizational process, functions, and services provided to residents based on the analysis of performance indicator data, resident and staff input, and other information. Each skilled nursing facility (SNF) is
- [Survive Being Served](https://proactiveltcexperts.com/survive-being-served/) - Receiving a subpoena requesting medical records or to give deposition or trial testimony, is the last thing on any health care professionals wish list. Carefully assembling medical records or preparing for testimony however, is extremely important. As with most difficult tasks, effective preparation and practice, can be the key to success. Responding to Medical Record,
- [Ask Proactive – Now that long term care annual surveys have resumed in most states, what are the most frequently cited F-Tags this year?](https://proactiveltcexperts.com/ask-proactive-now-that-long-term-care-annual-surveys-have-resumed-in-most-states-what-are-the-most-frequently-cited-f-tags-this-year/) - Q: Now that long term care annual surveys have resumed in most states, what are the most frequently cited F-Tags this year? A: The top 5 most frequently cited F-Tags in standard surveys conducted from Oct 2020 – present are: F812 Food Procurement, Store/Prepare/Serve Sanitary (cited in 34.8% of standard surveys) F880 Infection Control
- [Are you meeting the requirements for Respiratory Care and Services? Don’t hold your breath…](https://proactiveltcexperts.com/are-you-meeting-the-requirements-for-respiratory-care-and-services-dont-hold-your-breath/) - As reported by the CDC, chronic lower respiratory disease and respiratory infections are leading causes of morbidity and mortality in the elderly, and perhaps unsurprisingly, provisional data indicates COVID-19 was the third leading cause of death in 2020. Given the nature of the population served, coupled with an ongoing pandemic, it’s highly likely your facility
- [Ask Proactive – When should I code respiratory failure in Section I of the MDS?](https://proactiveltcexperts.com/ask-proactive-when-should-i-code-respiratory-failure-in-section-i-of-the-mds/) - Q: When should I code respiratory failure in Section I of the MDS? A: To code any active diagnose in Section I, RAI manual requirements must be met including MD documented diagnosis in the last 60 days & supporting documentation that the diagnosis is active in the 7-day reference period. The physician may exactly
- [Overcoming the Aftermath of COVID: Weight Loss](https://proactiveltcexperts.com/overcoming-the-aftermath-of-covid-weight-loss/) - The COVID-19 Pandemic has impacted rates of weight loss in long-term care facilities both directly and indirectly. Prior to the onset of the pandemic, the Quality Measure ‘Percent of Residents Who Lose Too Much Weight’ was 5.8% at the national average (QIES Database for October 31, 2019). From March 1, 2020 through February 28, 2021,
- [Ask Proactive – Is this a Fall with Major Injury? A resident had an unwitnessed fall and self-reported that she hit her head. No injuries or concerns were noted upon post-fall evaluations. Three days later, the resident was transferred to the hospital due to chest pain and non-reactive pupils. Diagnostic imaging showed a subdural hematoma. Should this be reported on the MDS as a fall with major injury?](https://proactiveltcexperts.com/ask-proactive-is-this-a-fall-with-major-injury-a-resident-had-an-unwitnessed-fall-and-self-reported-that-she-hit-her-head-no-injuries-or-concerns-were-noted-upon-post-fall-evaluations-thr/) - Q: Is this a Fall with Major Injury? A resident had an unwitnessed fall and self-reported that she hit her head. No injuries or concerns were noted upon post-fall evaluations. Three days later, the resident was transferred to the hospital due to chest pain and non-reactive pupils. Diagnostic imaging showed a subdural hematoma. Should this
- [Ask Proactive – I know the PHE is set to expire in July. As we continue to admit new patients using the SNF waivers, what will happen if the PHE ends during the patient’s benefit period?](https://proactiveltcexperts.com/ask-proactive-i-know-the-phe-is-set-to-expire-in-july-now-as-we-continue-to-admit-new-patients-using-the-snf-waivers-what-will-happen-if-the-phe-ends-during-the-patients-benefit-p/) - Q: I know the PHE is set to expire in July. As we continue to admit new patients using the SNF waivers, what will happen if the PHE ends during the patient’s benefit period? A: Effective April 21, 2021, HHS Secretary extended the PHE, the new expiration date begin July 20, 2021. According to
- [Pressure Ulcer Prevention: What We Need to Know](https://proactiveltcexperts.com/pressure-ulcer-prevention-what-we-need-to-know/) - Pressure ulcers/injuries are significant health issues and one of the biggest challenge’s facilities face on a day-to-day basis. Preventing pressure injuries has always been a challenge, not just in long term care, but for the entire health continuum. The presence of pressure ulcers is a marker of poor overall prognosis and may contribute to premature
- [Updated CDC & CMS Guidance for Fully Vaccinated Individuals](https://proactiveltcexperts.com/updated-cdc-cms-guidance-for-fully-vaccinated-individuals/) - On April 27, 2021, the CDC provided updated Healthcare Infection Prevention & Control Recommendations in Response to COVID-10 Vaccination and CMS updated guidance related to COVID-19 testing and visitation. Revisions to QSO-20-38-NH related to facility testing requirements include: Definitions to clarify “fully vaccinated” versus “unvaccinated” status Clarification that symptomatic staff and residents should be tested
- [How Hot is Your SNF PEPPER?](https://proactiveltcexperts.com/how-hot-is-your-snf-pepper/) - As part of CMS’ goal of preventing Medicare fraud, waste and abuse, PEPPER (Program for Evaluating Payment Patterns Electronic Report) analyzes billing patterns to determine the level of risk for improper payments in key target areas. PEPPER compares your SNF’s Medicare billing patterns to the aggregate nationally, as well as to peer facilities across your
- [Ask Proactive – In addition to the 6 feet spacing guidance, handwashing and the use of masks, what other things should be considered when opening up for communal dining?](https://proactiveltcexperts.com/ask-proactive-in-addition-to-the-6-feet-spacing-guidance-handwashing-and-the-use-of-masks-what-other-things-should-be-considered-when-opening-up-for-communal-dining/) - Q: In addition to the 6 feet spacing guidance, handwashing and the use of masks, what other things should be considered when opening up for communal dining? A: On April 6, 2021, AHCA/NCAL provided a summary of the CMS guidance with the following recommendations for consideration: Identify residents who are high-risk for choking and
- [2021 Audit Forecast: Cloudy with a Chance of Storms](https://proactiveltcexperts.com/2021-audit-forecast-cloudy-with-a-chance-of-storms/) - Following a year of little to no medical review and extensive government spending, most experts forecast reimbursement compliance audits ramping up in 2021. Multiple areas are ripe for potential scrutiny, including, but not limited to PDPM coding and supportive documentation, the proper use of SNF waivers, and appropriate access to and accounting for Provider Relief
- [Ask Proactive – Is it required that the SNF primary diagnosis and the primary diagnosis for the qualifying hospital stay match?](https://proactiveltcexperts.com/ask-proactive-is-it-required-that-the-snf-primary-diagnosis-and-the-primary-diagnosis-for-the-qualifying-hospital-stay-match/) - Q: Is it required that the SNF primary diagnosis and the primary diagnosis for the qualifying hospital stay match? A: No, the SNF primary diagnosis and the primary diagnosis from the qualifying hospital stay do not need to match. We want to be sure we are assigning the most appropriate diagnosis that is supporting
- [Proactive to Partner with McKnight's LTC News](https://proactiveltcexperts.com/proactive-to-partner-with-mcknights-ltc-news/) - Proactive Medical Review (PMR) is proud to announce that Eleisha Wilkes, RN, RAC-CTA, DNS-CT will join McKnight’s Long-Term Care News (McKnight’s) as the new monthly columnist for the Ask the Payment Expert News Column. This column features responses to frequently asked questions with updates and insight related to long-term care and skilled nursing facility reimbursement,
- [FY 2022 SNF PPS Proposed Rule Released](https://proactiveltcexperts.com/fy-2022-snf-pps-proposed-rule-released/) - On April 8, 2021, the Centers for Medicare and Medicaid Services (CMS) released the FY 2022 SNF PPS Proposed Rule which will take effect October 1, 2021. As anticipated, changes to the Patient Driven Payment Model (PDPM) rates and Case Mix Indexes (CMI) are proposed. To begin, CMS proposes that the SNF PPS payment update
- [Care of the SNF Dialysis Recipient](https://proactiveltcexperts.com/care-of-the-snf-dialysis-recipient/) - Per the CDC, the prevalence of CKD in adults aged 30 years or older is expected to increase from 14.4% in 2020 to 16.7% in 2030. For those progressing to End-Stage Renal Disease (ESRD), dialysis is a crucial intervention to prolong life. While you may already be providing care and services to this demographic, it
- [Ask Proactive – We had a resident that was discharged home with family, return not anticipated. He suffered a fall after returning home, the family decided they could not care for him and readmitted him to our facility 8 hours after discharge. Since he wasn’t out after midnight, do we have to complete discharge/entry MDS assessments?](https://proactiveltcexperts.com/ask-proactive-we-had-a-resident-that-was-discharged-home-with-family-return-not-anticipated-he-suffered-a-fall-after-returning-home-the-family-decided-they-could-not-care-for-him-and-read/) - Q: We had a resident that was discharged home with family, return not anticipated. He suffered a fall after returning home, the family decided they could not care for him and readmitted him to our facility 8 hours after discharge. Since he wasn’t out after midnight, do we have to complete discharge/entry MDS assessments?
- [COVID-19 Litigation](https://proactiveltcexperts.com/covid-19-litigation/) - Nursing homes have seen a wave of complaints alleging negligence and wrongful death as a result of purportedly failing to protect residents from contracting the COVID-19 virus. As of March 23, 2021, over 9,500 complaints related to COVID-19 have already been filed in US Courts, according to the daily tracker kept by the law firm
- [Ask Proactive – With the extension of the PHE effective January 21st, can we expect the 5-star rating related to Quality Measures to remain “frozen”?](https://proactiveltcexperts.com/ask-proactive-with-the-extension-of-the-phe-effective-january-21st-can-we-expect-the-5-star-rating-related-to-quality-measures-to-remain-frozen/) - Q: With the extension of the PHE effective January 21st, can we expect the 5-star rating related to Quality Measures to remain “frozen”? A: No. In December, CMS announced quality measures posted to the Care Compare website and used in the Five Star Quality Rating System will be updated with the January refresh of
- [Ask Proactive – What time periods are reflected in the current 5-Star Rating that was updated Jan. 2021?](https://proactiveltcexperts.com/ask-proactive-what-time-periods-are-reflected-in-the-current-5-star-rating-that-was-updated-jan-2021/) - Q: What time periods are reflected in the current 5-Star Rating that was updated Jan. 2021? A: The Jan. 2021 refresh includes data for the following: Health Inspections – Your current health inspection rating includes data from your last 3 recertification surveys and deficiency findings from complaint inspections and focused infection control surveys conducted
- [Ask Proactive – If we have a resident who has a bed that is lowered very close to the floor, and we have a mat beside the bed, and the resident rolls or moves off of the bed onto the mat, is that considered a fall?](https://proactiveltcexperts.com/ask-proactive-if-we-have-a-resident-who-has-a-bed-that-is-lowered-very-close-to-the-floor-and-we-have-a-mat-beside-the-bed-and-the-resident-rolls-or-moves-off-of-the-bed-onto-the-mat-is-t/) - Q: If we have a resident who has a bed that is lowered very close to the floor, and we have a mat beside the bed, and the resident rolls or moves off of the bed onto the mat, is that considered a fall? A: Unfortunately, as you will see in this section from
- [Ask Proactive – Now that standard surveys are beginning to resume, will surveyors still conduct the annual survey if we have active COVID-19 cases in the facility and will it trigger them to combine a Focused Infection Control (FIC) Survey with the annual survey?](https://proactiveltcexperts.com/ask-proactive-now-that-standard-surveys-are-beginning-to-resume-will-surveyors-still-conduct-the-annual-survey-if-we-have-active-covid-19-cases-in-the-facility-and-will-it-trigger-them-to-c/) - Q: Now that standard surveys are beginning to resume, will surveyors still conduct the annual survey if we have active COVID-19 cases in the facility and will it trigger them to combine a Focused Infection Control (FIC) Survey with the annual survey? A: Yes, the surveyors will still conduct the annual survey if you
- [Medication Management: Best Practices for Regulatory Compliance](https://proactiveltcexperts.com/medication-management-best-practices-for-regulatory-compliance/) - Are you ready for the annual survey and the Unnecessary Medications, Psychotropic Medications, and Medication Regimen Review task that is part of that process? Surveyors select 5 residents to conduct this review on following the Critical Element Pathway. Consider these best practices as you assess the quality of your medication management program. Medication Management Fundamentals
- [Setting Priorities for 5-Star Improvement](https://proactiveltcexperts.com/setting-priorities-for-5-star-improvement/) - 2020 was anything but normal in terms of survey processes and 5-Star rating system updates. All three of the 5-Star rating system domains were temporarily held constant at some point during 2020. On Jan. 27, 2021, CMS resumed calculating nursing home 5-Star ratings in all three domains. January 2021 5-Star Revisions Health Inspection Rating: In
- [Taking Your Nursing Documentation to Court](https://proactiveltcexperts.com/taking-your-nursing-documentation-to-court/) - “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 trial have realized that their clinical documentation did not paint as
- [Ask Proactive – How are reviewers determining PDPM payment accuracy from Section GG coding?](https://proactiveltcexperts.com/ask-proactive-how-are-reviewers-determining-pdpm-payment-accuracy-from-section-gg-coding/) - Q: How are reviewers determining PDPM payment accuracy from Section GG coding? A: The Function Score calculated from coding responses to certain Section GG items impacts your PDPM rate in the nursing component and the OT/PT component. Not surprisingly, reviewers are focusing on usual performance accuracy as well as documentation to support the IDT
- [PDPM Coding & Documentation Top Risks: Tips from an Auditor (Part 2 of 2)](https://proactiveltcexperts.com/pdpm-coding-documentation-top-risks-tips-from-an-auditor-part-2-of-2/) - As we began discussing in part 1 of this article last week, the accuracy of coding, documentation and data monitoring is vital as we prepare for the inevitable start of PDPM medical review audit activity. Provider data outliers will trigger audits, and any coding that drives payment, or supports skilled services on the MDS will potentially
- [PDPM Coding & Documentation Top Risks: Tips from an Auditor (Part 1 of 2)](https://proactiveltcexperts.com/pdpm-coding-documentation-top-risks-tips-from-an-auditor-part-1-of-2/) - CMS announced that Medicare Fee for Service medical review (which was temporarily suspended due to the public health emergency,) may now resume beginning August 3, 2020. CMS has expressed their intent to examine provider behavior, patterns of therapy provision and outcomes under PDPM. It is only realistic to expect some shift in MDS coding of
- [Post-Pandemic Considerations – Moving Forward Instead of Just ‘Back to Normal’](https://proactiveltcexperts.com/post-pandemic-considerations-moving-forward-instead-of-just-back-to-normal/) - There’s nothing quite like a National Public Health Emergency to shake things up and force an altered perspective. Most providers are doing well to keep up with near-daily changes relative to managing the pandemic in its current form and, in a whirlwind of Infection Prevention, waivers, vaccination clinics and organizational challenges-- it’s hard to guess
- [Ask Proactive – I am seeking assistance for accurate coding of CVA at item I4500 of the MDS. The physician acknowledges history of stroke in his progress note during the look-back period. The patient also receives daily aspirin and requires ongoing medication management for stroke prevention, nurses monitor for potential side effects from medication including signs & symptoms of bleeding and bruising. Would this meet the criteria to code active condition CVA at I4500?](https://proactiveltcexperts.com/ask-proactive-i-am-seeking-assistance-for-accurate-coding-of-cva-at-item-i4500-of-the-mds-the-physician-acknowledges-history-of-stroke-in-his-progress-note-during-the-look-back-period-the/) - Q: I am seeking assistance for accurate coding of CVA at item I4500 of the MDS. The physician acknowledges history of stroke in his progress note during the look-back period. The patient also receives daily aspirin and requires ongoing medication management for stroke prevention, nurses monitor for potential side effects from medication including signs &
- [Restorative Nursing Program-Overcoming the Barriers and Obstacles](https://proactiveltcexperts.com/rebuilding-restorative-nursing-programming-after-covid-19-2/) - Last week we reviewed Restorative Nursing and its relationship with COVID in part 1 of this 2-part series. It’s been a tumultuous time in long-term care and restorative programs may have had to be put on the back burner temporarily. How do we rebuild and possibly even grow restorative back better, overcoming the barriers and
- [Ask Proactive – I would like to code isolation for a resident who has COVID and was in single room isolation for 4 days in the look-back period. However, the therapy documentation reports 2 episodes of the resident walking in the hallway. Can we still code isolation?](https://proactiveltcexperts.com/ask-proactive-i-would-like-to-code-isolation-for-a-resident-who-has-covid-and-was-in-single-room-isolation-for-4-days-in-the-look-back-period-however-the-therapy-documentation-reports-2-ep/) - Q: I would like to code isolation for a resident who has COVID and was in single room isolation for 4 days in the look-back period. However, the therapy documentation reports 2 episodes of the resident walking in the hallway. Can we still code isolation? A: Isolation does not need to be provided for
- [Rebuilding: Restorative Nursing Programming After COVID-19](https://proactiveltcexperts.com/rebuilding-restorative-nursing-programming-after-covid-19/) - In the heat of the pandemic battle, staffing shortages and emergency prioritization of tasks left many facilities with no choice but to triage programming. Functional decline is not unusual as residents already prone to decline faced pandemic driven activity limitations, quarantine, periods of necessary in-room isolation and possible residual “long haul” deficits following COVID-19 infection.
- [Ask Proactive – Do you recommend including concurrent therapy in your POC & rationale?  For group tx, there is a separate CPT code.  Many therapists may provide concurrent tx later in the plan of care when patient is safer.](https://proactiveltcexperts.com/ask-proactive-do-you-recommend-including-concurrent-therapy-in-your-poc-rationale-for-group-tx-there-is-a-separate-cpt-code-many-therapists-may-provide-concurrent-tx-later-in-the-plan/) - Q: Do you recommend including concurrent therapy in your POC & rationale? For group tx, there is a separate CPT code. Many therapists may provide concurrent tx later in the plan of care when patient is safer. A: Modes of Therapy are outlined in Chapter 3 of the Resident Assessment Instrument (RAI) Manual, under
- [SNF QRP Update: Infections & Staff COVID-19 Vaccination Measures Proposed](https://proactiveltcexperts.com/snf-qrp-update-infections-requiring-hospitalization-and-staff-covid-19-vaccination-measures-proposed/) - In Dec 2020, CMS issued its 2020 measures under consideration (MUC) list that included two proposed new SNF QRP quality measures (QMs). The measures under consideration are: Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization (outcome measure) SARS-CoV-2 Vaccination Coverage among Healthcare Personnel (process measure) Skilled Nursing Facility Healthcare Associated Infections Requiring Hospitalization The goal
- [Ask Proactive – What are the ARD, completion and transmission requirements for the IPA?](https://proactiveltcexperts.com/ask-proactive-what-are-the-ard-completion-and-transmission-requirements-for-the-ipa/) - Q: What are the ARD, completion, and transmission requirements for the IPA? A: The ARD may be set for any day of the SF PPS stay, beyond the ARD of the 5-day assessment. The IPA must be completed within 14 days after the ARD (ARD+14 days). The IPA must be submitted and accepted within
- [Clinical Foundations: Person-Centered Care for the Resident with Dementia](https://proactiveltcexperts.com/providing-person-centered-care-for-the-resident-with-dementia/) - There are 47 million people worldwide diagnosed with dementia and 9.9 million new cases each year (World Health Organization Media Center, 2017). It is well known that residents living with dementia have complex care needs that should be taken into account by providers involved with their care. Recognizing these challenges, person-centered care has become a
- [Ask Proactive – I have a resident with an active diagnosis of hyperglycemia who is receiving blood glucose monitoring and scheduled and sliding scale insulin during the 5-day assessment look-back period. Why is the NTA Case-mix Group NF (0 points)?](https://proactiveltcexperts.com/ask-proactive-i-have-a-resident-with-an-active-diagnosis-of-hyperglycemia-who-is-receiving-blood-glucose-monitoring-and-scheduled-and-sliding-scale-insulin-during-the-5-day-assessment-look-b/) - Q: I have a resident with an active diagnosis of hyperglycemia who is receiving blood glucose monitoring and scheduled and sliding scale insulin during the 5-day assessment look-back period. Why is the NTA Case-mix Group NF (0 points)? A: Hyperglycemia alone is not a comorbidity associated with NTA points. 2 NTA points are applied
- [PDPM Top 10 Can’t Miss Success Strategies: Driving Quality Care & Reimbursement in 2021](https://proactiveltcexperts.com/pdpm-top-10-cant-miss-success-strategies-driving-quality-care-reimbursement-in-2021/) - They say hindsight is 20/20. Most are glad to see 2020 go; it’s certainly been a challenging year. After the first full calendar year of the Patient-Driven Payment Model (PDPM), several key takeaways in terms of successful implementation strategies have become clear. Though it is estimated that SNFs brought in an average of $200 more
- [Ask Proactive – In order for us to capture in room isolation for our COVID positive residents, what is needed for supportive documentation? Also, is there a length of time this resident has to be in isolation in order to capture it?](https://proactiveltcexperts.com/ask-proactive-in-order-for-us-to-capture-in-room-isolation-for-our-covid-positive-residents-what-is-needed-for-supportive-documentation-also-is-there-a-length-of-time-this-resident-has-to/) - Q: In order for us to capture in room isolation for our COVID positive residents, what is needed for supportive documentation? Also, is there a length of time this resident has to be in isolation in order to capture it? A: The resident must have an “active” infection that is highly transmissible or with
- [Does your Falls Management Program Have Room for Improvement?](https://proactiveltcexperts.com/does-your-falls-management-program-have-room-for-improvement/) - Did you know that of the 1.6 million residents in U.S. nursing facilities, approximately half fall annually? (CDC) About 1 in 3 of those who fall will fall two or more times in a year. The CDC also indicates that one in every 10 residents who fall has a serious related injury and about 65,000
- [Focused QAPI Programming During All-Time Census Low](https://proactiveltcexperts.com/focused-qapi-programming-during-all-time-census-low/) - With occupancy in senior living communities at an all-time low of 80.7% during the fourth quarter, planning to capture accurate payments, safeguarding revenue to withstand the scrutiny of Medical Review and securing 5 star status is more important than ever as we develop QA and Compliance workplans for 2021. Consider these top areas providers should
- [Best Practices with Skilled Nursing Documentation for COVID-19+ Patients](https://proactiveltcexperts.com/best-practices-with-skilled-nursing-documentation-for-covid-19-patients/) - Through the challenges of the pandemic, charting quality may have taken a backseat to other priorities during times of staffing shortages and outbreaks. However, claims for services related to COVID-19 care are vulnerable to medical review. Consider these best practices and case examples in skilled nursing documentation performance improvement efforts: Nursing Skilled Services Whether the
- [Ask Proactive – During the COVID-19 Pandemic, some states have been allowing facilities to temporarily certify beds during the declared pandemic emergency for Medicare/Medicaid that were not already certified.  Do MDS Assessments have to be completed for residents in these beds, that are only certified temporarily?](https://proactiveltcexperts.com/ask-proactive-during-the-covid-19-pandemic-some-states-have-been-allowing-facilities-to-temporarily-certify-beds-during-the-declared-pandemic-emergency-for-medicare-medicaid-that-were-not-a/) - Q: During the COVID-19 Pandemic, some states have been allowing facilities to temporarily certify beds during the declared pandemic emergency for Medicare/Medicaid that were not already certified. Do MDS Assessments have to be completed for residents in these beds, that are only certified temporarily? A: Yes. Whenever a bed becomes certified for Medicare and/or
- [Driving Clinical Quality - Identifying Changes in Condition](https://proactiveltcexperts.com/driving-clinical-quality-identifying-changes-in-condition/) - Early identification of a change in a resident’s condition can lead to timely and effective intervention to minimize risk, avoid hospitalization, and increase the likelihood of positive patient outcomes. To identify changes in condition and be confident in reporting, staff must first understand what is normal (baseline) for a resident when first admitted to the
- [Revised Criteria for Conducting Focused Infection Control Surveys](https://proactiveltcexperts.com/revised-criteria-for-conducting-focused-infection-control-surveys/) - On 01/04/2021 CMS issued revised QSO-20-31-All. In this memo, CMS has revised the criteria requiring states to conduct focused infection control surveys due to the increased availability of resources for the testing of residents and staff and factors related to the quality of care and CMS provided Frequently Asked Questions related to health, emergency preparedness
- [Ask Proactive – What effect does the IPA have on the variable per diem rate?](https://proactiveltcexperts.com/ask-proactive-what-effect-does-the-ipa-have-on-the-variable-per-diem-rate/) - Q: What effect does the IPA have on the variable per diem rate? A: The IPA does not affect the variable per diem. When an IPA is completed and payment changes, it continues the variable per diem schedule that was established by the 5-day PPS assessment. The IPA will pay for all days from
- [Ask Proactive – After completing the PPS 5-day assessment, a Medicare resident developed symptoms and tested positive for COVID-19 later in their stay. The resident was subsequently moved to the COVID (RED) unit in single room isolation. Should I complete an IPA?](https://proactiveltcexperts.com/ask-proactive-after-completing-the-pps-5-day-assessment-a-medicare-resident-developed-symptoms-and-tested-positive-for-covid-19-later-in-their-stay-the-resident-was-subsequently-moved-to-t/) - Q: After completing the PPS 5-day assessment, a Medicare resident developed symptoms and tested positive for COVID-19 later in their stay. The resident was subsequently moved to the COVID (RED) unit in single room isolation. Should I complete an IPA? A: Once assuring that coding criteria for isolation is met (RAI Ch. 3, pg.
- [COVID-19 Point of Care Testing, CLIA Waivers, Tracking & Reporting](https://proactiveltcexperts.com/covid-19-point-of-care-testing-clia-waivers-tracking-reporting/) - Since July 20, skilled nursing facilities have the availability of various COVID-19 point-of-care (POC) rapid results tests for both residents and staff in order to fulfill the CMS guidance that recommends a baseline test and weekly testing thereafter. Facilities performing POC testing should have a CLIA waiver. For facilities that do not already have a
- [Common Citations During Infection Focused Surveys](https://proactiveltcexperts.com/common-citations-during-infection-focused-surveys/) - Now that routine surveys are beginning to take place in most states, it is important that vigilant infection prevention and control practices do not take a backseat to other survey-ready quality assurance activities. Notably, In September 2020, HHS announced a $2.0 billion payment incentive program (VBP) with $500 million per month for four months Sept-December 2020
- [COVID-19 Considerations for IPA Completion](https://proactiveltcexperts.com/covid-19-considerations-for-ipa-completion/) - The Interim Payment Assessment (IPA) is an optional assessment that may be completed to capture changes in a resident’s status and condition and to report a change in a patient’s PDPM classification. Providers determine when to complete an IPA, which may be any time after an initial/5-day assessment is completed. This “open-ended” guidance leaves facilities
- [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)?](https://proactiveltcexperts.com/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/) - 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 – Admission Performance questions in section
- [Did you miss any of Proactive’s Top 10 Most Read Blogs of 2020?](https://proactiveltcexperts.com/did-you-miss-any-of-proactives-top-10-most-read-blogs-of-2020/) - Medicaid Case Mix Index (CMI): Common Errors and Opportunities Kristen Walden & Jessica Cairns OSHA Compliant COVID-19 Reporting Janine Lehman Restorative Nursing Under PDPM Part 1 and Part 2 Kristen Walden Reducing PDPM Non-Therapy Ancillary (NTA) Opportunities Jessica Cairns & Eleisha Wilkes Common Citations During Infection Focused Surveys Shelly Maffia
- [Plan to be Deficiency Free: Strategies for 2021 Survey Success](https://proactiveltcexperts.com/plan-to-be-deficiency-free-strategies-for-2021-survey-success/) - With the challenges of 2020 dictating the priority focus for most, the New Year presents the opportunity for goal setting and strategic planning that includes 5-Star Improvement and positive survey outcomes. What should your 2021 strategic plan for survey success include? 2020 was anything but normal in terms of survey processes and 5-Star rating system updates.
- [Ask Proactive – Would I be able to capture isolation for a resident with the documentation that the resident had periods of wandering out of her room?](https://proactiveltcexperts.com/ask-proactive-would-i-be-able-to-capture-isolation-for-a-resident-with-the-documentation-that-the-resident-had-periods-of-wandering-out-of-her-room/) - Q: Would I be able to capture isolation for a resident with the documentation that the resident had periods of wandering out of her room? A: No. The resident must remain in her room and alone because of active infection. Reference Center for Medicare and Medicaid Services. (2019). MDS 3.0 RAI Manual, p.
- [The Impact of Diagnosis Coding Under PDPM Reimbursement](https://proactiveltcexperts.com/the-impact-of-diagnosis-coding-under-pdpm-reimbursement-2/) - Diagnosis coding accuracy is paramount to appropriate payment under PDPM, as ICD-10 Diagnosis codes & other patient characteristics are used as the basis for classification in determining Medicare (MCR) payment. The 5-day/Initial MDS establishes the PDPM payment category for the entire Medicare stay-- which is why good processes are paramount for establishing the principal diagnosis
- [Ask Proactive – We have a patient nearing the end of their 100 Part A days, but now he is COVID+. Will we need to have 1 non-skilled day in order to elect the benefit period waiver?](https://proactiveltcexperts.com/ask-proactive-we-have-a-patient-nearing-the-end-of-their-100-part-a-days-but-now-he-is-covid-will-we-need-to-have-1-non-skilled-day-in-order-to-elect-the-benefit-period-waiver/) - Q: We have a patient nearing the end of their 100 Part A days, but now he is COVID+. Will we need to have 1 non-skilled day in order to elect the benefit period waiver? A: In November, CMS released an update to the MLN Matters Number (SE20011 Revised) for Medicare Fee-for-Service (FFS) Response
- [Ask Proactive – What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey?](https://proactiveltcexperts.com/ask-proactive-what-is-the-best-way-for-a-facility-to-prepare-for-a-covid-19-focused-infection-control-survey/) - Q: What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey? A: One of the best ways to prepare for a COVID-19 focused Infection Control Survey is to complete a facility QA review utilizing the CMS COVID-19 Focused Infection Control Survey: Acute and Continuing Care tool. This
- [Losing the War on Weight?](https://proactiveltcexperts.com/losing-the-war-on-weight/) - Approximately 50-60% of elders in nursing homes experience unintentional weight loss (Dodd, 2020). Weight loss and malnutrition is associated with delayed wound healing, decline in functional and cognitive status, immunodeficiency, impaired muscle function, anemia, decreased bone mass, delayed surgical recovery, increased hospital readmission rates, and mortality (Shilpa, 2015). The leading causes of unintended weight loss
- [Ask Proactive – If BIMS nor the CPS Staff Assessment is completed, how is the resident’s cognitive level determined under PDPM?](https://proactiveltcexperts.com/ask-proactive-if-bims-nor-the-cps-staff-assessment-is-completed-how-is-the-residents-cognitive-level-determined-under-pdpm/) - Q: If the BIMS nor the CPS Staff Assessment is completed, how is the resident’s cognitive level determined under PDPM? A: If BIMS nor the CPS Staff Assessment is not completed the resident would be classified under PDPM as cognitively intact. If the resident has a cognitive impairment, the cognitive impairment is not considered.
- [Updating Your Emergency Preparedness Plan in the Wake of COVID-19](https://proactiveltcexperts.com/updating-your-emergency-preparedness-plan-in-the-wake-of-covid-19/) - CMS defines “emergency/disaster” as an event that can affect the facility internally as well as the overall target population or the community at large or community or a geographic area(1). COVID-19 certainly meets that definition. Even if your facility has not experienced an outbreak of COVID-19, it is important to reassess your emergency preparedness and
- [Stark Law and Anti-Kickback Statute (AKS) Final Rules Published](https://proactiveltcexperts.com/stark-law-and-anti-kickback-statute-aks-final-rules-published/) - The Department of Health and Human Services (HHS) and The Centers for Medicare and Medicaid Services (CMS) published two final rules last week, targeting the reduction of regulatory barriers to care coordination and increased flexibility for provider participation in value-based arrangements. The final rules also aim to ease compliance requirements that have, in the past,
- [Ask Proactive – Do we have to place new admissions in transmission based precautions for 14 days after admission if we have a negative COVID-19 test at the time of admission?](https://proactiveltcexperts.com/pdpm-coding-question-do-we-have-to-place-new-admissions-in-transmission-based-precautions-for-14-days-after-admission-if-we-have-a-negative-covid-19-test-at-the-time-of-admission/) - Q: Do we have to place new admissions in transmission-based precautions for 14 days after admission if we have a negative COVID-19 test at the time of admission? A: Yes, Per the CDC, new admissions should be placed in a single-person room or in a separate observation area so the resident can be monitored
- [Supporting Skilled Level of Care for the COVID Positive Resident](https://proactiveltcexperts.com/supporting-skilled-level-of-care-for-the-covid-positive-resident/) - As most providers are aware, the Centers for Medicare & Medicaid Services (CMS) suspended most Medicare fee-for-service medical reviews because of the COVID-19 pandemic on March 30, 2020. This included pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate (TPE) program, and post-payment reviews conducted by the MACs, Supplemental
- [PDPM Coding Question – What MDS assessments need to be completed when newly skilling a current resident who develops COVID? Is a Significant Change required?](https://proactiveltcexperts.com/pdpm-coding-question-what-mds-assessments-need-to-be-completed-when-newly-skilling-a-current-resident-who-develops-covid-is-a-significant-change-required/) - Q: What MDS assessments need to be completed when newly skilling a current resident who develops COVID? Is a Significant Change required? A: Presuming skilled care requirements outlined in Chapter 8 of the Medicare Benefit Policy Manual have been met, a PPS 5-day assessment will need to be scheduled with an ARD set for
- [Compliance in Action: Yearly Licensed Nurse Competency Evaluations](https://proactiveltcexperts.com/yearly-licensed-nurse-competency-evaluations/) - Under regulation §483.35 Nursing Services we find the regulatory requirement for sufficient and competent nursing staff at section §483.35(a)(3) which states “The facility must ensure that licensed nurses have the specific competencies and skill sets necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care”. The intent
- [PDPM Coding Question – Can we code morbid obesity for resident with Dx on DC Summary but BMI is not 40 or above?](https://proactiveltcexperts.com/pdpm-coding-question-can-we-code-morbid-obesity-for-resident-with-dx-on-dc-summary-but-bmi-is-not-40-or-above/) - Q: Can we code morbid obesity for resident with Dx on DC Summary but BMI is not 40 or above? A: You can assign the E66 morbid obesity code if it is specifically documented by the provider & some sort of intervention/treatment due to obesity (i.e. reduced calorie diet or weight reduction plan). If
- [PDPM Coding Question – What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey?](https://proactiveltcexperts.com/pdpm-coding-question-what-is-the-best-way-for-a-facility-to-prepare-for-a-covid-19-focused-infection-control-survey/) - Q: What is the best way for a facility to prepare for a COVID-19 focused Infection Control Survey? A: One of the best ways to prepare for a COVID-19 focused Infection Control Survey is to complete a facility QA review utilizing the CMS COVID-19 Focused Infection Control Survey: COVID-19 Focused Survey for Nursing Homes.
- [Quality Measure Coding Deep Dive: Antipsychotics](https://proactiveltcexperts.com/quality-measure-coding-deep-dive-antipsychotics/) - There are two antipsychotic quality measures, the percent of short stay residents who newly received an antipsychotic medication and the percent of long-stay residents who received an antipsychotic medication. Significantly, both of these quality measures impact the facility 5-Star rating. Currently, 1.8% of the nation’s short stay residents are started on an antipsychotic medication after
- [PDPM Coding Question – What happens if someone leaves prior to being assessed?](https://proactiveltcexperts.com/pdpm-coding-question-what-happens-if-someone-leaves-prior-to-being-assessed/) - Q: What happens if someone leaves prior to being assessed? A: When the Part A resident dies or is discharged prior to the end of the look-back period for a required assessment, the ARD must be adjusted to equal the discharge date. The provider should prepare a 5-Day assessment as completely as possible and
- [Quality Measure Coding Deep Dive: UTI & Indwelling Catheters](https://proactiveltcexperts.com/quality-measure-coding-deep-dive-uti-indwelling-catheters/) - Use of an indwelling catheter can place a resident at a higher risk for conditions such as Urinary Tract Infections (UTIs), sepsis, trauma, and hospitalization. Indwelling catheters should only be used when medically necessary and periodically re-evaluated for the appropriateness of continued use. Percent of Residents Who Have/Had a Catheter Inserted and Left in Their
- [COVID-19 Preparedness and Response Policy Quick List](https://proactiveltcexperts.com/covid-19-preparedness-and-response-policy-quick-list/) - Since the COVID-19 pandemic began, guidance from CDC, CMS, and states on effective preparedness and outbreak management is being updated frequently. It is essential that LTC providers have strong processes in place for updating facility policies and procedures and staff training on policy updates as guidance changes. Do you have all of the necessary written
- [QM Deep Dive: How Does ADL Coding Impact Quality Measures?](https://proactiveltcexperts.com/qm-deep-dive-how-does-adl-coding-impact-quality-measures/) - You may have heard that Section G of the Minimum Data Set (MDS) was going away; however, that will not be happening anytime soon. While it is true that Section G may eventually be eliminated, this change has been pushed back due to stakeholder concerns as well as the impact of the Coronavirus. As of
- [Nursing PDPM Documentation Suffering Due to COVID-19?](https://proactiveltcexperts.com/nursing-pdpm-documentation-suffering-due-to-covid-19/) - Has nursing documentation and internal auditing suffered due to COVID-19 prevention or outbreak efforts? Many facilities have had to prioritize staff and resources in order to meet the challenge of the public health emergency and the many additional responsibilities being faced in nursing homes. However, as Medicare medical review activity has restarted, we are seeing
- [PDPM Coding Question – A resident had a fall and suffered a traumatic brain injury. Should we be using the 169 codes for deficits following other nontraumatic intracranial hemorrhage if the deficits are related to the fall with traumatic brain injury?](https://proactiveltcexperts.com/pdpm-coding-question-why-am-i-receiving-this-error-message-for-submitted-obra-assessments-on-my-final-validation-report-2/) - Q: A resident had a fall and suffered a traumatic brain injury. Should we be using the 169 codes for deficits following other nontraumatic intracranial hemorrhage if the deficits are related to the fall with traumatic brain injury? A: S06.9- is the appropriate category for coding traumatic brain injury. D should be used as
- [Medicare Medical Review Activity Expected to Resume in August](https://proactiveltcexperts.com/medicare-medical-review-activity-expected-to-resume-in-august/) - CMS suspended most Medicare Fee-For-Service (FFS) medical review in late March due to the public health emergency (PHE). However, CMS has recently updated the COVID-19 Provider Burden Relief FAQ related to claim audit waivers. This update states that Medical Review activity is expected to resume beginning August 3, 2020, regardless of the status of the
- [PDPM Coding Questions - ARD day 7 verses day 8?](https://proactiveltcexperts.com/pdpm-coding-questions-ard-day-7-verses-day-8/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Our therapy provider said they are putting everyone’s ARD as day 7. We were planning day 8. Is there any advantage to day 7 verses 8? A: ARDs should be selected for each individual resident based on the
- [Insights on New Draft Version of 2020 MDS Item Sets](https://proactiveltcexperts.com/insights-on-new-draft-version-of-2020-mds-item-sets/) - The Centers for Medicare & Medicaid Services (CMS) announced that a new DRAFT version of the 2020 MDS item sets (v1.18.0) has been posted. The most impactful change was removing Section G from all Federal item sets. This will help eliminate the coding misunderstandings between section G & GG and place ADL evaluation solely in
- [PDPM Coding Questions - Which reimburses more: the orthopedic or neurological clinical category?](https://proactiveltcexperts.com/pdpm-coding-questions-is-the-ortho-or-neurological-category-more-reimbursement/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Which reimburses more: the orthopedic or neurological category? A: In most cases, the orthopedic pays more. In some cases, as when the resident also has cognitive impairment or SLP comorbidity, Acute Neurologic as the primary diagnosis will make overall
- [PDPM Coding Questions - Is a pacemaker placement considered a major enough surgery to use the “aftercare following surgery on the circulatory system” code?](https://proactiveltcexperts.com/pdpm-coding-questions-is-a-pacemaker-placement-considered-a-major-enough-surgery-to-where-you-would-use-the-aftercare-following-surgery-on-the-circulatory-system-code/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Is a pacemaker placement considered a major enough surgery to use the “aftercare following surgery on the circulatory system” code? A: It would generally be acceptable to use the aftercare code for pacemaker placement as an additional active
- [CMS Releases Memo Regarding COVID-19 Survey Activities and Enhanced Enforcement for Infection Control Deficiencies](https://proactiveltcexperts.com/cms-releases-memo-regarding-covid-19-survey-activities-and-enhanced-enforcement-for-infection-control-deficiencies/) - Focused Infection Control Surveys and CARES Act Funding On June 1, 2020, CMS released a memo to State Survey Agency Directors calling on states to ensure that all Medicare and Medicaid certified nursing homes receive an on-site infection control focused survey and that access to the new CARES Act funding for states will be tied
- [Q & A - Are we still restricted from utilizing telehealth therapy services for our Medicare Part A beneficiaries?](https://proactiveltcexperts.com/q-a-i-understand-that-cms-has-approved-telehealth-services-for-outpatient-therapy-as-billable-on-institutional-claims-ub-04-are-we-still-restricted-from-utilizing-telehealth-therapy-services-fo/) - Q: I understand that CMS has approved telehealth services for outpatient therapy as billable on institutional claims (UB-04). Are we still restricted from utilizing telehealth therapy services for our Medicare Part A beneficiaries? A: The Centers for Medicare & Medicaid Services (CMS) released an updated FAQ document on May 28, 2020. The document addresses 3 new
- [Q & A - When interviewing the resident using the questions in the PHQ-9, what do you do when they answer them all as “no”, but in the charting and documentation, you see they had episodes of crying or tearfulness, pain, insomnia, etc.? Is this information to be incorporated into the PHQ-9 or must we code using only the resident’s actual responses?](https://proactiveltcexperts.com/q-a-when-interviewing-the-resident-using-the-questions-in-the-phq-9-what-do-you-do-when-they-answer-them-all-as-no-but-in-the-charting-and-documentation-you-see-they-had-episo/) - Q: When interviewing the resident using the questions in the PHQ-9, what do you do when they answer them all as “no”, but in the charting and documentation, you see they had episodes of crying or tearfulness, pain, insomnia, etc.? Is this information to be incorporated into the PHQ-9 or must we code using only
- [Q & A - Will a set of updated item sets be released along-side this Errata or will the existing v3.00.3 items sets remain the official item sets?](https://proactiveltcexperts.com/q-a-will-a-set-of-updated-item-sets-be-released-along-side-this-errata-or-will-the-existing-v3-00-3-items-sets-remain-the-official-item-sets/) - Q: Will a set of updated item sets be released along-side this Errata or will the existing v3.00.3 items sets remain the official item sets? A: In response to State Medicaid Agency and stakeholder requests, CMS has updated the MDS 3.0 item sets (version 1.17.2) and related technical data specifications. These changes will support
- [Q & A - When can we expect the state PDPM OBRA CD to be released?](https://proactiveltcexperts.com/q-a-when-can-we-expect-the-state-pdpm-obra-cd-to-be-released/) - Q: When can we expect the state PDPM OBRA CD to be released? A: That item should be on ALL assessments with target date of 10/01/2020 or later. Excerpted from CMS MDS 3.0 Vendor Call on June 11, 2020.
- [Q & A - Where should the OBRA PDPM HIPPS be calculated (historically this has been Z0200, however Issue ID #12 seems to call for Z0100)?](https://proactiveltcexperts.com/q-a-where-should-the-obra-pdpm-hipps-be-calculated-historically-this-has-been-z0200-however-issue-id-12-seems-to-call-for-z0100/) - Q: Where should the OBRA PDPM HIPPS be calculated (historically this has been Z0200, however Issue ID #12 seems to call for Z0100)? A: It will be placed in Z0100 for states that have indicated they want PDPM calculations for OBRAs. We are not using Z0200 because states may want to continue calculating RUGs
- [Q & A - Will there be an updated RAI manual that will accompany these changes? If so, when will it be available?](https://proactiveltcexperts.com/q-a-will-there-be-an-updated-rai-manual-that-will-accompany-these-changes-if-so-when-will-it-be-available/) - Q: Will there be an updated RAI manual that will accompany these changes? If so, when will it be available? A: CMS will post coding instructions, but a complete RAI manual will not be occurring at this point. Excerpted from CMS MDS 3.0 Vendor Call on June 11, 2020.
- [Returning to Work After Suspected or Confirmed COVID-19](https://proactiveltcexperts.com/returning-to-work-after-suspected-or-confirmed-covid-19/) - Healthcare personnel (HCP) who are suspected or confirmed to have COVID-19 should meet the Centers for Disease Control and Prevention (CDC) Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance)[i]. Decisions about returning to work should be made in the context of local circumstances. Options include: Symptomatic HCP with
- [Facility Assessment Updates related to COVID-19 PHE](https://proactiveltcexperts.com/facility-assessment-updates-related-to-covid-19-phe/) - Federal regulations require each facility to conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies. The intent of the facility assessment is to help you determine the resources you need to competently care for your resident population during day to
- [Quality Measure Coding Deep Dive: Falls with Major Injury](https://proactiveltcexperts.com/quality-measure-coding-deep-dive-falls-with-major-injury/) - Falls management presents one of the greatest challenges to the long-term care profession. Preventing and managing falls in the facility is difficult enough without adding the increased complication of QM data that might not accurately reflect the true facility percentage of falls. The current national average on Nursing Home Compare for the Falls with Major
- [AHRQ No-Cost Nursing Home COVID-19 Networking Opportunities with $6000 PRF Incentive](https://proactiveltcexperts.com/ahrq-no-cost-nursing-home-covid-19-networking-opportunities-with-6000-prf-incentive/) - Supported by the Agency for Healthcare Research and Quality (AHRQ), and in collaboration with the Institute for Healthcare Improvement (IHI), Project ECHO is launching an interactive and collaborative community of practice for nursing homes around the country to advance improvements in COVID-19 preparedness, safety and infection control. You'll hear from experts about clinical management of
- [PDPM Coding Question – Why am I receiving this error message for submitted OBRA assessments on my Final Validation Report?](https://proactiveltcexperts.com/pdpm-coding-question-why-am-i-receiving-this-error-message-for-submitted-obra-assessments-on-my-final-validation-report/) - Q: Why am I receiving this error message for submitted OBRA assessments on my Final Validation Report? MDS 3.0 Item(s): Z0100B, RECALCULATED_Z0100B Item Values: 1.0007, 1.0008 Message Number: -3935b WARNING Message: Incorrect RUG/PDPM Version: The submitted value of the RUG/PDPM version code does not match the value calculated by the QIES ASAP System.
- [Percent of Residents Who Have Depressive Symptoms (Long Stay)](https://proactiveltcexperts.com/percent-of-residents-who-have-depressive-symptoms-long-stay/) - Percent of Residents Who Have Depressive Symptoms (Long Stay) Background The Long Stay Quality Measure, Percent of Residents Who Have Depressive Symptoms reports the percentage of long-stay residents – those whose stay is 101 days or more – who have had symptoms of depression during the 2 weeks preceding the MDS 3.0 target assessment
- [PDPM Coding Question – Should PRF payments offset expenses on the Medicare cost report?](https://proactiveltcexperts.com/should-prf-payments-offset-expenses/) - Q: Should PRF payments offset expenses on the Medicare cost report? A: No, providers should not adjust the expenses on the Medicare cost report based on PRF payments received. However, providers must adhere to HRSA’s guidance regarding appropriate uses of PRF payments, in order to ensure that the money is used for permissible purposes
- [Pressure Ulcers: How Does Your Facility Measure Up?](https://proactiveltcexperts.com/pressure-ulcers-how-does-your-facility-measure-up/) - Improving performance in pressure ulcer/injury prevalence rates within your facility will result in many benefits including improved quality measures, star ratings, survey results, and patient outcomes. If your facility’s pressure ulcer rate is above industry benchmarks or is increasing, initiating a quality improvement plan and monitoring process is imperative. It is necessary to objectively assess
- [PDPM Coding Question – Our IDT team writes a progress note for section GG collaboration. Can the note generally state, "Section GG codes vary but IDT team have collaborated to decide on appropriate GG coding for MDS?”](https://proactiveltcexperts.com/pdpm-coding-question-our-idt-team-writes-a-progress-note-for-section-gg-collaboration-can-the-note-generally-state-section-gg-codes-vary-but-idt-team-have-collaborated-to-decide-on-appr/) - Q: Our IDT team writes a progress note for section GG collaboration. Can the note generally state, "Section GG codes vary but IDT team have collaborated to decide on appropriate GG coding for MDS?” A: This statement may need to be more detailed for usual performance determination to clearly validate the MDS coding. RAI
- [PDPM Coding Question – Recently, we’ve had several new admissions who have a diagnosis of major depression. Just by talking with some residents in my rounds, I would think depression would be captured on the MDS assessment. I’m told that we almost never capture depression, but our residents seem depressed. What are we missing?](https://proactiveltcexperts.com/pdpm-coding-question-recently-weve-had-several-new-admissions-who-have-a-diagnosis-of-major-depression-just-by-talking-with-some-residents-in-my-rounds-i-would-think-depression-w/) - Q: Recently, we’ve had several new admissions who have a diagnosis of major depression. Just by talking with some residents in my rounds, I would think depression would be captured on the MDS assessment. I’m told that we almost never capture depression, but our residents seem depressed. What are we missing? A: On average,
- [Compliant Baseline Activity Care Plans](https://proactiveltcexperts.com/compliant-baseline-activity-care-plans/) - We are now all familiar with the 48-hour baseline care plan that was implemented with the Requirements of Participation (ROP). One of the often overlooked or under developed components of this care plan is the resident activity needs. While the comprehensive MDS and supplemental data collection tools are usually not fully completed within the first
- [New Details on Incentive Based Provider Relief Funds](https://proactiveltcexperts.com/new-details-on-incentive-based-provider-relief-funds/) - CARES Act Provider Relief Fund The U.S. Department of Health and Human Services (HHS) Provider Relief Fund has made $50 billion available for distribution to Medicare fee-for-service providers as financial relief during the coronavirus (COVID-19) pandemic. Phases of Distribution For Phase 1 General Distribution, HHS distributed $30 billion to eligible providers throughout the American healthcare
- [PDPM Coding Question – Can I use M codes as primary diagnosis?](https://proactiveltcexperts.com/pdpm-coding-question-can-i-use-m-codes-as-primary-diagnosis/) - Q: Can I use M codes as primary diagnosis? A: M codes can be used as long as they are not "return to provider" codes. Recommend utilizing the CMS ICD-10 Mapping Tool listed under the resources below to determine if diagnosis can be considered as primary. According to the Medicare Benefit Policy Manual, Chapter
- [PDPM Coding Question – If MDS Section GG documentation information is not filled out, can we use section G documentation to code Section GG?](https://proactiveltcexperts.com/pdpm-coding-question-if-mds-section-gg-documentation-information-is-not-filled-out-can-we-use-section-g-documentation-to-code-section-gg/) - Q: If MDS Section GG documentation information is not filled out, can we use section G documentation to code Section GG? A: The difference between Section G & Section GG is more than one letter. Key variances include the steps for assessment, assessment/look-back periods, rating scales and scoring and activity definitions. For Section G,
- [Supporting Coronavirus (COVID-19) Positive Staff Members](https://proactiveltcexperts.com/supporting-coronavirus-covid-19-positive-staff-members/) - As we know, Skilled Nursing Facilities (SNF’s) have a lot to manage during the current pandemic. Ensuring the staff and residents remain healthy has always been at the forefront in the fight against COVID-19. While there are efforts everyone needs to take to prevent the spread of illness, leaders of the facility are in a
- [PDPM Coding Question – What procedure should we follow if a staff member refuses to participate in our facility’s mandatory routine COVID-19 testing?](https://proactiveltcexperts.com/pdpm-coding-question-what-procedure-should-we-follow-if-a-staff-member-refuses-to-participate-in-our-facilitys-mandatory-routine-covid-19-testing/) - Q: What procedure should we follow if a staff member refuses to participate in our facility’s mandatory routine COVID-19 testing? A: It is recommended that your facility policy and procedure regarding COVID-19 testing is consistent with your policies for other mandated tests, such as TB testing. Because the routine testing is mandated by CMS,
- [PDPM Coding Question – Does the resident have to have a cannula in their tracheostomy to be able to code O0100E tracheostomy care?](https://proactiveltcexperts.com/pdpm-coding-question-does-the-resident-have-to-have-a-cannula-in-their-tracheostomy-to-be-able-to-code-o0100e-tracheostomy-care/) - Q: Does the resident have to have a cannula in their tracheostomy to be able to code O0100E tracheostomy care? A: No, they do not. According to page 0-9 pf the RAI manual, you can “code cleansing of the tracheostomy and/or cannula in this item”, so the presence of a cannula is not required.
- [Care Planning Considerations for COVID-19](https://proactiveltcexperts.com/care-planning-considerations-for-covid-19/) - A person-centered, comprehensive, and realistic plan of care is integral to ensuring an individual receives the best care possible. The insurgence of COVID-19 has complicated the care of those affected, either directly or indirectly in a myriad of ways. From common Coronavirus symptoms to undesired psychosocial impacts, care planning relative to this condition should be
- [PDPM Coding Question – Are days when therapy completes an evaluation only supposed to be counted as therapy days on the MDS?](https://proactiveltcexperts.com/pdpm-coding-question-are-days-when-therapy-completes-an-evaluation-only-supposed-to-be-counted-as-therapy-days-on-the-mds/) - Q: Are days when therapy completes an evaluation only supposed to be counted as therapy days on the MDS? A: The day of evaluation should be counted in terms of determining the Therapy Start Date, but not counted as a “therapy day” if no direct treatment was provided. See the below explanation from RAI
- [CMS Issues Guidance on COVID-19 Testing of NF Staff & Residents](https://proactiveltcexperts.com/cms-issues-guidance-on-covid-19-testing-of-nf-staff-residents/) - Yesterday, CMS released guidance related to Long-Term Care (LTC) facility COVID-19 testing requirements and a revised COVID-19 Focused Survey Tool. CMS has added a new regulation at 42 CFR § 483.80(h) which requires that the facility test all residents and staff for COVID-19. Noncompliance related to this new requirement will be cited at new tag F886.
- [PDPM Coding Question – If a resident admits the skilled nursing facility with two pressure ulcers and the ulcers then merge, is it appropriate to continue to code the ulcer as “present on admission”?](https://proactiveltcexperts.com/pdpm-coding-question-if-a-resident-admits-the-skilled-nursing-facility-with-two-pressure-ulcers-and-the-ulcers-then-merge-is-it-appropriate-to-continue-to-code-the-ulcer-as-present/) - Q: If a resident admits the skilled nursing facility with two pressure ulcers and the ulcers then merge, is it appropriate to continue to code the ulcer as “present on admission”? A: If two pressure ulcers merge, that were both present on admission, it would be appropriate to continue to code the merged pressure
- [Enforcement Cases Held during the Prioritization Period and Revised Survey Prioritization](https://proactiveltcexperts.com/enforcement-cases-held-during-the-prioritization-period-and-revised-survey-prioritization/) - On 08/17/2020 CMS announced that they are revising guidance on the expansion of survey activities to authorize onsite revisits and other surveys, and guidance was provided to State Survey Agencies (SA) on resolving previously “on hold” enforcement cases. A temporary expansion to the desk review policy was also announced. Background & Recent Updates On June
- [PDPM Mistakes are Costing SNFs, Analysis Indicates](https://proactiveltcexperts.com/enforcement-cases-held-during-the-prioritization-period-and-revised-survey-prioritization-2/) - Skilled Nursing News (8/20, Spanko) reports that many SNFs are failing to accurately capture PDPM reimbursement while continuing to struggle with the costs and operational concerns surrounding the pandemic. Read the full article here. Schedule a PDPM coding audit with Proactive today and ensure the coding accuracy and supportive documentation required for proper Medicare payment.
- [PDPM Coding Question – If someone comes in at a more dependent level, such as 01 - total assist for majority of things, then seems to improve to 02 – max assist on the second day, are we supposed to continue doing GG for the full 3 days?](https://proactiveltcexperts.com/pdpm-coding-question-if-someone-comes-in-at-a-more-dependent-level-such-as-01-total-assist-for-majority-of-things-then-seems-to-improve-to-02-max-assist-on-the-second-day-are/) - Q: If someone comes in at a more dependent level, such as 01 - total assist for majority of things, then seems to improve to 02 – max assist on the second day, are we supposed to continue doing GG for the full 3 days? A: The RAI Steps for Assessment (pg. GG-10) state
- [Coronavirus Disease 2019 (COVID-19) and Diabetes](https://proactiveltcexperts.com/coronavirus-disease-2019-covid-19-and-diabetes/) - The Centers for Disease Control recently held a call for providers to review the effects COVID-19 is having on those with multiple comorbidities. One of the most prevalent comorbidities in the long-term care setting is diabetes. While we still have much to learn about COVID-19 and the effects it has on individuals with diabetes, we
- [OSHA Compliant COVID-19 Reporting](https://proactiveltcexperts.com/osha-compliant-covid-19-reporting/) - Recently some facilities have been finding out the hard way that in addition to all of the other COVID-19 reporting requirements, certain employee COVID-19 cases must also be reported to OSHA. According to the Ohio Health Care Association (OHCA) presentation “Preparing for OSHA Inspections Related to COVID-19”, OSHA has been monitoring the employee cases being
- [Updated CDC Guidance: Symptom-based Strategy for DC Isolation and Return to Work](https://proactiveltcexperts.com/updated-cdc-guidance-blog-symptom-based-strategy-for-dc-isolation-and-return-to-work/) - On July 17, 2020, CDC updated the guidance related to Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance) and the Criteria for Return to Work for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance). Based on the updated guidance, a test-based strategy is no longer recommended to determine when
- [SNF PPS Final Rule, How Will It Impact Your Facility?](https://proactiveltcexperts.com/snf-pps-final-rule-how-will-it-impact-your-facility/) - On July 31, 2020 the Centers for Medicare and Medicaid Services (CMS) issued the FY 2021 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule. This updates the Medicare payment rates and Value-Based Purchasing program for Skilled Nursing Facilities effective October 1, 2020. These updates include routine technical rate-setting updates to the SNF
- [SNF Censuses Shrink as COVID-19 Concerns Grow](https://proactiveltcexperts.com/snf-censuses-shrink-as-covid-19-concerns-grow/) - In addition to the obvious concerns related to the current Public Health Emergency (PHE), the Coronavirus pandemic has created secondary challenges that numerous SNFs are facing including increased public scrutiny, changes in admission patterns, and declining census numbers. For some facilities, struggles to maintain a census comparable to that of “the good old (pre-COVID) days”
- [PBJ Staffing Data for Q2 Must be Submitted this Week](https://proactiveltcexperts.com/pbj-staffing-data-for-q2-must-be-submitted-this-week/) - Nursing home providers must resume submission of payroll-based journal (PBJ) staffing data by the end of this week. While an 1135 federal blanket waiver related to the COVID-19 public health emergency had previously suspended these data submissions, this waiver was terminated by CMS effective June 25. Nursing home providers must submit PBJ data for the
- [PDPM Coding Question – We have isolated new admissions in our facility during the Coronavirus pandemic. Can we report and get “credit” for this precautionary isolation or does the resident have to have an active infection?](https://proactiveltcexperts.com/pdpm-coding-question-we-have-isolated-new-admissions-in-our-facility-during-the-coronavirus-pandemic-can-we-report-and-get-credit-for-this-precautionary-isolation-or-does/) - Q: We have isolated new admissions in our facility during the Coronavirus pandemic. Can we report and get “credit” for this precautionary isolation or does the resident have to have an active infection? A: Precautionary isolation should not be reported in the MDS. According to the RAI we should only code O100M2 if the
- [Q & A – A resident had a UTI in the hospital but their antibiotics were finished before admitting to the facility. The DC Summary notes “UTI-Resolved”. Should UTI be coded?](https://proactiveltcexperts.com/q-a-a-resident-had-a-uti-in-the-hospital-but-their-antibiotics-were-finished-before-admitting-to-the-facility-the-dc-summary-notes-uti-resolved-should-uti-be-coded/) - Q: A resident had a UTI in the hospital but their antibiotics were finished before admitting to the facility. The DC Summary notes “UTI-Resolved”. Should UTI be coded? A: Yes, UTI must be coded in I2300 if occurred in the last 30 days. The RAI Manual (page I-13) notes, “If the diagnosis of UTI
- [PDPM Operations:  Selecting Primary Diagnosis](https://proactiveltcexperts.com/pdpm-operations-selecting-primary-diagnosis/) - Driving PDPM Operations: Selecting the Primary Diagnosis Under PDPM, the diagnosis coded on the 5-day/Initial Minimum Data Set (MDS) in section I0020B (primary reason for skilled stay) largely determines reimbursement for the entire Medicare stay, unless an Interim Payment Assessment (IPA) is necessary. CMS has mapped each primary diagnosis to one of ten PDPM clinical
- [PDPM Coding Questions - Is the malnutrition code enough?](https://proactiveltcexperts.com/pdpm-coding-questions-is-the-malnutrition-code-enough/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Is the Registered Dietician’s documentation / finding of malnutrition enough to code malnutrition or is a diagnosis needed from the MD? A: The disease conditions in Section I require a physician-documented diagnosis (or by a nurse practitioner, physician
- [Part 1:  CASPER Reports with Recommended Run Schedule](https://proactiveltcexperts.com/casper-reports-with-recommended-run-schedule/) - Using CASPER Reports for Quality Measure Monitoring with Recommended Run Schedule This is part 1 or a 2 part blog on the effective using of CASPER reports. Certification and Survey Provider Enhanced Reports, better known as CASPER, offer an assortment of real-time data that allows skilled nursing facilities (SNFs) the opportunity to pinpoint areas where
- [PDPM Coding Question – How should providers handle the claims from October?](https://proactiveltcexperts.com/pdpm-coding-question-how-should-providers-handle-the-claims-from-october/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Do you know how providers should handle the October claims that are either overpaying or underpaying since PDPM went into effect? A: To be sure, I suggest you inquire with the MAC. But CMS has indicated that they are
- [PDPM Coding Question - Can you count IV fluids given in the hospital?](https://proactiveltcexperts.com/pdpm-coding-question-can-you-count-iv-fluids-given-in-the-hospital/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Under PDPM, can you count IV fluids given in the hospital? A: Yes, any and all nutrition and hydration received in the last 7 days given at the hospital as an outpatient or an inpatient, provided they were
- [5 Action Items in 2020 to Drive 5 Star](https://proactiveltcexperts.com/5-action-items-in-2020-to-drive-5-star/) - Five Star Quality Rating System with Public Reporting 2020 marks 13 years of the Five Star Quality Rating System with public reporting on the CMS Nursing Home Compare website. Since 2008, the rating system and website have evolved with updates in 2012, 2015, 2018 and during this past year. With the April 2019 update, nearly
- [Top Priorities for Staff Development in 2020](https://proactiveltcexperts.com/top-priorities-for-staff-development-in-2020/) - Top Priorities for Staff Development in 2020 As you plan your 2020 staff training itinerary, consider addressing these important topics: Phase 3 staff training and competency requirements, advancing PDPM skills, and 5 Star Quality. The Phase 3 SNF §483.95 Training Requirements went into effect on November 28, 2019. As part of the new requirements, nursing
- [PDPM Coding Question - Will all of the IPAs during the Sept-Oct transition period be audited by CMS?](https://proactiveltcexperts.com/pdpm-coding-question-will-all-of-the-ipas-during-the-sept-oct-transition-period-be-audited-by-cms/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Will all of the IPAs during the Sept-Oct transition period be audited by CMS? A: There is no indication at this time that CMS plans to audit all of the Sept-Oct. IPAs. CMS recently posted an update to
- [PDPM Coding Question - Must Z0400 be signed if there is supporting documentation?](https://proactiveltcexperts.com/pdpm-coding-question-must-z0400-be-signed-if-there-is-supporting-documentation/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Must Z0400 be signed if there is supporting documentation in the record with the name and date completed by the correct staff member? A: All staff who completed any part of the MDS must enter their signatures, titles,
- [PDPM Coding Questions - How are IV fluids received coded?](https://proactiveltcexperts.com/pdpm-coding-questions-where-would-you-code-the-iv-fluids-for-hydration-in-hospital-if-7-day-look-back-goes-into-hospital-days/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: I have heard that IV fluids received in the hospital can be reported on the MDS if administered within the look-back period. Where is this information coded? A: IV fluids are reported at item K0510 – Parenteral/IV feeding.
- [To IPA or not to IPA, That is the Question](https://proactiveltcexperts.com/to-ipa-or-not-to-ipa-that-is-the-question/) - While a SNF's decision to complete the IPA itself is optional, they must remain fully aware of any changes in a resident's condition. The Interim Payment Assessment (IPA) is an optional assessment that may be completed to capture changes in a resident’s status and condition and to report a change in a patient’s PDPM
- [Support Nurse Retention With Targeted Professional Development](https://proactiveltcexperts.com/why-should-you-sign-up-for-the-6-week-mds-session/) - Targeted vs. Targeting Nursing staff have undergone a major change with the transition to PDPM creating an added stressor to an already demanding job. Opportunities for professional development have been found to be a key retention factor contributing to career satisfaction and quality of care. Even the most seasoned RAI coordinators are traversing new territory as
- [PDPM Coding Questions - Why aren’t the Nursing and NTA components reflecting the MDS report?](https://proactiveltcexperts.com/pdpm-coding-questions-what-mds-item-is-in-the-crosswalk-for-these-to-map-and-for-the-nursing-category-is-to-map-to-clinically-complex/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: We reported on the MDS that a resident received IV medications in the hospital within the look-back period. Why aren’t the Nursing and NTA components reflecting this? A: IV medications only impact the NTA and Nursing component if
- [Do you have necessary Policies & Procedures in place for PDPM Compliance?](https://proactiveltcexperts.com/do-you-have-necessary-policies-procedures-in-place-for-pdpm-compliance/) - Join our 2020 Webinar Series! If you’re like most facilities, you’ve spent the past year training staff, improving coding practices and updating interdisciplinary meetings to incorporate the many changes brought with the onset of PDPM. But have you included a review of facility policies and procedures in your operational updates? PDPM requires many process adaptations
- [PDPM Coding Questions – We have a new Part A skilled admission who was treated during qualifying hospital stay. What should we do in this situation?](https://proactiveltcexperts.com/we-have-a-new-part-a-skilled-admission-who-was-treated-during-qualifying-hospital-stay-what-should-we-do-in-this-situation/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: We have a new Part A skilled admission who was treated for dehydration, weakness, and nausea during qualifying hospital stay. There are no other diagnosis requiring treatment noted in the hospital documentation. All of these diagnosis map to
- [PDPM Coding Questions – Does the Primary diagnosis code entered at I0020B also need to be entered as an active diagnosis at I8000?](https://proactiveltcexperts.com/does-the-primary-diagnosis-code-entered-at-i0020b-also-need-to-be-entered-as-an-active-diagnosis-at-i8000/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Does the Primary diagnosis code entered at I0020B also need to be entered as an active diagnosis at I8000? A: Yes, per the RAI guidelines for coding I0020, it states “Include the primary medical condition coded in this
- [Reducing Missed Non-Therapy Ancillary (NTA) Opportunities](https://proactiveltcexperts.com/reducing-missed-non-therapy-ancillary-nta-opportunities/) - When reviewing the CMI components driving PDPM reimbursement it’s important to consider the critical role of the Non-Therapy Ancillary (NTA) score. The NTA component score is based on the presence of certain comorbidities and/or the use of extensive services. CMS identified 50 conditions and services that were related to an increased cost for skilled nursing
- [PDPM Coding Questions – Who would be the best person to lead the daily clinical meeting for new admissions?](https://proactiveltcexperts.com/pdpm-coding-questions-who-would-be-the-best-person-to-lead-the-daily-clinical-meeting-for-new-admissions/) - Q: Who would be the best person to lead the daily clinical meeting for new admissions? A: This may differ from facility to facility. The person would preferably be a clinician who has the most knowledge of the newly admitted patient(s). While this is usually the DON, in some cases it is another member of
- [Responding to an Allegation of Abuse](https://proactiveltcexperts.com/responding-to-an-allegation-of-abuse/) - An allegation of abuse has been made in your facility—how do you respond? Providers should be well trained and prepared for this possibility, beginning with a clear understanding of the definition of abuse and the related regulations. Per regulatory guidance of F600, “Abuse,” is defined at §483.5 as “the willful infliction of injury, unreasonable confinement,
- [PDPM Coding Questions – With section GG replacing Section G in October, will CNA ADL charting go away?](https://proactiveltcexperts.com/pdpm-coding-questions-with-section-gg-replacing-section-g-in-october-will-cna-adl-charting-go-away/) - Q: With section GG replacing Section G in October, will CNA ADL charting go away? A: CMS posted a new DRAFT version of the 2020 MDS item sets (v1.18.0) on December 20, 2019 in which Section G has been removed from all Federal item sets. This will help eliminate the coding misunderstandings between section G
- [Have you updated your Facility Assessment for 2020?](https://proactiveltcexperts.com/have-you-updated-your-facility-assessment-for-2020/) - Nursing facilities are required to complete a comprehensive Facility Assessment as part of the Requirements of Participation (RoP.) The assessment must be presented to surveyors during each annual survey within four hours of entrance. Surveyors will review the assessment to determine the level to which care and resources have been thoroughly evaluated to make thoughtful
- [PDPM Coding Questions – I have NPO resident on tube feeding. He coughed during trials of nectar thick liquids per speech therapy. Should the MDS be coded for swallow problems?](https://proactiveltcexperts.com/pdpm-coding-questions-i-have-npo-resident-on-tube-feeding-he-coughed-during-trials-of-nectar-thick-liquids-per-speech-therapy-should-the-mds-be-coded-for-swallow-problems/) - Q: I have NPO resident on tube feeding. He coughed during trials of nectar thick liquids per speech therapy. Should the MDS be coded for swallow problems? The RD says directions on the MDS RAI manual say “do not code if interventions are successful in treating problem.” Successful intervention is NPO, she says. The other
- [Top 3 Survey Tags of 2019 and How to Avoid Them](https://proactiveltcexperts.com/top-3-survey-tags-of-2019-and-how-to-avoid-them/) - As we begin a new year, there is benefit in evaluating lessons learned in 2019 to establish improvement goals for 2020. As you know, both annual surveys and complaint surveys can have a significant impact on the overall 5-Star Rating. To help guide action planning, let’s review the top 3 citations of 2019 and strategies
- [PDPM Coding Questions – What would happen if the interrupted stay criteria was met, but the resident came back from the hospital with a new diagnosis?](https://proactiveltcexperts.com/pdpm-coding-questions-what-would-happen-if-the-interrupted-stay-criteria-was-met-but-the-resident-came-back-from-the-hospital-with-a-new-diagnosis/) - Q: What would happen if the interrupted stay criteria was met, but the resident came back from the hospital with a new diagnosis? A: In order to utilize Medicare benefits, even if the criteria of the Interrupted Stay Policy have been met, the resident must first meet all Original Part A technical and level
- [PDPM Coding Questions – If a resident is cut from skilled services but a new skilled need arises during the interrupted stay window, would the facility be allowed to re-skill the resident?](https://proactiveltcexperts.com/pdpm-coding-questions-if-a-resident-is-cut-from-skilled-services-but-a-new-skilled-need-arises-during-the-interrupted-stay-window-would-the-facility-be-allowed-to-re-skill-the-resident/) - Q: If a resident is cut from skilled services but a new skilled need arises during the interrupted stay window, would the facility be allowed to re-skill the resident? A: The Medicare Benefit Policy Manual, Chapter 8 states that “Another qualifying hospital stay would not be required, providing the care furnished is clearly related
- [Infection Preventionist Work Plan Considerations](https://proactiveltcexperts.com/infection-control/) - Infection control is a crucial, though sometimes overlooked, component of health care. It’s been suggested that nursing home residents are at greater risk of developing infections than the general population. This can be tied to the congregative setting of the nursing home, as well as the comorbidities that many of the residents within the nursing
- [PDPM Coding Questions – Can you continue to skill with a resolved diagnosis? We have been discharging resident from skilled services once the active diagnosis is resolved example: UTI, E. coli, and pneumonia. Are we correctly doing this?](https://proactiveltcexperts.com/pdpm-coding-questions-can-you-continue-to-skill-with-a-resolved-diagnosis-we-have-been-discharging-resident-from-skilled-services-once-the-active-diagnosis-is-resolved-example-uti-e-coli/) - Q: Can you continue to skill with a resolved diagnosis? We have been discharging resident from skilled services once the active diagnosis is resolved example: UTI, E. coli, and pneumonia. Are we correctly doing this? A: Providers should assess the resident’s need for skilled services based on the whole clinical picture. Skilled coverage requirements
- [PDPM Coding Questions – If a physician diagnoses “sepsis” but no mention of septicemia, and blood cultures come back negative, can you still code “Septicemia” in I2100?](https://proactiveltcexperts.com/pdpm-coding-questions-if-a-physician-diagnoses-sepsis-but-no-mention-of-septicemia-and-blood-cultures-come-back-negative-can-you-still-code-septicemia-in/) - Q: If a physician diagnoses “sepsis” but no mention of septicemia, and blood cultures come back negative, can you still code “Septicemia” in I2100? A: When you search for septicemia in the ICD-10 coding guidelines, you are cross-referenced to see sepsis & specify the type of organism or use the unspecified code. Therefore, if
- [Nursing Home Compliance:  HIPAA Privacy & Security Essentials](https://proactiveltcexperts.com/nursing-home-compliance-hipaa-privacy-security-essentials/) - As you prepare the SNF Compliance and Ethics Program work plan for 2020, consider planning a review of the facility HIPAA privacy and security program and take steps to manage risk. Consider these 12 tips to get started: Designate a privacy officer, security officer, and/or compliance designee that fulfills the obligations related to ongoing
- [CMS Decides to Retain the CCI Edits That Were in Effect Prior to January 1, 2020](https://proactiveltcexperts.com/cms-decides-to-retain-the-cci-edits-that-were-in-effect-prior-to-january-1-2020/) - The therapy industry recently received some good news in terms of hard edits that were previously applied effective January 1, 2020 without warning. Our blog posted on 1/16/2020 shared that therapeutic activities (97530) and group therapy (97150) could no longer be billed on the same day as an occupational or physical therapy evaluation - 97161-97163
- [Person-Centered Care Planning](https://proactiveltcexperts.com/person-centered-care-planning/) - “Person-centered”, “Individualized”, “Resident-focused”; whatever you may call it, it’s past time to evolve from the institutionalized, staff-focused care planning we’ve become accustomed to and embrace the requirement that the individual has control over their life and care choices. But you may be thinking, many people make poor choices! That’s the catch. As always, it is
- [Restorative Nursing Under PDPM - Part 1](https://proactiveltcexperts.com/restorative-nursing-under-pdpm-part-1/) - The QM, Functional Outcome & Reimbursement Perks of Restorative Nursing Restorative & PDPM Several months into the swing of PDPM, some facilities are taking a second look at the benefits of restorative nursing programs. In many cases, facilities may need to develop a restorative program from the ground up, and in others there may be significant
- [Q & A – How do you pull the 5-Star Report?](https://proactiveltcexperts.com/q-a-how-do-you-pull-the-5-star-report/) - Q: How do you pull the 5-Star Report? A: Select the CASPER Reporting link located on the CMS QIES Systems for Providers page. Once in the CASPER Reporting system, select the 'Folders' button and access the Five Star Report in your 'st LTC facid' folder, where st is the 2-character postal code of the
- [Upcoming Five Star Insights: Achieve 5 Star in 2020 Webinar Series](https://proactiveltcexperts.com/upcoming-five-star-insights-achieve-5-star-in-2020-webinar-series/) - This 10-part webinar series will focus on mastering the three domains of the CMS 5-Star Quality Rating System: Health Inspections, Staffing, and Quality Measures. You will learn how to analyze your data and develop a results-oriented action plan to achieve 5-Star status applying QAPI principles. Why should you attend? This series will help to focus
- [Restorative Nursing Under PDPM - Part 2](https://proactiveltcexperts.com/restorative-nursing-under-pdpm-part-2/) - The QM, Functional Outcome & Reimbursement Perks of Restorative Nursing Restorative & PDPM As we began discussing in part 1 of this blog last week, there are many benefits to considering Restorative Nursing programs. In part 2 of this blog, let’s review some of the key operational considerations to address for an effective program. Training Restorative techniques
- [PDPM Coding Questions – The physician documented dehydration on the discharge summary, however the resident does not qualify for any of the 3 items listed in the RAI manual in J1550. Should dehydration be coded on the MDS?](https://proactiveltcexperts.com/pdpm-coding-questions-the-physician-documented-dehydration-on-the-discharge-summary-however-the-resident-does-not-qualify-for-any-of-the-3-items-listed-in-the-rai-manual-in-j1550-should-de/) - Q: The physician documented dehydration on the discharge summary, however, the resident does not qualify for any of the 3 items listed in the RAI manual in J1550. Should dehydration be coded on the MDS? A: The coding for dehydration is based on the presence of 2 or more indicators listed in the RAI
- [PDPM Medical Review Preparation: Tips for Assessing Data & Documentation](https://proactiveltcexperts.com/data-documentation-the-new-model-of-mitigating-audit-risks/) - Most facilities have fared better than anticipated under Patient-Driven Payment Model (PDPM). What will this mean from the standpoint of Medicare claims audits and how should we prepare for the inevitable start of medical review activity for PDPM claims? For many years, SNF medical review has focused on validating rehab medical necessity and daily skilled
- [PDPM Coding Questions – Can you capture the respiratory therapy reimbursement if the nebulizer is being administered by a nurse?](https://proactiveltcexperts.com/pdpm-coding-questions-can-you-capture-the-respiratory-therapy-reimbursement-if-the-nebulizer-is-being-administered-by-a-nurse/) - Q: Can you capture the respiratory therapy reimbursement if the nebulizer is being administered by a nurse? A: Yes, as long as the nurse is proficient in the modalities. RAI Appendix A defines Respiratory Therapy as: Services that are provided by a qualified professional (respiratory therapists, respiratory nurse). Respiratory therapy services are for the
- [PDPM Coding Questions – If the dietitian completed a malnutrition assessment and the score indicates “at risk for malnutrition”, is the assessment considered sufficient supportive documentation to code Malnutrition in Section I if the physician were to review and sign the assessment form?](https://proactiveltcexperts.com/pdpm-coding-questions-if-the-dietician-completed-the-malnutrition-assessment-and-the-the-score-indicates-at-risk-for-malnutrition-or-malnutrition-if-the-physician-reviews-and-signs-this-ass/) - Q: If the dietitian completed a malnutrition assessment and the score indicates “at risk for malnutrition”, is the assessment considered sufficient supportive documentation to code Malnutrition in Section I if the physician were to review and sign the assessment form? A: A dietician can identify and treat malnutrition, but the NTA comorbidity requires a
- [PDPM Coding Questions – If a resident has a BMI greater than 40 but the MD has not documented “morbid obesity”, can we enter the Z code for BMI in the MDS and receive the NTA point?](https://proactiveltcexperts.com/pdpm-coding-questions-in-reference-to-the-bmi-usually-section-v-of-the-mds-will-provide-us-a-bmi-score-if-it-is-greater-than-the-40-of-bmi-but-md-has-not-documented-can-we-add-the-z-code/) - Q: If a resident has a BMI greater than 40 but the MD has not documented “morbid obesity”, can we enter the Z code for BMI in the MDS and receive the NTA point? A: Yes, but as stated in the ICD-10-CM Code Book: BMI codes should only be assigned when the associated diagnosis
- [National Emergency Declaration: Quick Summary of Medicare Impact](https://proactiveltcexperts.com/national-emergency-declaration-quick-summary-of-medicare-impact/) - With the growing concern surrounding Coronavirus (COVID-19) and the slew of emails you’re likely receiving, we want to provide you with a brief, focused summary of how this pandemic has temporarily changed our current practices and regulations surrounding our Medicare beneficiaries. On Friday, March 13, 2020 the Centers for Medicare & Medicaid Services (CMS) relaxed
- [PDPM Coding Question – How should situations, in which the 3-day qualifying hospital stay normally required for a covered Medicare admission to the SNF is waived due to the national emergency, be reported on the UB04 claim form?](https://proactiveltcexperts.com/pdpm-coding-question-how-should-situations-in-which-the-3-day-qualifying-hospital-stay-normally-required-for-a-covered-medicare-admission-to-the-snf-is-waived-due-to-the-national-emergency/) - Q: How should situations, in which the 3-day qualifying hospital stay normally required for a covered Medicare admission to the SNF is waived due to the national emergency, be reported on the UB04 claim form? A: Providers that receive beneficiaries without a 3-day qualifying stay (and for whom the requirement was waived under section
- [How do we code Coronavirus (COVID-19) on the MDS?](https://proactiveltcexperts.com/how-do-we-code-coronavirus-covid-19-on-the-mds/) - COVID-19 ICD-10-CM Effective April 1 On 3/18/20, the Centers for Disease Control and Prevention (CDC) announced that the effective date of a new diagnosis code U07.1, COVID-19, from October 1, 2020 to April 1, 2020. According to the CDC, “this off-cycle update is unprecedented and is an exception to the code set updating process established
- [COVID-19 CDC Nursing Home Guidance and Managing Suspected Cases](https://proactiveltcexperts.com/covid-19-cdc-nursing-home-guidance-and-managing-suspected-cases/) - Residents of long-term care facilities are at the highest risk of being affected by COVID-19 because of advanced age and chronic medical conditions and co-morbidities. Not only are they at higher risk but have an increased risk of critical illness. Also, there are opportunities that include group settings in long-term care facilities that increases risk
- [Coding Isolation on MDS](https://proactiveltcexperts.com/coding-isolation-on-mds/) - The RAI Manual provides clear instruction on the coding of isolation. Documentation must support the medical necessity of isolation. Per the MDS 3.0 RAI User’s Manual, Isolation is coded only when: The resident requires transmission-based precautions AND Single room isolation (alone in a separate room) BECAUSE OF An active infection (i.e., symptomatic and/or have a
- [Critical Action Steps for LTC Facilities' COVID-19 Response](https://proactiveltcexperts.com/critical-action-steps-for-ltc-facilities-covid-19-response/) - As of a March 23 report by CMS, at least 147 nursing homes across 27 states have at least one resident with COVID-19. As we work to protect our residents and staff in response to the risk of COVID-19 infection, providers are encouraged to consider these action items and resources: General Guidance & Source Documents All
- [PDPM Coding Questions – How should isolation be coded on the MDS since there is guidance to restrict movement around the facility as part of the COVID-19 prevention plan?](https://proactiveltcexperts.com/pdpm-coding-questions-how-should-isolation-be-coded-on-the-mds-since-there-is-guidance-to-restrict-movement-around-the-facility-as-part-of-the-covid-19-prevention-plan/) - Q: How should isolation be coded on the MDS since there is guidance to restrict movement around the facility as part of the COVID-19 prevention plan? A: You cannot code isolation on the MDS if it is only in place to prevent contracting the COVID 19 virus, the resident must be in isolation
- [Reporting Staff COVID-19 Infection-OSHA Requirements](https://proactiveltcexperts.com/reporting-staff-covid-19-infection-osha-requirements/) - COVID-19 can be a recordable illness if a worker is infected as a result of performing their work-related duties. However, employers are only responsible for recording cases of COVID-19 if all of the following are met: The case is a confirmed case of COVID-19 (see CDC information on persons under investigation and presumptive positive and
- [Coronavirus Stimulus Bill Passes by House Today](https://proactiveltcexperts.com/coronavirus-stimulus-bill-passes-by-house/) - The Senate passed the $2 trillion bipartisan Coronavirus Stimulus Bill 3/25/2020 and the House passed this bill 3/27/2020 with President Trump signing the bill into law the same day. The Coronavirus Stimulus Bill includes $200 million in funding for CMS to assist nursing homes with infection control and prevention of the spread of COVID-19. The
- [Coronavirus Waivers & Flexibilities](https://proactiveltcexperts.com/coronavirus-waivers-flexibilities/) - This week CMS announced blanket Coronavirus waivers and flexibilities impacting multiple provider types including nursing facilities and a 221-page Interim Final Rule adjusting a wide range of Medicare and Medicaid regulations to give providers additional flexibility to respond to the COVID-19 pandemic. The waivers are retroactive to March 1 and will be effective through the
- [Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule](https://proactiveltcexperts.com/q-a-can-pts-and-ots-bill-for-telehealth-services-including-virtual-check-ins-and-or-e-visits/) - On March 30, CMS issued the Interim Final Rule with Comment (IFC) entitled, Medicare & Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule with Comment Period (CMS-1744-IFC). The rule gives individuals and entities that provide services to Medicare beneficiaries “needed flexibilities to respond effectively to the
- [Q & A – What is an advance payment and how do I apply for one?](https://proactiveltcexperts.com/q-a-what-is-an-advance-payment-and-how-do-i-apply-for-one/) - Q: What is an advance payment and how do I apply for one? A: An accelerated/advance payment is a payment intended to provide necessary funds when there is a disruption in claims submission and/or claims processing. These expedited payments can be offered in circumstances such as national emergencies, or natural disasters in order to assist
- [ICD10 Mappings and PDPM Grouper DLL updated for COVID-19](https://proactiveltcexperts.com/icd10-mappings-and-pdpm-grouper-dll-updated-for-covid-19/) - The Centers for Disease Control and Prevention (CDC) published the final guidelines for the new diagnosis code U07.1, COVID-19, effective April 1 to September 30, 2020. As a result, the Centers for Medicare & Medicaid Services (CMS) also updated the ICD-10-CM to Clinical Category Mapping for PDPM that takes effect April 1, 2020. The FY
- [COVID-19: Best Practices for Communication & Cooperation](https://proactiveltcexperts.com/covid-19-best-practices-for-communication-cooperation/) - Quickly sharing information about prevention efforts and disease outbreak can help stop the spread of disease, and reduce the incidence of illness and even death. In addition to immediately reporting details of positive cases to your state and local health departments, ongoing communication and cooperation with officials is crucial. Equally significant, prompt and effective communication
- [Proper Use and Conservation of Personal Protective Equipment (PPE)](https://proactiveltcexperts.com/proper-use-and-conservation-of-personal-protective-equipment-ppe/) - The unexpected surge in patient volume within our healthcare facilities due to the COVID-19 pandemic has caused PPE shortages around the country. Healthcare facilities are having difficulty accessing the needed PPE and are having to find alternative ways to provide patient care safely. Taking steps to conserve the PPE we have is important. Consider the
- [Q & A – What should be documented in the medical record when therapy treatment is disrupted because of COVID-19?](https://proactiveltcexperts.com/q-a-what-should-be-documented-in-the-medical-record-when-therapy-treatment-is-disrupted-because-of-covid-19/) - Q: What should be documented in the medical record when therapy treatment is disrupted because of COVID-19? For example, in my facility essential therapy staff are unavailable to treat because they are on a 14 day quarantine. A: In many cases, therapy services are being impacted as a result of efforts to minimize resident
- [COVID-19: Staffing Measures](https://proactiveltcexperts.com/covid-19-staffing-measures/) - Staff Monitoring & Return to Work Ill employees are one of the most common sources of COVID-19 transmission into facilities. Therefore, it is important to screen and manage employees with symptoms of respiratory illness. Staff should promptly report any symptoms of respiratory illness (i.e. cough, fever, sore throat, runny nose, and/or shortness of breath) and
- [Care Planning & Charting for COVID-19](https://proactiveltcexperts.com/care-planning-charting-for-covid-19/) - While documentation and care planning requirements are a well-established part of the daily SNF routine, it is important to consider the impact of Coronavirus (COVID-19) on each resident’s treatment plan. Along with managing and supporting those known or suspected to be infected, additional challenges arise in the form of psychosocial well-being for individuals in the
- [Q & A – Who can bill for the Medicare specimen collection fee for COVID-19 testing?](https://proactiveltcexperts.com/q-a-who-can-bill-for-the-medicare-specimen-collection-fee-for-covid-19-testing/) - Q: Who can bill for the Medicare specimen collection fee for COVID-19 testing ? A: Independent laboratories can bill Medicare through their MAC for the specimen collection fee. The specimen collection fee applies if the specimen is collected by trained laboratory personnel from a homebound or non-hospital inpatient and the specimen is a type
- [Q & A – Who are the Qualified Providers who are permitted to furnish telehealth services under the PHE waiver?](https://proactiveltcexperts.com/q-a-who-are-the-qualified-providers-who-are-permitted-to-furnish-telehealth-services-under-the-phe-waiver/) - Q: Who are the Qualified Providers who are permitted to furnish telehealth services under the PHE waiver? A: The same health care providers are still permitted to furnish Medicare telehealth services under the waiver authority during the Public Health Emergency, including physicians and certain non-physician practitioners such as nurse practitioners, physician assistants and certified
- [Q & A – Does the section 1812(f) waiver for the 3-day qualifying hospital stay apply only to those beneficiaries who are actually diagnosed with COVID-19, or does the waiver apply to all SNF-level beneficiaries under Medicare Part A? ](https://proactiveltcexperts.com/q-a-does-the-section-1812f-waiver-for-the-3-day-qualifying-hospital-stay-apply-only-to-those-beneficiaries-who-are-actually-diagnosed-with-covid-19-or-does-the-waiver-apply-to-all-snf-l/) - Q: Does the section 1812(f) waiver for the 3-day qualifying hospital stay apply only to those beneficiaries who are actually diagnosed with COVID-19, or does the waiver apply to all SNF-level beneficiaries under Medicare Part A? A: The qualifying hospital stay waiver applies to all SNF-level beneficiaries under Medicare Part A, regardless of whether
- [COVID-19: Stimulus Package Provides Relief for Providers](https://proactiveltcexperts.com/covid-19-stimulus-package-provides-relief-for-providers/) - In response to increased expenses related to the COVID-19 response, financial relief to nursing homes is being released as part of the COVID-19 Stimulus Package. Spending for PPE and supplies; establishing isolation units, hazard pay or other staff incentives, overtime, staff leaves and declining occupancy rates leading to decreased revenues has had a significant impact
- [SNF PPS Proposed Rule FY2021 Released](https://proactiveltcexperts.com/snf-pps-proposed-rule-fy2021-released/) - CMS issued the FY2021 SNF PPS Proposed Rule (effective October 1, 2020) on 4/10/20 with a 2.3% payment increase yielding an approximate increase of $784 million in payments to SNFS. Other changes to the code mappings for PDPM case-mix classification and updates for the SNF Value-Based Purchasing (VBP) Program were also proposed. The comment period
- [COVID-19 Clinical Tips for Respiratory Assessment](https://proactiveltcexperts.com/covid-19-clinical-tips-for-respiratory-assessment/) - COVID-19 is an acute, sometimes severe, respiratory illness caused by a novel coronavirus SARS-CoV2. Person-to-person spread occurs through contact with infected secretions, mainly via contact with large respiratory droplets, but can also occur via contact with a surface contaminated by respiratory droplets. Nursing facilities face higher risk of transmission due to high population density creating
- [Q & A – Can practitioners provide Medicare telehealth services using their phones?](https://proactiveltcexperts.com/q-a-can-practitioners-provide-medicare-telehealth-services-using-their-phones/) - Q: Can practitioners provide Medicare telehealth services using their phones? A: Yes, for use of certain phones. Section 1135(b)(8) of the Social Security Act allows the Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. Additionally, CMS amended its regulations
- [Q & A – Can a Medicare Part A beneficiary who has exhausted his or her SNF benefits, but continues to need and receive skilled care in the SNF (e.g., for a qualifying feeding tube), renew SNF benefits under the section 1812(f) waiver regardless of whether or not the SNF or hospital was affected by the COVID-19 emergency?](https://proactiveltcexperts.com/q-a-can-a-medicare-part-a-beneficiary-who-has-exhausted-his-or-her-snf-benefits-but-continues-to-need-and-receive-skilled-care-in-the-snf-e-g-for-a-qualifying-feeding-tube-renew-snf/) - Q: Can a Medicare Part A beneficiary who has exhausted his or her SNF benefits, but continues to need and receive skilled care in the SNF (e.g., for a qualifying feeding tube), renew SNF benefits under the section 1812(f) waiver regardless of whether or not the SNF or hospital was affected by the COVID-19 emergency?
- [Five Star Quality Rating System Updates](https://proactiveltcexperts.com/five-star-quality-rating-system-updates/) - On April 24, CMS issued a memo (QSO-20-28-NH) regarding Nursing Home Five Star Rating System updates, staffing data and frequently asked questions. In this memo, they announced that the health inspection domain of the five-star rating system will temporarily be frozen. Results of health inspections conducted on or after March 4, 2020 will be posted
- [Q & A – Is COVID19 coded as a MDRO?](https://proactiveltcexperts.com/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 and the rest of the Proactive team.
- [Q & A – Is PNA related to COVID-19 an opportunistic infection?](https://proactiveltcexperts.com/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 and the rest of the Proactive team.
- [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?](https://proactiveltcexperts.com/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 with COVID-19 but a definitive diagnosis has
- [Reducing Liability Risk Related to COVID-19](https://proactiveltcexperts.com/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 provided during this national pandemic. This civil immunity, granted to health care providers responding
- [OSHA Releases Enforcement Guidance for Recording Cases of COVID-19](https://proactiveltcexperts.com/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 enforcing the requirements of 29 CFR Part 1904 – Recording and Reporting Occupational Injuries and Illnesses. While expected
- [Coronavirus Commission for Safety and Quality in Nursing Homes](https://proactiveltcexperts.com/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 effort builds upon CMS Administrator Seema Verma’s five-part plan to ensure safety and quality in
- [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?](https://proactiveltcexperts.com/q-a-is-pna-related-to-covid-19-an-opportunistic-infection-2/) - 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 clinicians as eligible practitioners that can furnish and bill for Medicare telehealth services
- [New Reporting Process Rules Released for Long Term Care Facilities](https://proactiveltcexperts.com/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 requirement will be effective once published in the Federal Register. The new rule is
- [Q & A – Can you use a "Z" code as a primary diagnosis under PDPM and map to a Clinical Category?](https://proactiveltcexperts.com/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 "history of" diagnoses or status codes, but
- [Reimbursement Pitfalls When Coding the Primary Diagnosis: Tips from an MDS Auditor](https://proactiveltcexperts.com/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 we’ve noted in hopes that it will guide facilities in implementing improvements in preparation for
- [Safely Reopening Nursing Homes: Quick Summary of New CMS Guidance](https://proactiveltcexperts.com/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 restrictions and mitigating the risk of resurgence, visitation and service considerations, and restoration of survey activities. The guidance
- [COVID-19 Medical Review Preparedness and Reimbursement Compliance Risks](https://proactiveltcexperts.com/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 staffing shortages, PPE limitations, or virus outbreaks, it’s understandable that many providers have felt overwhelmed. As nursing
- [Q & A – Should presumptive positive COVID-19 test results be coded as confirmed?](https://proactiveltcexperts.com/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 state level, but it has not yet been confirmed by the Centers for
- [Q & A – What is the #1 ICD.10 coding error that you find in your audits?](https://proactiveltcexperts.com/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 codes in I0020B. Sequelae and other such codes should be used instead.
- [Q & A – How should SNF facilities handle employee requests off related to traveling out of state? Should we look at a mandatory negative test or a quarantine?](https://proactiveltcexperts.com/how-should-snf-facilities-handle-employee-requests-off-related-to-traveling-out-of-state-should-we-look-at-a-mandatory-negative-test-or-a-quarantine/) - Q: How should SNF facilities handle employee requests off related to traveling out of state? Should we look at a mandatory negative test or a quarantine? A: Since every contact increases the risk of transmission to residents, it is recommended to continue to encourage your staff to practice social distancing outside of work and
- [Q & A – When can Podiatrists, Optometrists and Dentists return to Nursing Facilities?](https://proactiveltcexperts.com/q-a-when-can-podiatrists-optometrists-and-dentists-return-to-nursing-facilities/) - Q: When can Podiatrists, Optometrists and Dentists return to Nursing Facilities? A: This should be determined on a case-by-case basis based on resident specific needs for the specialized service in consultation with the resident's attending physician. These providers would need to be screened when entering the facility and wear appropriate PPE when providing services
- [CDC Guidance on Contact Tracing for Healthcare Personnel](https://proactiveltcexperts.com/cdc-guidance-on-contact-tracing-for-healthcare-personnel/) - This week, multiple states across the nation announced increased funding to be used to help provide COVID-19 testing and contact tracing. Contact tracing involves retracing movements of an individual with COVID-19 to locate, test, and isolate anyone who has come in close contact with that individual, which includes anyone who was within 6 feet of
- [Medicaid Case Mix Index (CMI): Common Errors & Opportunities](https://proactiveltcexperts.com/medicaid-case-mix-index-cmi-common-errors-opportunities/) - Case mix index (CMI) is the metric by which the relative cost of treating residents covered by Medicaid is measured. It also sheds light on the type of residents being treated and the burden of care required. Because the primary payer source for most facilities is Medicaid, it is important that providers monitor CMI accuracy
- [SNF PEPPER Now Available: Is Your Facility an Outlier?](https://proactiveltcexperts.com/snf-pepper-now-available-is-your-facility-an-outlier/) - PEPPER summarizes Medicare claims data statistics for billed claims in target areas that may be at risk for improper payments. Your facility data is compared to all SNFs in the nation, in your state, and in your jurisdiction to assess how your past billing practices compare to peers. CMS uses PEPPER as a means of
- [PDPM Interrupted Stay Issue – You may need to modify claims](https://proactiveltcexperts.com/pdpm-interrupted-stay-issue-you-may-need-to-modify-claims/) - Per the MLN Connects news issued July 23, 2020, a new issue is affecting some inpatient hospital and Skilled Nursing Facility (SNF) claims when an interrupted stay is billed at the end of the month. The system incorrectly assigns edits U5601-U5608 (overlapping a hospital claim). If you billed the interrupted stay correctly, and your claim
- [Q & A – Do I have to restart the Medicare physician certification process when a resident qualifies for an interrupted stay?](https://proactiveltcexperts.com/q-a-do-i-have-to-restart-the-medicare-physician-certification-process-when-a-resident-qualifies-for-an-interrupted-stay/) - Q: Do I have to restart the Medicare physician certification process when a resident qualifies for an interrupted stay? A: The requirements for physician certifications and recertifications for the SNF PPS stay did not change with the implementation of PDPM. The facility should continue existing physician certifications where left off when the resident readmits
- [CLIA Waiver Required for COVID-19 Point of Care Testing](https://proactiveltcexperts.com/clia-waiver-required-for-covid-19-point-of-care-testing/) - Is your facility CLIA certified? Beginning this week, COVID-19 point of care (POC) testing instruments and supplies will start to be provided to skilled nursing facilities, prioritizing “hot spots” first. Only facilities with a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Waiver will receive a testing machine and be able to perform and bill for
- [Q & A – How often do restorative progress notes need to be written?](https://proactiveltcexperts.com/q-a-how-often-do-restorative-progress-notes-need-to-be-written/) - Q: How often do restorative progress notes need to be written? A: The RAI Manual, p. O-43 states, “Evidence of periodic evaluation by the licensed nurse must be present in the resident’s medical record.” Facility policy should determine the frequency of the evaluation (i.e. weekly, monthly). However, if your facility is in a case
- [All In! Interdisciplinary Supportive Documentation to Succeed Under PDPM](https://proactiveltcexperts.com/all-in-interdisciplinary-supportive-documentation-to-succeed-under-pdpm/) - Working together for the best clinical outcomes and for reimbursement accuracy requires good systems for communication – both verbally and in our documentation. The fundamental expectations for documentation to support skilled level of care, medical necessity, and appropriate intensity and duration of services remain critical under PDPM. One step to ensuring optimal patient outcomes is
- [Safe Strategies for Visitation](https://proactiveltcexperts.com/safe-strategies-for-visitation/) - Nursing facilities are moving toward safe reopening while adhering to guidance described in the CMS reopening recommendations, CDC guidance and state and local directives. While recognizing the potential psychosocial effects of resident separation from family and other loved ones, resident and staff safety are the priority as reopening proceeds. General considerations for advancing through the
- [Q & A – Can we query the MD AFTER the MDS assessment is completed for documentation of an active diagnosis, or does it have to be prior to the ARD?](https://proactiveltcexperts.com/q-a-can-we-query-the-md-after-the-mds-assessment-is-completed-for-documentation-of-an-active-diagnosis-or-does-it-have-to-be-prior-to-the-ard/) - Q: Can we query the MD AFTER the MDS assessment is completed for documentation of an active diagnosis, or does it have to be prior to the ARD? A: Unfortunately, the documentation needs to be present during the appropriate assessment reference period (which ends with the Assessment Reference Date). The RAI defines Active Diagnosis
- [Q & A – Would C-diff be a qualifying diagnosis when coding Multi-Drug Resistant Organism (MDRO) in I1700?](https://proactiveltcexperts.com/q-a-would-c-diff-be-a-qualifying-diagnosis-when-coding-multi-drug-resistant-organism-mdro-in-i1700/) - Q: Would C-diff be a qualifying diagnosis when coding Multi-Drug Resistant Organism (MDRO) in I1700? A: According to the Centers for Disease Control, C-diff is not considered a MDRO. Common MDRO’s include, Methicillin/oxacillin-resistant Staphylococcus aureus (MRSA) , Vancomycin-resistant enterococci (VRE), Extended-spectrum beta-lactamases (ESBL’s), Penicillin-resistant Streptococcus pneumoniae (PRSP) and Multi-drug resistant Tuberculosis (MDR) TB.
- [Enhanced Enforcement for Infection Control Deficiencies](https://proactiveltcexperts.com/enhanced-enforcement-for-infection-control-deficiencies/) - Infection Control requirements are nothing new, but the Centers for Medicare and Medicaid Services (CMS) is ramping up efforts to identify and assist providers who may be performing poorly in infection control practices. Providers struggling to comply with requirements could face corrective action and Civil Monetary Penalties (CMP) as outlined below. See the full memo
- [Q & A – Can I code TIA if a resident is receiving Eliquis routinely to prevent further TIAs](https://proactiveltcexperts.com/q-a-can-i-code-tia-if-a-resident-is-receiving-eliquis-routinely-to-prevent-further-tias/) - Q: Can I code TIA if a resident is receiving Eliquis routinely to prevent further TIAs A: In order for TIA to be considered an active diagnosis, the physician would need to specifically document that the diagnosis is active (and not by listing TIA on the resident’s diagnosis list or face sheet), or have
- [Current State of the 5-Star Rating System](https://proactiveltcexperts.com/current-state-of-the-5-star-rating-system/) - As of mid-June, the only announcement that CMS has made regarding the 5-Star Rating system is that the Health Inspection rating is being held constant to include only data from surveys that occurred on or before March 3, 2020. Health inspections conducted after March 3, 2020 are publicly posted in a link on the Nursing
- [Virtual Activity Resources for Resident Engagement](https://proactiveltcexperts.com/back-to-basics-environmental-services-infection-control-best-practices-to-avoid-f880-citation-2/) - Across the nation, nursing homes have accessed new and creative ways of facilitating social interaction with their residents while minimizing the spread of COVID-19. As staff and residents began to settle into the ‘new normal,’ facilities were adjusting to rapidly evolving rules and guidelines impacting activities and community access. As most nursing homes remain closed
- [Back to Basics:  Environmental Services Infection Control Best Practices to Avoid F880 Citation](https://proactiveltcexperts.com/back-to-basics-environmental-services-infection-control-best-practices-to-avoid-f880-citation/) - Preventing and mitigating the spread of COVID-19 in long-term care centers is a top priority considering CMS’ enhanced enforcement effective June 1, 2020 for infection control deficiencies. CMS has cited F880 at immediate jeopardy level relating to examples such as: Failure to adequately clean and disinfect common areas to reduce the transmission of infection Not
- [PDPM Coding Questions – Where do we find guidelines on how to establish a baseline temp?](https://proactiveltcexperts.com/pdpm-coding-questions-where-do-we-find-guidelines-on-how-to-establish-a-baseline-temp/) - Q: Where do we find guidelines on how to establish a baseline temp? A: Fever is defined as a temperature 2.4 degrees F higher than baseline. The resident’s baseline temperature should be established prior to the Assessment Reference Date. A temperature of 100.4 degrees F (38 degrees C) on admission (i.e., prior to the
- [Ohio CMP Funded Grant Project Awarded to Proactive: Seeking Participants for Ohio Nursing Home Competency Training](https://proactiveltcexperts.com/ohio-cmp-funded-grant-project-awarded-seeking-participants-for-ohio-nursing-home-competency-training/) - CMS has approved funds for an Ohio Medicaid Grant Project in partnership with Proactive Medical Review & Consulting, LLC to administer a targeted Nursing Home Competency Certification Program that will include access to regional workshops, webinars, support from a project consultant and Competency Toolkits for participating Ohio nursing facilities. As part of Ohio's nursing home
- [10 Tips for a Better Medicare Meeting](https://proactiveltcexperts.com/10-tips-for-a-better-medicare-meeting/) - With focus primarily on successful implementation of the Patient Driven Payment Model (PDPM) in recent months, now is a good time to revisit the importance of a solid process for the Medicare Meeting, or Utilization Review Meeting. Under PDPM, some providers have shifted away from the traditional Medicare Meeting in favor of an initial meeting
- [New Part B Therapy NCCI PTP Edits Effective January 1st](https://proactiveltcexperts.com/new-therapy-ncci-ptp-edits-effective-january-1st/) - Hindsight is 20/20… this is something that comes to mind when taking a deep dive into the new and unforeseen National Correct Coding Initiative (NCCI) procedure to procedure (PTP) edits that were effective January 1, 2020. Without any warning, Capitol Bridge, LLC, CMS’ NCCI contractor, applied two major changes that have taken the therapy community
- [PDPM Coding Questions – Is it correct that CNA's are not allowed to complete section GG? Is it possible to have CNAs submit documentation to an RN who then completes the assessment for GG?](https://proactiveltcexperts.com/pdpm-coding-questions-is-it-correct-that-cnas-are-not-allowed-to-complete-section-gg-is-it-possible-to-have-cnas-submit-documentation-to-an-rn-who-then-completes-the-assessment-for-gg/) - Q: Is it correct that CNA's are not allowed to complete section GG? Is it possible to have CNAs submit documentation to an RN who then completes the assessment for GG? A: As per the RAI - assess the resident’s self-care and mobility performance based on direct observation, incorporating resident self-reports and reports from qualified clinicians,
- [PDPM Coding Questions – When should the comprehensive care plan be completed if you are submitting MDS' day 14 as best practice?](https://proactiveltcexperts.com/pdpm-coding-questions-when-should-the-comprehensive-care-plan-be-completed-if-you-are-submitting-mds-day-14-as-best-practice/) - Q: When should the comprehensive care plan be completed if you are submitting MDS' day 14 as best practice? A: As per regulation - a comprehensive care plan must be developed within 7 days after completion of the comprehensive assessment (Admission, Annual, or Significant Change in Status). For newly admitted residents, the comprehensive care plan
- [PDPM Coding Questions – If a resident discharges and returns from an interrupted stay do we start over on the Medicare certification?](https://proactiveltcexperts.com/pdpm-coding-questions-if-a-resident-discharges-and-returns-from-an-interrupted-stay-do-we-start-over-on-the-medicare-certification/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: If a resident discharges and returns from an interrupted stay do we start over on the Medicare certification? A: If the resident qualifies for the interrupted stay, certs/recerts do NOT have to be restarted. From CMS FAQ: 13.21
- [Some of our favorite recipes to ring in the New Year...](https://proactiveltcexperts.com/some-of-our-favorite-recipes-to-ring-in-the-new-year/) - To celebrate the New Year, we thought it would be fun to share some of our favorite recipes. We hope you and your family will enjoy trying these delicious treats together in 2020! Recipe by Amie Martin, OTR/L, CHC, RAC-CT, Proactive Medical Review Hot Spinach Artichoke Dip Ingredients 2 (8oz.) packages cream cheese, softened
- [Phase 3 RoP](https://proactiveltcexperts.com/phase-3-rop/) - The Long-Awaited Phase 3 Requirements Are Now In Effect… But Still No Interpretive Guidance For the Phase 3 Regulations The Phase 3 requirements went into effect on Nov. 28 as planned and facilities are now required to comply with these and all requirements. In a memo released by CMS on Nov. 22, 2019, CMS stated
- [Casper Reports Part 2:  Insights for PBJ, QRP and Final Validation Reports](https://proactiveltcexperts.com/part-2-effectively-using-casper-reports/) - Using CASPER Reports for Quality Measure Monitoring with Recommended Run Schedule This is part 2 or a 2 part blog on the effective use of CASPER reports. As a continued review of CASPER Reports with Recommended Run Schedule, let’s take a look at Payroll Based Journal (PBJ), Final Validation, and Quality Reporting Period (QRP) reports
- [New in 2020!  3 Targeted Webinar Series Coming Soon](https://proactiveltcexperts.com/new-in-2020-3-targeted-webinar-series-coming-soon/) - PDPM Master Class with Optional Certification January through December 2020 This 12 month webinar series focuses on developing mastery of the skills required to successfully lead clinical reimbursement excellence under PDPM. Participants may register for each session individually or register for the full series at a discounted rate. Recordings of live sessions are included with
- [PDPM Coding Question - Interrupted Stay MDS Error Code?](https://proactiveltcexperts.com/pdpm-coding-question-interrupted-stay-mds-error-code/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Why am I getting an error message when trying to complete an Interrupted Stay MDS Assessment? A: CMS has reported that providers are receiving “error” messages when coding the MDS Items A0310G1 and A2400 per RAI v1.17.1 instructions.
- [PDPM Coding Question – Indiana Medicaid: QMs for Quality Score](https://proactiveltcexperts.com/pdpm-coding-question-indiana-medicaid-qms-for-quality-score/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Indiana Medicaid: QMs for Quality Score Q: With recent and future quality measure changes to 5-star / Nursing Home Compare, will the Quality Measure Score used to determine the Total Quality Score for Indiana Medicaid Value Based Purchasing Phase
- [PDPM Coding Question - I69 Code Timeline?](https://proactiveltcexperts.com/pdpm-coding-question-i69-code-timeline/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Is there a "timeline" to using I69 codes? For example: My new patient had cognitive deficits and Dysphagia and had CVA in 2016. Do I use I69 codes or R codes? A: There is no time limit on
- [Medicare Final 2020 Physician Fee Schedule](https://proactiveltcexperts.com/medicare-final-2020-physician-fee-schedule/) - Medicare Final 2020 Physician Fee Schedule (PFS) Released & Rule Includes Challenges for Part B Therapy Providers CMS released the final 2020 Medicare Physician Fee Schedule on November 1, 2019 which includes updates to payment policies, rates and quality provisions under the PFS effective January 1, 2020. Several clarifications impact part B therapy including the
- [How you may be missing the mark in the Nursing CMG under PDPM.](https://proactiveltcexperts.com/how-you-may-be-missing-the-mark-in-the-nursing-cmg-under-pdpm/) - How well did you identify, document, and report conditions and services under RUG-IV? With all the changes the Patient-Driven Payment Model (PDPM) brought in October, it was comforting to think that, at least, determinations for the Nursing Case-Mix Group (CMG) weren't going to be that different from RUG-IV. This may have given some providers a
- [PDPM Coding Question - NTA Conditions Parenteral / IV Feeding Level?](https://proactiveltcexperts.com/pdpm-coding-question-nta-conditions-parenteral-iv-feeding-level/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: What is the difference between the NTA conditions parenteral / IV Feeding level high and low? A: In order to qualify for high intensity parental / IV feeding and 7 NTA points, the resident must receive 51% or
- [SNF QAPI Program:  What to Know for November Phase 3 Readiness](https://proactiveltcexperts.com/snf-qapi-program-what-to-know-for-november-phase-3-readiness/) - Possible one year delay of the SNF QAPI Program requirements While CMS published a proposed rule to delay for one year the Phase 3 SNF QAPI Program requirements, providers have good reason to move forward in implementing a comprehensive QAPI Program with the original phase 3 target date of November 28, 2019. (1) The proposed
- [Don't let documentation HAUNT you under PDPM!](https://proactiveltcexperts.com/dont-let-documentation-haunt-you-under-pdpm/) - Have you been SPOOKED by the recent implementation of PDPM? The recent implementation of PDPM has been a scary time for all and while the focus seems to be back on nursing, so are the challenges. One such challenge is enhancing the quality of supportive documentation. Documentation in the patient’s medical record must reflect the
- [SNF Compliance & Ethics Programs: What to Know for November Phase 3 Readiness](https://proactiveltcexperts.com/snf-compliance-ethics-programs-what-to-know-for-november-phase-3-readiness/) - Delay for one year the SNF Compliance and Ethics Program requirements While CMS published a proposed rule to delay for one year the SNF Compliance and Ethics Program requirements, providers have good reason to move forward in implementing the Compliance and Ethics Program with the original phase 3 target date of November 28, 2019. (1)
- [PDPM Coding Questions - E66 Morbid Obesity Code?](https://proactiveltcexperts.com/pdpm-coding-questions-e66-morbid-obesity-code/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Can the E66 morbid obesity codes be assigned if the BMI is less than 40 when there is physician documentation of morbid obesity diagnosis? A: You can assign the E66 morbid obesity code if it is specifically documented
- [Medicaid and the Optional State Assessment (OSA)](https://proactiveltcexperts.com/medicaid-and-the-optional-state-assessment-osa/) - CMS Will Continue to Report RUG-III and RUG-IV HIPPS Codes, as Requested by the State, Until September 30, 2020 As of October 1, 2019, all scheduled PPS assessments (except the 5-day) and all unscheduled PPS assessments were retired. If you’re in a Medicaid case-mix state you may be wondering, “How will we calculate RUG-III or
- [PDPM Coding Questions - Cerebrovascular Disease?](https://proactiveltcexperts.com/pdpm-coding-questions-cerebrovascular-disease/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: I am hearing other SLPs in the area stating they have been told that "cerebrovascular disease" can include Parkinson’s, dementia, etc. and to use these codes for these patients... Can you confirm/deny this for me? What does "other"
- [PDPM Coding Questions - GG Daily for 3 Days?](https://proactiveltcexperts.com/pdpm-coding-questions-gg-daily-for-3-days/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: Does GG have to be completed daily for 3 days? Would it be sufficient to only have it as part of our nursing admission assessment and therapy evaluation by day 3 and then nursing/MDS document a collaborative review
- [PDPM Coding Questions - GG coding clinical judgement?](https://proactiveltcexperts.com/pdpm-coding-questions-gg-coding-clinical-judgement/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: For section GG, we understand that unless the professional-nurse or therapist-views the resident doing the task we would fill out 88. Instead, the therapy provider is using their “clinical judgement” . For example, resident may be dependent, can
- [PDPM Coding Questions - BIMS on the ARD date?](https://proactiveltcexperts.com/pdpm-coding-questions-bims-on-the-ard-date/) - PDPM coding questions? Proactive has answers. Click here to see all these PDPM Coding Questions blogs. Q: We are completing the BIMS on the ARD date. Should it be done earlier? A: BIMS is to be conducted “within the look-back period” and “preferably” on or one day prior to the ARD Have questions? Contact us
- [Upcoming Proactive Training Events](https://proactiveltcexperts.com/upcoming-proactive-training-events/) - *This blog was updated 10/15/19. Join These Upcoming Proactive Training Events: Oct. 22nd HIN Compliance & Ethics Webinar Learn more. Nov. 5-6th Moving Mountains webinars “ Skilled Nursing Supportive Documentation for PDPM” Nov. 7th PDPM: How’s It Going So Far? Ft. Wayne, IN Adams Health Network Fall Conference Nov. 12-13th Samaritan Alliance Fall Conference: PDPM
- [Changes Coming to Five-Star Quality Rating System](https://proactiveltcexperts.com/changes-coming-to-five-star-quality-rating-system/) - *Information coming soon on Proactive’s 2020 5-Star Insights webinar series focused on helping your facility achieve or maintain 5 Star in 2020. Make plans to join us beginning in March! Easier for Consumers to Identify Facilities with Instances of Non-compliance On October 7, 2019, CMS announced additional changes to the Five-Star Quality Rating System that
- [Effective Use of the Optional IPA](https://proactiveltcexperts.com/effective-use-of-the-optional-ipa/) - IPA is an optional SNF PPS stand-alone MDS item set under PDPM The Interim Payment Assessment (IPA) is an optional SNF PPS stand-alone MDS item set under PDPM. The IPA can be completed when providers determine that the resident has experienced changes to his or her clinical condition that would be sufficient to change payment
- [CMS Final Rule: Revisions to Requirements for Hospital Discharge Planning to Post-Acute Care Settings](https://proactiveltcexperts.com/cms-final-rule-revisions-to-requirements-for-hospital-discharge-planning-to-post-acute-care-settings/) - It's important that your local hospital discharge planners understand your quality measure data September 26th, CMS issued a final rule requiring hospitals to provide patients greater access to information about available post-acute provider choices as part of the discharge planning process. Required performance data reporting includes several quality measures including falls, pressure ulcers and readmissions.
- [Pulling the RUG Out: Steps to Completing the PDPM Transitional IPA](https://proactiveltcexperts.com/pulling-the-rug-out-steps-to-pdpm-transitional-ipa/) - What does PDPM mean for Medicare Part A beneficiaries who will reside in the facility under both payment models? RUG-IV comes to a hard stop at 11:59pm on September 30th, 2019 and will be replaced with the Patient Driven Payment Model at 12:00am on October 1st. What does this mean for Medicare Part A beneficiaries
- [Last minute PDPM advice](https://proactiveltcexperts.com/last-minute-pdpm-advice/) - Tips to focus your attention in October based on actual Proactive client pre-PDPM audit trends You’ve followed the PDPM transition checklists. You’ve analyzed historic billing patterns and projected revenue shifts under the new model. You’ve trained extensively. You’ve honed the admissions and MDS data collection processes and updated various clinical meeting procedures to include discussions
- [Top 5 Recommendations for Accurately Coding Cognitive Scoring Under PDPM](https://proactiveltcexperts.com/top-5-recommendations-for-accurately-coding-cognitive-scoring-under-pdpm/) - Cognitive Scoring impacts revenue under PDPM The Brief Instrument for Mental Status (BIMS) and Cognitive Performance Scale (CPS) – is completed as part of MDS Section C and used to guide care planning of residents with confusion or a cognitive impairment. Under PDPM, Cognitive Scoring impacts revenue with an add-on to the SLP component for
- [PDPM Top 10 To-Do List for September](https://proactiveltcexperts.com/pdpm-top-10-to-do-list-for-september/) - PDPM Top 10 To-Do List for September 1) Integrate PDPM processes for all new traditional Medicare Part A admissions; establish a plan to capture all unique patient conditions/characteristics for those with an anticipated discharge after September 30th. Incorporate the CMS ICD-10 Mapping Tool into daily processes. Practice with new September admissions identifying the principle reason
- [Phase 3 & PDPM Ready? Jump Start with Trauma Informed Care](https://proactiveltcexperts.com/phase-3-pdpm-ready-jump-start-with-trauma-informed-care/) - How will you meet Trauma Informed Care standards required under the Phase 3 Requirements of Participation (ROP)? Trauma-informed care is an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma. Trauma informed care emphasizes physical, psychological and emotional safety for staff, families, and the residents
- [Moving Mountains Webinar Series Update](https://proactiveltcexperts.com/moving-mountains-webinar-series-update/) - *This blog was updated 8/27/19. To register for an upcoming "Moving Mountains" webinar in your area, visit your organization’s website for details. Click here to find your association. More Moving Mountains Webinar Details Added! We've partnered with industry organizations across the country to bring you this webinar series! 2019 has been a busy year of
- [Skilled Charting Under PDPM:  Role of Providers & Nursing in Supportive Charting](https://proactiveltcexperts.com/skilled-charting-under-pdpm-role-of-providers-nursing-in-supportive-charting/) - Factors Impacting Reimbursement Become More Complex Under PDPM, the factors impacting reimbursement become more complex. Supportive documentation should reflect this complexity through descriptions of the relevant care and services impacting each of the five payment components. However, old habits die hard and with the former reliance on therapy as the primary skilling service, facilities may
- [LeadingAge IL Full Day PDPM Implementation Workshop](https://proactiveltcexperts.com/leadingage-il-full-day-pdpm-implementation-workshop/) - Join Us at this LeadingAge Illinois Event Don't miss this! We've partnered with LeadingAge Illinois to bring you this special event! We're almost 1 month away from the PDPM deadline.... ARE YOU PREPARED? PDPM Implementation Intensive Advanced PDPM Skill Building Workshop Wednesday, September 18, 2019 This 6-hour live event will address advanced skills required for
- [Are you prepared for the Phase 3 RoP Infection Preventionist requirements?](https://proactiveltcexperts.com/are-you-prepared-for-the-phase-3-rop-infection-preventionist-requirements/) - Nursing facilities will be required to designate one or more individual(s) as the Infection Preventionist(s) The Phase 3 SNF §483.80(b) Infection Preventionist requirements must be in place by November 28, 2019. As part of the new requirements, nursing facilities will be required to designate one or more individual(s) as the infection preventionist(s) (IP)(s) who are
- [EVENT: PDPM Implementation Intensive Summer Road Trip](https://proactiveltcexperts.com/event-pdpm-implementation-intensive-summer-road-trip/) - UPDATE: This blog has been updated 8/16/19. Please see below for details. Feedback from Summer Road Trip Attendees: “I started going to trainings last October for PDPM, but this was by far the best PDPM session I’ve ever attended!” "Relevant content & interesting speakers. Thank you for the resources and examples—very helpful!" "Excellent! This seminar
- [PDPM Coding & Documentation Worries?](https://proactiveltcexperts.com/pdpm-coding-documentation-worries/) - PDPM Coding Support Solutions For Compliance and Reimbursement Accuracy Proactive provides the MDS coding support and pre-submission audits you need to capture what scrubbers miss. On average, our clients experience a 90% return on their audit investment. How can we help? Schedule a September and October PDPM audit project to identify opportunities for improvement and
- [Therapy Vendor Contracts Under PDPM](https://proactiveltcexperts.com/therapy-vendor-contracts-under-pdpm/) - Providers will benefit from moving beyond a billable minute or RUGs based therapy contract under PDPM Therapy contracts are under review for many providers. In most cases, providers will benefit from moving beyond a billable minute or RUGs based therapy contract under PDPM. Most contracts are being bid based on a % of the PDPM
- [Auditing & Monitoring Updates Essential under PDPM](https://proactiveltcexperts.com/auditing-monitoring-updates-essential-under-pdpm/) - PDPM should be included in the Compliance and Ethics program work plan Challenges during the transition to PDPM (Patient Driven Payment Model) are unavoidable, but compliance oversight doesn’t need to be one of them. PDPM should be included in the Compliance and Ethics program work plan for 2020, including updating current auditing and monitoring systems.
- [Expert Panel Session on Operational Strategies for Success Under PDPM](https://proactiveltcexperts.com/expert-panel-session-on-operational-strategies-for-success-under-pdpm/) - Don’t miss the expert panel session on Operational Strategies for Success Under PDPM coming in August in our Moving Mountains Series! SNF experts in MDS coding, software, reimbursement, accounting, compliance and legal issues will share tips and strategies to conquer the PDPM implementation process and thrive under the new payment model. Dates: August 6, 2019
- [CMS Requests Provider Input to Reduce Administrative Burden](https://proactiveltcexperts.com/cms-requests-provider-input-to-reduce-administrative-burden/) - As part of the CMS Patients Over Paperwork Initiative, CMS is requesting comments on how to reduce administrative burden for providers. The purpose is to “increase quality of care, lower costs, improve program integrity, and make the health care system more effective, simple, and accessible.” Comments must be received at one of the submission methods
- [PDPM Ready! ICD.10 Codes and RTP Status](https://proactiveltcexperts.com/pdpm-ready-icd-10-codes-and-rtp-status/) - ICD.10 coding will have a major impact under PDPM ICD.10 coding will have a major impact under PDPM with the PT, OT, SLP and the bulk of the NTA items (35 of the 50 are diagnosis related items) paid in part based on the diagnoses coded on the MDS. You’ve attended training on ICD.10, now
- [Planning Ahead for PDPM Success](https://proactiveltcexperts.com/planning-ahead-for-pdpm-success/) - Missed coding will have a significant impact on the bottom line PDPM considers a vast array of patient characteristics in the reimbursement calculation. Primarily based on MDS coding accuracy to “paint the picture” of each resident’s needs, missed coding will have a significant impact on the bottom line. The graphic below demonstrates the highest potential
- [QIO Contract Updates](https://proactiveltcexperts.com/qio-contract-updates/) - The Quality Improvement Organization (QIO) Program originated with the Peer Review Improvement Act of 1982 and is authorized by Title XI Part B and Title XVIII the Act. The goal of the QIO program is to improve the quality of care for Medicare beneficiaries, including beneficiary complaints, skilled service termination appeals, and Immediate Advocacy to
- [National Correct Coding Initiative Update](https://proactiveltcexperts.com/national-correct-coding-initiative-update/) - CMS developed The National Correct Coding Initiative (NCCI) for Medicare Part B and Medicaid claims. NCCI is an automated edit system to control Current Procedural Terminology (CPT) code pairs that can be reported on the same day. The goal is to assure therapists are not billing codes considered to be a part of more comprehensive
- [New Webinar Rehab Audit Success, Register Now!](https://proactiveltcexperts.com/new-webinar-rehab-audit-success-register-now/) - Rehab Medical Review & Auditing: Fundamentals of Success This four part webinar series reviews recent trends of rehabilitation service medical review, common denial trends and proactive measures to reduce risk and improve outcomes during active medical review. Recent audit activity will be discussed under both part A and part B as well as Managed Care
- [Are You in Compliance with PBJ Reporting?](https://proactiveltcexperts.com/are-you-in-compliance-with-pbj-reporting/) - In April 2018, CMS began using the PBJ data to calculate staffing measures which will be posted on Nursing Home Compare and used in the Five Star Quality System. Staffing measures and staffing star ratings were calculated based on the data for the 2017 Calendar Quarter 4 that was submitted prior to the February 14, 2018 deadline. Nursing
- [Rehab Medical Review & Auditing: Fundamentals of Success](https://proactiveltcexperts.com/rehab-medical-review-auditing-fundamentals-of-success/) - This four part webinar series reviews recent trends of rehabilitation service medical review, common denial trends and proactive measures to reduce risk and improve outcomes during active medical review. Recent audit activity will be discussed under both part A and part B as well as Managed Care denial activity using actual denial decisions. For more
- [Communicating PDPM essentials to Hospital Discharge Planners, the Medical Director, and Attending Physicians just got simpler.](https://proactiveltcexperts.com/communicating-pdpm-essentials-to-hospital-discharge-planners-the-medical-director-and-attending-physicians-just-got-simpler/) - Proactive has released two new PDPM toolkits: PDPM Physician Toolkit and Hospital PDPM Quick Guide and Hospital to SNF Discharge PDPM Documentation Checklist PDPM Physician Toolkit ($129) The PDPM Physician Toolkit provides the essential information and query process tools providers need to know to effectively partner with SNFs in caring for Medicare residents under PDPM.
- [Phase 3 SNF Compliance and Ethics Program Essentials: Reporting Processes](https://proactiveltcexperts.com/phase-3-snf-compliance-and-ethics-program-essentials-reporting-processes/) - Effective systems critical for a robust Compliance Program A compliance program is made up of the written policies, procedures and day to day operational actions that focus on preventing and detecting violations of law and regulations and on promoting care quality. The program should include an established framework for accountability, setting standards that outline expectations
- [The Path to 5 Star Quality Measures: Percent of residents whose need for help with activities of daily living has increased](https://proactiveltcexperts.com/the-path-to-5-star-quality-measures/) - This blog is one in a series of blogs focusing on SNF 5-Star Quality Measures. Click here to see all 5 star blogs. CMS Five-Star Quality Rating System: The Path to 5-Star QMs Percent of residents whose need for help with activities of daily living has increased One of the eight quality measures derived from
- [Payment for HIV/AIDS- related cost under the PDPM](https://proactiveltcexperts.com/payment-for-hiv-aids-related-cost-under-the-pdpm/) - PDPM includes specific provisions to ensure that it accounts for the increased costs associated with caring for SNF patients with HIV/AIDS. Is your facility prepared to manage complex care plans associated with higher acuity admissions? Historically in accordance with §511(a) of the Medicare Modernization Act of 2003 (MMA Public Law 108-173) the previous Resource Utilization
- [Restorative Considerations for PDPM](https://proactiveltcexperts.com/restorative-considerations-for-pdpm/) - It may be time to assess your facility Restorative Nursing Program as part of your PDPM transition preparedness plan. Restorative Basics The fundamental requirements for Restorative nursing will remain the same under PDPM. Per the RAI manual, Restorative Nursing Programs actively focus on achieving and maintaining a resident’s optimal physical, psychosocial and mental well-being while
- [CMS releases 2019 RAI](https://proactiveltcexperts.com/cms-releases-2019-rai/) - Highlights from the new RAI release Opportunity to Review Assessment Steps and Coding Guidance CMS has released the MDS 3.0 Resident Assessment Instrument (RAI) Manual v1.17 effective for assessments with an ARD of 10/1/2019 and after. PDPM guidance and calculation worksheets can be found in Chapter 6. Please note this is an early release and
- [Achieve Section GG - PDPM Function Score Accuracy](https://proactiveltcexperts.com/achieve-section-gg-pdpm-function-score-accuracy/) - New! Easy Front-Line Staff Training Tool-Kit for Section GG Is your team up to speed on GG coding for PDPM? Under PDPM, Section GG significantly impacts Medicare reimbursement. Section GG replaces the Section G ADL score coding as the function measure under the new payment model. Accurate GG coding requires strong interdisciplinary team communication, data
- [Does your staff training and competency assessment program measure up?](https://proactiveltcexperts.com/does-your-staff-training-and-competency-assessment-program-measure-up/) - Protect your facility and residents from adverse events and negative survey outcomes. The Phase 3 SNF §483.95 Training Requirements must be in place by November 28, 2019. As part of the new requirements, nursing facilities will be required to develop, implement, and maintain an effective training program for all new and existing staff; individuals providing
- [WEBINAR: PDPM Ready! Supporting Section K for Rehab and Dietary](https://proactiveltcexperts.com/webinar-pdpm-ready-supporting-section-k-for-rehab-and-dietary/) - UPDATE: This webinar is now available to purchase as a RECORDED WEBINAR DOWNLOAD. Click here for details. Register now for our upcoming webinar! Earn CEs! Seminar Details: Seminar Title: PDPM Ready! Supporting Section K for Rehab & Dietary: Identify & Code Swallowing Disorders & Modified Diets on the 5-Day MDS Presentation Date: Thursday, May 9,
- [5 Star Rating take a hit in April?](https://proactiveltcexperts.com/5-star-rating-take-a-hit-in-april/) - 5 Star Rating take a hit in April? We can help! Nearly 40% of SNFs experienced a decline in overall star rating due to the changes in the 5 Star Rating calculation put into effect in April. Proactive partners with providers to drive 5 Star improvement through a targeted work plan. Our proven training, resources
- [MDS Accuracy Key For PDPM Success](https://proactiveltcexperts.com/implementation-of-the-medicare-patient-driven-payment-model-pdpm/) - PDPM: MDS Accuracy and QAPI Initiatives With the implementation of the Medicare Patient Driven Payment Model (PDPM) on October 1st, 2019 comes the need for increased MDS accuracy and supportive documentation. Under PDPM, responses to 188 MDS items will be used to determine a resident’s PT, OT, SLP, Nursing, and NTA case mix groups (CMGs),
- [SNF Proposed Payment Updates for FY 2020](https://proactiveltcexperts.com/snf-proposed-payment-updates-for-fy-2020/) - On Friday 4/19, CMS released the pre-publication of the FY 2020 Skilled Nursing Facility Prospective Payment System Proposed Rule. As expected, the Patient-Driven Payment Model is confirmed to go into effect October 1, 2019. SNF Proposed Payment Updates for FY 2020: Proposed SNF payment update is 2.5% (increase of $887 million from FY2019) The proposed
- [The Impact of Diagnosis Coding Under PDPM Reimbursement](https://proactiveltcexperts.com/the-impact-of-diagnosis-coding-under-pdpm-reimbursement/) - Reimbursement under PDPM Reimbursement under PDPM will require updates to clinical systems, policies and procedures, and operational focus. Diagnosis coding accuracy will be paramount to appropriate payment under PDPM, as ICD-10 Diagnosis codes & other patient characteristics are used as basis for classification in determining MCR payment. The 5-day MDS will establish the PDPM payment
- [SNF PEPPER Available - Do you have outlier Medicare billing patterns?](https://proactiveltcexperts.com/snf-pepper-available-do-you-have-outlier-medicare-billing-patterns/) - PEPPER: Program for Evaluating Payment Patterns Electronic Report Skilled Nursing Facility PEPPER Available The Q4FY18 release of the Skilled Nursing Facility (SNF) Program for Evaluating Payment Patterns Electronic Report (PEPPER) with statistics through September 2018 is now available for download through the PEPPER Resources Portal. To obtain your SNF's PEPPER, the Chief Executive Officer, President,
- [Five Star Update](https://proactiveltcexperts.com/five-star-update/) - Five Star Rating Changes Effective April 2019 This week CMS released upcoming improvements to Nursing Home Compare and the Five Star Rating system that will go into effect in April 2019. Key changes that will take place in April include: Health Inspection Rating: The freeze on the Health Inspection rating will end Surveys occurring

## Pages

- [Home](https://proactiveltcexperts.com/) - Consulting services, MDS Audits, & Regulatory Compliance for LTC, skilled nursing facilities, nursing homes, & senior care providers. Call (812) 471-7777.
- [Education and Training](https://proactiveltcexperts.com/education-and-training/) - Upcoming Education Proactive partners with industry associations, trade groups, and other affiliates for collaborative training projects and provider support initiatives. Looking for NAB credit? Check out our NAB-approved webinars. Survey & Clinical Risk Management DON Playbook: Skills for Today’s LTC Nurse Leader Team MDS! Insights & Coaching for Quality Coding and PDPM Success Payroll-Based Journal
- [Calendar of Events](https://proactiveltcexperts.com/calendar-of-events/) - Calendar of Events Check out the calendar below for all upcoming VIRTUAL education opportunities from Proactive. Client-Only Webinar – Documentation Excellence: Protecting Your Facility in Survey and Legal Review Client-Only Webinar – Documentation Excellence: Protecting Your Facility in Survey and Legal Review August 03, 2026 More Info Restorative Nursing Excellence: Revitalizing Programs and Restoring Function
- [Progress with Proactive](https://proactiveltcexperts.com/progress-with-proactive/) - Progress with Proactive Client-Only Webinars The Progress with Proactive webinar series is for Proactive clients only and offers complimentary monthly webinars to educate facilities on hot topics and provide industry updates. Email invites are sent to clients for advance registration prior to each session. Webinars take place at 11:00 a.m. Eastern/10:00 a.m. Central. Upcoming Sessions
- [Payroll-Based Journal (PBJ) Mastery for Skilled Nursing Facilities](https://proactiveltcexperts.com/payroll-based-journal-pbj-mastery-for-skilled-nursing-facilities/) - Payroll-Based Journal (PBJ) Mastery for Skilled Nursing Facilities Virtual Workshop on Wednesday, August 19 9:00 a.m. – 2:30 p.m. Eastern Time Payroll-Based Journal (PBJ) reporting is one of the most critical—and highly scrutinized—compliance requirements for Skilled Nursing Facilities. Accurate PBJ data directly impacts Five-Star Staffing ratings, survey outcomes, public reporting, and overall facility credibility with
- [Fall Program Reboot](https://proactiveltcexperts.com/fall-program-reboot/) - Fall Prevention Program Reboot This comprehensive 6-week series will provide the LTC/AL team with detailed fall management program components to effectively reduce fall risk, occurrences and possible fall-related injuries. Topics will include QAPI systems to drive improved safety, keys to better fall risk assessments, insights into effective Root Cause Analysis, intervention selection that target individual
- [Quality Measure Deep Dive](https://proactiveltcexperts.com/quality-measure-deep-dive/) - Quality Measure Deep Dive Navigate the Quality Measures (QMs) that define SNF performance with practical strategies to improveoutcomes, strengthen compliance, and protect reimbursement. Participants will develop a clearunderstanding of how key measures are defined, coded, and calculated—and how day-to-day clinicalpractice translates into overall facility performance. Each session includes practical strategies, realworldexamples, and focused documentation guidance
- [Medicare Bootcamp Workshop](https://proactiveltcexperts.com/medicare-bootcamp-workshop/) - Medicare Bootcamp Virtual Workshop Tuesday, October 6 9:00 a.m. - 4:00 p.m. Eastern Time A strong foundation in the Medicare Basics is essential to compliance with SNF Medicare program requirements and accurate reimbursement for each Medicare resident’s Part A stay. The course will provide an overview of the Medicare benefit period rules, the technical and
- [Roadmap to 5-Star Wins](https://proactiveltcexperts.com/roadmap-to-5-star-wins/) - Roadmap to 5-Star Wins This series will focus on exploring the three domains of the CMS 5 Star Quality Rating System: Health Inspections, Staffing, and Quality Measures, as well as a review of the SNF QRP program. Attendees will deepen knowledge in calculation of the health inspection, staffing, quality measure and overall rating. Tips on
- [Skin and Wound Essentials Workshop](https://proactiveltcexperts.com/skin-and-wound-essentials-workshop/) - Skin and Wound Essentials Workshop Thursday, March 5 10:00 a.m. - 2:30 p.m. Central Time Wound care in post-acute settings presents assessment, treatment and documentation challenges for the nursing team. This workshop is designed to equip healthcare professionals with the essential knowledge and skills needed for implementing a comprehensive and effective wound care management system.
- [DON Playbook](https://proactiveltcexperts.com/don-playbook/) - DON Playbook: Skills for Today’s LTC Nurse Leader This series focuses on the core competencies and strategies of an effective Director of Nursing. Monthly sessions focus on critical skills including leading teams, implementing strong systems for key tasks, and mastering the QAPI approach to drive performance outcomes. Experienced nurse leaders share keyinsights to address common problems
- [Team MDS! Insights & Coaching for Quality Coding and PDPM Success](https://proactiveltcexperts.com/team-mds-insights-coaching-for-quality-coding-and-pdpm-success/) - TEAM MDS! Insights & Coaching for Quality Coding and PDPM Success This 12-part monthly webinar and coaching series is designed to strengthen facility MDS teams with practical, hands-on lessons in coding accuracy, documentation, and PDPM proficiency. Each session tackles a high-impact topic—ranging from mastering GG and self-care/mobility items, rooting outcommon coding errors, ICD-10 sequencing, and
- [Savvy Social Services](https://proactiveltcexperts.com/savvy-social-services/) - Savvy Social Services Thursday, October 15 9:00 a.m. - 4:00 p.m. CENTRAL TIME The Social Services Director plays a vital, multifaceted role in nursing home care. This workshop will focus on the key areas that will guide the Social Service staff to meet the needs of the residents as well as enhancing their quality of
- [Survey & Clinical Risk Management](https://proactiveltcexperts.com/survey-clinical-risk-management/) - Survey & Clinical Risk Management This year-long virtual series is designed to equip LTC leaders, clinicians, and staff with the knowledge and skills needed to stay compliant, improve quality outcomes, and strengthen survey readiness. Each monthly session focuses on a critical area of LTC operational or clinical risk, blending regulatory guidance with practical strategies for
- [Strategies for Workforce Retention](https://proactiveltcexperts.com/strategies-for-workforce-retention/) - Strategies for Workforce Retention This 4-session series provides actionable insights and resources to bolster retention of nursing staff and other healthcare professionals. Participants will receive information on evaluating key risk factors for staff exiting employment with strategies to perform root cause analysis and prioritize retention interventions. Series content will include methods for measuring staff engagement
- [MO Grant Project - Proactive Solutions Center](https://proactiveltcexperts.com/solutionscentergrant/) - Pending CMP Grant Funded Project for Missouri Nursing Facilities MISSOURI FACILITIES: Register to participate (pending grant funding approval)! REGISTER Missouri nursing homes are invited to join a grant-funded initiative designed to close compliance gaps and improve quality of care. Through CMP funding, your facility could receive a fully covered subscription to the Proactive Solutions Center
- [Perspectives: A Behavioral Health Workshop](https://proactiveltcexperts.com/perspectives-a-behavioral-health-workshop/) - Behavioral Health Workshop Virtual Workshop Tuesday, August 26 8:30 a.m. - 4:00 p.m. Central Time Gain a fresh perspective on your LTC facility’s behavioral health program by registering for this full-day workshop presented by Proactive’s team of post-acute care experts. Take a deep dive into: Assessment, Care Planning & Documentation Psychotropic Medication Management & Systems
- [Disputing Deficiencies Successfully Through IDR, IIDR and Administrative Law Hearing Processes](https://proactiveltcexperts.com/disputing-deficiencies-successfully-through-idr-iidr-and-administrative-law-hearing-processes/) - Disputing Deficiencies Successfully Through IDR, IIDR and Administrative Law Hearing Processes Virtual Workshop Thursday, November 13 10:00 a.m. - 1:00 p.m. Central Time Nursing facility leadership should be confident in their ability to effectively dispute survey deficiencies through the IDR, IIDR and Administrative Law Hearing processes. Even low-level deficiencies can negatively impact a facility’s star
- [Driving QMs Through Clinical Excellence](https://proactiveltcexperts.com/driving-qms-through-clinical-excellence/) - Driving QMs Through Clinical Excellence This 6-week masterclass is designed to equip skilled nursing facility (SNF) professionals with the knowledge and tools needed to drive Quality Measures (QMs) through the pursuit of clinical excellence. Each week, participants will delve into critical aspects of resident care that directly impact QMs, from comprehensive assessments and care planning
- [Infection Preventionist Workshop for Skilled Nursing Facilities](https://proactiveltcexperts.com/infection-preventionist-workshop-for-skilled-nursing-facilities/) - Infection Preventionist Virtual Workshop for Skilled Nursing Facilities September 16 & 17, 2026 9:00 a.m. - 2:30 p.m. CST each day This 2-day intensive workshop is designed for Skilled Nursing Facility (SNF) Infection Preventionists (IPs) and healthcare professionals responsible for infection prevention and control (IPC) programs. With increasing regulatory scrutiny and evolving infection threats, this
- [QAPI Program Refresh](https://proactiveltcexperts.com/qapi-program-refresh/) - QAPI Program Refresh Thursday, May 29 8:30 a.m. - 4:00 p.m. Central Time What to Expect: This workshop will assist SNF providers in effectively designing and implementing a QAPI program in the nursing facility setting. Participants will gain the skills needed to improve quality nursing care and quality of life of nursing facility residents
- [CMS Revised Surveyor Guidance](https://proactiveltcexperts.com/cms-revised-surveyor-guidance/) - CMS Revised Surveyor Guidance This 2-hour webinar will provide an in-depth review of the significant revisions to the LTC survey process released on November 18, 2024 as QSO-25-07-NH. Attendees will gain insights into these updates, explore available training and resources, and identify key readiness considerations to ensure compliance before the changes take effect on April
- [Proactive Solutions Center](https://proactiveltcexperts.com/proactive-solutions-center/) - Proactive Solutions Center Elevate Your Quality & Compliance with Member-Only Resources, Training, and Support The Proactive Solutions Center is your all-in-one solution for compliance, leadership development, and operational excellence. Subscribe today to access expert guidance, essential tools, and a community of professionals dedicated to success. At Proactive, we believe in empowering long-term care facilities to
- [Secrets of a Great Department Head](https://proactiveltcexperts.com/secrets-of-a-great-department-head/) - Secrets of a Great Department Head This weekly series will address essential functions, quality care and department-specific management functions for department heads with sessions specific to Administrators, DONs, Housekeeping, Social Services, Activities, Dietary, Maintenance and Therapy. Topics will include department-specific considerations for infection control, survey preparedness, role in meetings, IDT systems integration, MDS supportive documentation,
- [5-Star Work Plans A-Z](https://proactiveltcexperts.com/5-star-work-plans-a-z/) - 5-Star Work Plans A to Z This series examines the three domains of the CMS 5-Star Quality Rating System: Health Inspections, Staffing and Quality Measures including how the rating is calculated and analyzing your data with a focus on developing a work plan to improve or maintain 5-Star Status. Common obstacles to 5-Star status will
- [Free Resources](https://proactiveltcexperts.com/free-resources/) - Free Resources Proactive’s user-friendly tools and practical training solutions allow you to spend more time focusing on care.
- [Welcome to the World of Dietary!](https://proactiveltcexperts.com/dietaryworkshop/) - Welcome to the World of Dietary! Dietary department need a refresh? Sharpen your dietary knowledge and establish effective dietary department systems when you join Proactive for this virtual workshop. This 4-hour training will review team building, food service regulations, documentation requirements, IDT collaboration, preventing common deficiencies and much more! Co-presented by a dual Registered Dietitian
- [Services - Home Health Consulting](https://proactiveltcexperts.com/homehealth/) - Home Health Consulting Proactive provides Home Health Consulting to advance compliance, care quality and reimbursement accuracy. Home Health Consulting Services: Mock Survey & Survey Management Mergers and Acquisition Support and Due Diligence Start-up and Expansion QAPI/Star Ratings/VBP/HHCAHPs Interim Management Strategic Planning and KPI Reimbursement/Finance Revenue Cycle Management Recruitment and Retention P&P Development Compliance Coaching
- [Survey Smart: LTC Deficiency Trends & Solutions](https://proactiveltcexperts.com/survey-smart-ltc-deficiency-trends-solutions/) - Survey Smart: LTC Deficiency Trends & Solutions This series offers long-term care professionals an in-depth understanding of the most frequently cited deficiencies in nursing homes with practical solutions to avoid similar citations. Each session focuses on a specific regulatory requirement, such as infection prevention, accident hazards, comprehensive care planning, and pharmacy services. Participants will learn
- [Reducing Litigation Risk for SNF & AL](https://proactiveltcexperts.com/reducing-litigation-risk-for-snf-al/) - Reducing Litigation Risk for SNF & AL This wide-ranging 12-month compliance and risk management focused series will provide the healthcare professional with insight into the long-term care litigation process and best practices for avoiding lawsuits. Instructors will include a LTC Legal Nurse Consultant with guest sessions by experienced nursinghome defense attorneys. Monthly discussion will include
- [Facility Assessment](https://proactiveltcexperts.com/facility-assessment/) - Optimize safety and compliance with our facility assessment services. Proactive offers consultation options to assist your facility with the assessment.
- [KY Grant Project - Empowering Excellence](https://proactiveltcexperts.com/empoweringexcellence/) - Pending CMP Grant Funded Project for Kentucky Nursing Facilities KENTUCKY FACILITIES: Register to participate (pending grant funding approval)! REGISTER The “Empowering Excellence” grant project aims to develop and nurture nurse leaders within long-term care (LTC) facilities through enhancement of facility-wide systems for nurse leadership skill development, career advancement pathways and nursing staff retention. The project’s
- [Survey Prep & Understanding Post-Survey Elements](https://proactiveltcexperts.com/survey-prep-understanding-post-survey-elements/) - Survey Prep & Understanding Post-Survey Elements Need to ensure your team is survey ready? This intensive 8-week workshop establishes department specific expectations and provides the insights key staff members need to understand the survey process, ensure collective survey preparedness, and overcome deficiencies. Whether you're new to the LTC Survey process, seeking to refresh staff skills,
- [2024 Training Events](https://proactiveltcexperts.com/2024-training-events/) - Upcoming Training Events Client-Only Webinar - Documentation Excellence: Protecting Your Facility in Survey and Legal Review Date August 03, 2026 Learn more & Register View Events Website Restorative Nursing Excellence: Revitalizing Programs and Restoring Function Date August 05, 2026 Learn more & Register View Events Website Medication Management & Adverse Drug Event Prevention Date August
- [Services - MDS (In Depth)](https://proactiveltcexperts.com/services-mds-in-depth/) - MDS consulting services for SNF (skilled nursing facilities) & LTC (long term care). MDS audits & training. Contact Proactive Medical Review @ (812) 471-7777.
- [Upcoming Training Events](https://proactiveltcexperts.com/upcoming-events/) - Upcoming Training Events Client-Only Webinar - Documentation Excellence: Protecting Your Facility in Survey and Legal Review Date August 03, 2026 Learn more & Register View Events Website Restorative Nursing Excellence: Revitalizing Programs and Restoring Function Date August 05, 2026 Learn more & Register View Events Website Medication Management & Adverse Drug Event Prevention Date August
- [Terms of Use](https://proactiveltcexperts.com/terms/) - Website Terms of Use This Privacy Policy was last updated on December 13, 2022. Please read these Terms of Use carefully before using ProactiveMedicalReview.com and ProactiveLTCExperts.com (the “Website”). If you do not agree to these Terms of Use, please do not use this Website. YOU AGREE AND ACKNOWLEGE THAT BY USING THIS WEBSITE, OR PURCHASING
- [MDS Orientation](https://proactiveltcexperts.com/mds-orientation/) - MDS Orientation Training Building Blocks for Superior MDS Teams 15 contact hours of live virtual MDS orientation training with expert trainers over 3 interactive training days, with break out groups and coding practice. Extensive resource manual and opportunities for Q&A provided in this MDS orientation that introduces critical clinical assessment, care planning and MDS concepts
- [RAC-CT & RAC-CTA](https://proactiveltcexperts.com/rac-ct/) - RAC-CT & RAC-CTA Certification Workshops Virtual RAC-CT June 2-4 8AM-5PM (ET) Daily REGISTER In Person RAC-CT September 1-3 in Louisville, KY 8AM-5PM (ET) Daily Register Virtual RAC-CTA September 22-24 8AM-5PM (ET) Daily Registration Coming Soon! RESIDENT ASSESSMENT COORDINATOR—CERTIFIED (RAC-CT®) CERTIFICATION WORKSHOP Increase your knowledge of clinical assessment and care planning, completion of the MDS, the
- [Kentucky Grant Project - QAPI Programs in the LTC Setting](https://proactiveltcexperts.com/qapi-grant-project-2023/) - Grant Funded Training Program for LTC Facilities This project provides grant funded resources, training, and consultation to Kentucky nursing facilities on driving quality care through effective quality assurance and performance improvement (QAPI) programs. Participants will build skills in designing, implementing, and documenting evidence of QAPI program activities to improve resident quality of care and quality
- [Templates](https://proactiveltcexperts.com/templates/) - Templates Proactive’s user-friendly tools and practical training solutions allow you to spend more time focusing on care.
- [NAB Approved Webinars](https://proactiveltcexperts.com/nab-approved-webinars/) - NAB Approved Webinars Webinars in the series below are approved for NAB credit for attending the LIVE webinar. Credit cannot be issued for viewing the recording. Survey & Clinical Risk Management DON Playbook: Skills for Today’s LTC Nurse Leader TEAM MDS! Insights & Coaching for Quality Coding and PDPM Success Quality Measure Deep Dive PROACTIVE
- [Toolkits](https://proactiveltcexperts.com/toolkits/) - Toolkits Proactive’s user-friendly tools and practical training solutions allow you to spend more time focusing on care.
- [On-Demand Webinars](https://proactiveltcexperts.com/on-demand-webinars/) - On-Demand Webinars Strategies for Workforce Retention This 4-session series provides actionable insights and resources to bolster retention of nursing staff and other healthcare professionals. Participants will receive information on evaluating key risk factors for staff exiting employment with strategies to perform root cause analysis and prioritize retention interventions. Series content will include methods for measuring
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- [Dynamic DON](https://proactiveltcexperts.com/dynamic-don-3/) - Dynamic DON Virtual Workshop March 31 & April 1 11:00 a.m. - 2:15 p.m. Central Time each day This 6-hour virtual workshop will take place over 2 days focusing on skill building for serving effectively as the Director of Nursing with emphasis on effective leadership and staff engagement, nursing operations and systems of care for
- [Proactive Shop](https://proactiveltcexperts.com/proactive-shop/) - The Proactive Shop On-Demand Webinars Toolkits Templates
- [Service Areas](https://proactiveltcexperts.com/service-areas/) - Service Areas Proactive serves facilities in all 50 states across the United States. Here are some cities in the regions we currently serve. Northeast Albany, NY Columbia, MD Greater Boston Area Hartford, CT Lancaster, PA Newark, DE New York City, NY Princeton, NJ Pembroke, NH Rochester, NY Scranton, PA South Barre, VT Southeast Asheville, NC
- [Services](https://proactiveltcexperts.com/services/) - Our Services  Medical Review Proven compliance audit programs, as well as ADR and Appeal solutions to reduce error rates. Experienced clinical support for UPIC/ZPIC, RAC, TPE, Commercial Insurance and other medical review types.  INFECTION PREVENTION & CONTROL Effective education, resources and support services you need to implement and sustain an effective Infection Prevention
- [Services - Rehabilitation Support & Oversight](https://proactiveltcexperts.com/rehabilitation-support-oversight/) - Compliance Compliance Program support for rehabilitation settings including program development, policies and procedures, auditing and monitoring and compliance investigation assistance. Learn more Medical Review ADR and Appeals management services for Medicare, Managed Care and Insurance claims. Proactive’s medical review team has a proven history of success of achieving successful outcomes for RAC, UPIC/ZPIC,
- [Services - MDS Support](https://proactiveltcexperts.com/services-mds-support/) - MDS consulting services for SNF (skilled nursing facilities) & LTC (long term care). MDS audits & training. Contact Proactive Medical Review @ (812) 471-7777.
- [Services - Reimbursement](https://proactiveltcexperts.com/reimbursement/) - Medicare-PDPM Audit & Support Services PDPM is complex. Proactive’s MDS coding and documentation experts provide the coaching and validation services you need to succeed under PDPM. QA AUDITS: Our proven audit program drives coding accuracy to capture the patient-centered care you’re providing to ensure proper Medicare Remote MDS validation audits, therapy medical necessity audits,
- [Services - Medical Review](https://proactiveltcexperts.com/medical-review/) - Medical Review Support Proactive assists providers to prepare for and respond to program integrity audits. Our experts have successfully managed thousands of Medicare ADRs and Appeals, assisting providers to implement effective medical review response systems, to promote substantive charting in defense of skilled services, and to reduce error rates during government contractor investigations and
- [Services - Compliance](https://proactiveltcexperts.com/compliance/) - Compliance Program Development & Support Proactive’s team includes experts certified through the Healthcare Compliance Association (HCCA) with the skills to meet your needs for the development and ongoing implementation of a SNF Compliance and Ethics Program. Contact us for information on compliance program development, risk-based work plan implementation, program oversight and assistance with potential
- [Services - Legal Nurse Consulting](https://proactiveltcexperts.com/legal-nurse-consulting/) - Legal nurse consultants provide support to legal counsel in medical related matters. Members of the National Alliance of Certified Legal Nurse Consultants.
- [Services - QAPI](https://proactiveltcexperts.com/qapi/) - Program Development & Support Drive continual quality and care excellence by engaging Proactive’s QAPI certified professionals (QCP) to assist in enhancing programs and team skills to bring QAPI to life in your facility. Let us assist in Identifying potential gaps and in achieving tangible quality outcomes. Our qualified consulting team provides the systems analysis
- [Services - Infection Prevention & Control](https://proactiveltcexperts.com/infection-prevention-control-2/) - Infection Preventionist Training & Support Proactive’s team of qualified Infection Preventionist Consultants provide the education, resources and support services you need to implement and sustain an effective Infection Prevention and Control program. Contact us to schedule a program evaluation. Services include, but are not limited to: Mock survey & survey management support Onsite monitoring
- [Services - 5-Star](https://proactiveltcexperts.com/5-star/) - Proactive consultants can develop a facility specific Five-Star Road map and assist in driving continual improvement in QMs, Health Inspections and Staffing.
- [Services - Clinical Nurse Consulting](https://proactiveltcexperts.com/clinical-nurse-consulting/) - Nurse Consulting Proactive provides the nurse consulting services you need to achieve your clinical quality and compliance goals. Our team of clinical experts support clients through short term consulting projects or long term work plans with an established schedule of regular onsite visits combined with remote assistance. From policy and procedure development to 5
- [Our Mission](https://proactiveltcexperts.com/our-misssion/) - Our ambitions are shaped by Colossians 3:23 Whatever you do, work at it with all your heart, as working for the Lord and not for men. Proactive’s mission is to positively impact our healthcare clients in the areas of compliant practice, care excellence and appropriate reimbursement for services. Proactive’s vision is to be a
- [ICD-10 CM Coding for Beginners](https://proactiveltcexperts.com/icd-10-cm-coding-for-beginners/) - ICD-10-CM for Beginners 2-Day Webinar Workshop August 12 & 13 8:30 - 3:30 CENTRAL TIME each day $499.00 What to Expect: Do you have new staff members with little to no experience in assigning ICD-10 codes? This training, designed for individuals new to ICD-10 coding in nursing facilities, will assist you in gaining the
- [Services - Regulatory](https://proactiveltcexperts.com/regulatory/) - Survey Management Proactive’s regulatory experts help your facility achieve survey success through: Mock Surveys Survey Management Consultation Immediate Jeopardy Removal Assistance Plan of Correction Development and Implementation Directed Plan of Correction (DPoC) Consultation Informal Dispute Resolution (IDR) Support Mock Survey Proactive offers mock survey services to assist providers in preparing for the annual
- [ICD-10 CM Coding Refresher](https://proactiveltcexperts.com/icd-10-cm-coding-refresher/) - Virtual ICD-10 CM Coding Refresher for Skilled Nursing Facilities Wednesday, September 30 8:30 a.m. - 4:00 p.m. Central Time What to Expect: Diagnosis coding accuracy is paramount to appropriate payment under PDPM, as ICD-10 Diagnosis codes & other patient characteristics are used as basis for classification in determining MCR payment. The 5-day MDS
- [Restorative Nursing](https://proactiveltcexperts.com/restorative-nursing/) - Restorative Nursing Excellence: Revitalizing Programs and Restoring Function Virtual Workshop Wednesday, August 5 10:00 a.m. - 4:45 p.m. Eastern Time This full-day training will focus on restorative nursing programs (RNP) by reviewing program fundamentals including the types of programs, RAI definitions, and regulatory requirements. Attendees will gain insight into evaluating RNP candidates, the connection
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- [Careers](https://proactiveltcexperts.com/careers/) - Careers Proactive’s team includes certified MDS/RAI coordinators, Health Facility Administrators, former corporate Clinical Nurse Specialists, Therapy Operations Directors and Compliance Officers. Join the Proactive Team We’re open to growing our team with talented, innovative individuals who have a passion for quality care and a history of successfully leading change in the SNF environment. A minimum
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- [Shop](https://proactiveltcexperts.com/shop/) - Ready to take your facility to the next level? The Proactive Solutions Center is your all-in-one solution for compliance, leadership development, and operational excellence. Subscribe today to access expert guidance, essential tools, and a community of professionals dedicated to success. Learn more!  Upcoming Training  On-Demand Webinars  Toolkits i Forms Library What our
- [Who We Serve](https://proactiveltcexperts.com/who-we-serve/) - Proactive Offers Solutions that Allow Providers to Focus on Care Proactive offers solutions for SNF/post-acute providers, therapy providers, and attorneys. Our team of expert PT, OT, and SLP therapists, nurse, administrator, and billing consultants is uniquely positioned to assist SNF providers. Post-acute care providers are facing many challenges--an ever changing regulatory environment, expanded government auditing, and a growing list of publicly
- [Contact Us](https://proactiveltcexperts.com/contact-us/) - Contact Us Do you have questions about what solutions Proactive can offer? Contact us today!  Proactive Offers Solutions that Allow Providers to Focus on Care Post-acute care providers are facing many challenges--an ever changing regulatory environment, expanded government auditing, and a growing list of publicly reported quality measures. But your mission is centered on
- [SNF/Post Acute Providers](https://proactiveltcexperts.com/snf/) - Skilled Nursing Facilities Proactive Offers Solutions that Allow Providers to Focus on Care Post-acute care providers are facing many challenges--an ever changing regulatory environment, expanded government auditing, and a growing list of publicly reported quality measures. But your mission is centered on care excellence and consistently satisfying resident, referral source and community expectations. For smaller
- [Rehabilitation](https://proactiveltcexperts.com/rehabilitation/) - Proactive Partners with Therapy Providers As an independent consulting firm specializing in post-acute rehabilitation, our team assists contract therapy companies, in-house SNF therapy programs, and outpatient clinics manage compliance and medical review preparedness. We help providers to: Ensure Regulatory Compliance Manage Clinical Operations Achieve Medical Review Success 3rd Party Audits Advance Documentation and Coding Skills
- [Attorneys](https://proactiveltcexperts.com/attorneys/) - Proactive Medical Review offers legal nurse consulting services to in-house & outside counsel, defense & plaintiff attorneys. Call (812) 471-7777 to learn more.
- [Services - OLD](https://proactiveltcexperts.com/services-old/) - Proactive is an independent consulting firm specializing in post-acute care clinical excellence, regulatory & reimbursement compliance, medical reviews, and more.
- [About Us](https://proactiveltcexperts.com/about/) - Leadership Team Proactive LTC Consulting specializes in providing clinical, regulatory & reimbursement support to post acute care providers. Our team includes Nurse Consultants, Infection Preventionists, Legal Nurse Consultants, Therapist Consultants, Healthcare Compliance Certified Practitioners, AAPACN certified RAC-CT/RAC-CTA MDS Experts, Certified Coders and Billing Experts to assist your team in managing clinical and operational challenges, so
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## Topics

- [Session 5: LTC Litigation Briefing](https://proactiveltcexperts.com/topic/session-5-ltc-litigation-briefing/) - What questions do you have that we can answer during this session?
- [Session 4: Easing Workforce Woes](https://proactiveltcexperts.com/topic/session-4-easing-workforce-woes/) - Let me know your thoughts on this session!
- [Session 3: ABC's of QRP and VBP](https://proactiveltcexperts.com/topic/session-3-abcs-of-qrp-and-vbp/)
- [Session 2: Survey School in Session](https://proactiveltcexperts.com/topic/session-2-survey-school-in-session-4/) - Let us know what questions you have for this session!
- [Session 1: Avoiding Facility Assessment Failures](https://proactiveltcexperts.com/topic/session-1-avoiding-facility-assessment-failures/) - Please let us know your thoughts or questions about session 1!

## Replies

- [](https://proactiveltcexperts.com/reply/11136/) - This month we have a bonus handout for QRP Measures. Download it at https://proactiveltcexperts.com/wp-content/uploads/2023/03/QRP-Measures.pdf
- [](https://proactiveltcexperts.com/reply/11052/) - Check out this CMS resource RE: Revisions to Appendix Q, Guidance on Immediate Jeopardy https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/QSO19-09-ALL.pdf
- [](https://proactiveltcexperts.com/reply/10838/) - What template are you using to complete your facility assessment? Does anyone have a good FA template they would like to share?

## Layouts

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- [text box with blue border](https://proactiveltcexperts.com/et_pb_layout/text-box-with-blue-border/) - What our clients say about us... The Proactive team has expertise with audits, new startups, ongoing reviews, setting up systems related to triple check and internal audits, as well as working with us on 5 STAR plans, and reviewing our preparation for ongoing regulatory and compliance changes. We can rely on Proactive to help us
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- [Pull out - Quote](https://proactiveltcexperts.com/et_pb_layout/pull-out-quote/) - “Our facility does not have a corporate office to engage for training purposes. Proactive Consultants have worked with us in the areas of Quality Measures, survey expectations, and day to day clinical operations. The engagement resulted in the identification of facility system barriers and insight into improving processes for the best resident care outcomes. We
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- [Project Outline Chrt](https://proactiveltcexperts.com/et_pb_layout/project-outline-chrt/) - Project Overview Nurse Leadership Skill Development Leadership training modules (12) every other week Mentorship cohort meetings (12) every other week Mentor matching with established Proactive consultant nurse leader Staff Retention/Leadership Gap Analysis Leadership needs assessment Staff engagement assessment Staff satisfaction and retention gap analysis Implement Career Pathway RN/LPN/CNA career pathways using project resources Identify individual
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- [Presenter Bio Section](https://proactiveltcexperts.com/et_pb_layout/presenter-bio-section/) - Shelly Maffia Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, CLNC, CPCDirector of Regulatory Services Shelly Maffia is a Registered Nurse and licensed Nursing Home Administrator with extensive experience in the long-term care setting. She holds AANAC’s QAPI Certified Professional (QCP) credential, is certified in healthcare compliance through the Healthcare Compliance Association (HCCA), is an
- [Webinar Top](https://proactiveltcexperts.com/et_pb_layout/webinar-top/) - Deconstructing Immediate Jeopardy & High-Risk Tags This 12-month webinar series is designed to empower nursing home professionals with the knowledge and strategies needed to navigate the top risk areas associated with Immediate Jeopardy citations. Drawing from real-life examples of IJ citations, we’ll delve into actionable solutions to prevent these critical citations in facilities. Participants will
- [Webinar Middle with dates/time](https://proactiveltcexperts.com/et_pb_layout/webinar-middle-with-dates-time/) - Webinar Dates January 9 - Immediate Jeopardy Risk: Elopement - View Recording February 13 - Immediate Jeopardy Risk: Falls & Accidents - View Recording March 12 - Immediate Jeopardy Risk: Abuse & Neglect April 9 - Immediate Jeopardy Risk: Quality of Care May 14 - Immediate Jeopardy Risk: Infection Control June 11 - Immediate Jeopardy
- [Webinar middle with dates/time](https://proactiveltcexperts.com/et_pb_layout/webinar-middle-with-dates-time-2/) - Webinar Dates January 9 - Immediate Jeopardy Risk: Elopement - View Recording February 13 - Immediate Jeopardy Risk: Falls & Accidents - View Recording March 12 - Immediate Jeopardy Risk: Abuse & Neglect April 9 - Immediate Jeopardy Risk: Quality of Care May 14 - Immediate Jeopardy Risk: Infection Control June 11 - Immediate Jeopardy
- [What our clients say about us - testimonial block](https://proactiveltcexperts.com/et_pb_layout/what-our-clients-say-about-us-testimonial-block/) - What our clients say about us... Braun’s Nursing Home has been a client of Proactive LTC Consulting for several years. During this time, they have provided us with friendly, knowledgeable, and conscientious nurse consultants. Their guidance and recommendations have helped us maintain our 5-Star Quality Measures rating, successfully pass a Myers and Stauffer Audit, and
- [EVENTS TEMPLATE](https://proactiveltcexperts.com/et_pb_layout/events-template/) - Client-Only Webinar - Documentation Excellence: Protecting Your Facility in Survey and Legal Review Date August 03, 2026 Learn more & Register View Events Website Restorative Nursing Excellence: Revitalizing Programs and Restoring Function Date August 05, 2026 Learn more & Register View Events Website Medication Management & Adverse Drug Event Prevention Date August 11, 2026 Learn
- [FINAL EVENTS TEMPLATE](https://proactiveltcexperts.com/et_pb_layout/final-events-template/) - Client-Only Webinar - Documentation Excellence: Protecting Your Facility in Survey and Legal Review Date August 03, 2026 Learn more & Register View Events Website Restorative Nursing Excellence: Revitalizing Programs and Restoring Function Date August 05, 2026 Learn more & Register View Events Website Medication Management & Adverse Drug Event Prevention Date August 11, 2026 Learn
- [Services - Clinical Consulting](https://proactiveltcexperts.com/et_pb_layout/services-clinical-consulting/) -  5 - Star Solutions and partnerships to drive SNF Quality Measures, Survey results and appropriate staffing. Achieve 5-Star results through facility specific work plan and on-site performance improvement help from a dedicated expert.  Regulatory Mock Surveys, Phase 1-3 Requirements of Participation help, and regulatory guidance to manage the many industry changes facing providers.
- [Katie Niehoff testimonial](https://proactiveltcexperts.com/et_pb_layout/katie-niehoff-testimonial/) - IHCA/INCAL has been working with the consultants at Proactive Medical Review for many years. All of the consultants are very knowledgeable in the clinical and regulatory requirements of the long term care industry. Their training materials, handouts, tools, and forms are always top notch! Katie Niehoff MSW, LSW, ASW-G, CADDCT, CDP Director of Education and
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- [Grey Boxes](https://proactiveltcexperts.com/et_pb_layout/grey-boxes/) - Virtual RAC-CTA April 27-29 9AM-6PM (ET) Daily Register In-Person RAC-CT May 9-11 Indianapolis, IN 8AM-5PM (ET) Daily Register In-Person RAC-CT July 11-13 Lansing, MI 8AM-5PM (ET) Daily Register
- [Services - LNC](https://proactiveltcexperts.com/et_pb_layout/services-lnc/) -  Reimbursement Medicare, Medicaid, and commercial insurance reimbursement experts. CMI and PDPM consulting partnerships.  LEGAL NURSE CONSULTING Quality Assurance Performance Improvement tools, training and partnerships.  QAPI Quality Assurance Performance Improvement tools, training and partnerships.  Compliance Compliance & Ethics program implementation services including policies/tools, training, investigations, and HCCA certified Compliance Officer partnerships available
- [Product List](https://proactiveltcexperts.com/et_pb_layout/product-list/) - F-Tag Series - Past Webinar Recordings These webinars focus on top deficiencies cited nationally with a review of the regulation, analysis of associated Interpretive Guidance and survey procedures (e.g. Critical Element Pathway and/or Surveyor Probes) discussion. Actual citation examples are examined with tools for compliance and performance improvement shared. See more F-Tag Review Series Webinars
- [Shop Products to Copy](https://proactiveltcexperts.com/et_pb_layout/shop-products-to-copy/) - Winning the Fall Prevention Battle - Past Webinar Recordings This 8-week series guides the interdisciplinary team through the elements of an effective falls prevention program. Sessions focus on assessment strategies that guide targeted risk-based interventions, responding to a fall event, and promoting a fall prevention environment. Presented by a team of nurse and therapist experts,
- [See products by category](https://proactiveltcexperts.com/et_pb_layout/see-products-by-category/) - Click here to see products by category… Select a categoryInfection ControlOHCA 5 Star Webinar Series2024 Impact of the MDSTrainingPressure Ulcers2021 Cultivating LTC Leaders2025 Reducing Litigation Risk for SNF & AL Webinar SeriesADLVBP2023 Deep Dive into Federal Regulations2026 Webinar SeriesMedication ManagementOHCA MDS Webinar Series2023 Activities Webinar SeriesChecklistsQuality Measures2025 Dietary WorkshopBehavioral HealthMoving Mountains2023 Administrator If…MDS2020 Webinar Series2024
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- [Services](https://proactiveltcexperts.com/et_pb_layout/services/) - Proactive provides expertise in Survey Management including: Mock survey Survey support Plan of correction development and implementation Not sure what should go here Is this really necessary? Should we just have more information about it under Survey Management? Proactive has Partnership Plans to guide your facility through the Requirements of Participation. We drive compliance alongside
- [Meet Our Leadership Team](https://proactiveltcexperts.com/et_pb_layout/meet-our-leadership-team/) - Meet Our Leadership Team Our clinical and operations specialists include expert nurse, administrator, PT, OT, and SLP therapists, and billing consultants. Our experienced staff is uniquely positioned to assist skilled nursing facility providers through phase 1-3 requirements of participation, 5-star survey obstacles, and Medical Review involving rehabilitation services Learn more about our team here. Amie
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## Products

- [Skin & Wound Assessment Fundamentals](https://proactiveltcexperts.com/product/skin-wound-assessment-fundamentals/) - DOWNLOAD: This session explores the significant impact that advance directives, informed consent, and end-of-life can care have on behavioral health and psychosocial well-being. This first presentation in the 6-part series will enhance the participants grasp of skin and wound assessment basics, as well as providing insight into common assessment pitfalls that can result in poor clinical outcomes, survey deficiencies and potential litigation.
- [Deconstructing Immediate Jeopardy & High Risk Tags: Reducing Risks Related to Respiratory Care](https://proactiveltcexperts.com/product/deconstructing-immediate-jeopardy-high-risk-tags-reducing-risks-related-to-respiratory-care/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [All In! PDPM Supportive Documentation for Physicians, Nursing, Rehab, Dietary & Social Services](https://proactiveltcexperts.com/product/pdpm-master-class-series-all-in-pdpm-supportive-documentation-for-physicians-nursing-rehab-dietary-social-services/) - This session of the PDPM Master Class Series will focus on interdisciplinary team documentation requirements and best practices as it relates to PDPM. The webinar will include review of skilled level of care criteria with an emphasis on supporting the skilled stay and coding that impacts reimbursement of skilled SNF services under the Patient Driven Payment Model (PDPM). Emphasis will be on understanding the critical role of the Physician, Nurse, Therapist, Dietary, and Social Services in supportive documentation for key areas impacting PDPM payment, and in driving facility documentation quality.
- [Personnel Management](https://proactiveltcexperts.com/product/personnel-management/) - Webinar on 7/21/2026
- [Addressing Fall Root Causes with Targeted Interventions](https://proactiveltcexperts.com/product/addressing-fall-root-causes-with-targeted-interventions/) - Recorded webinar from 7/1/2026
- [Getting to the “Root” of the Fall with Root Cause Analysis](https://proactiveltcexperts.com/product/getting-to-the-root-of-the-fall-with-root-cause-analysis/) - Recorded webinar from 6/24/2026
- [Considering all the Evidence Assessing Fall Risk Critically](https://proactiveltcexperts.com/product/considering-all-the-evidence-assessing-fall-risk-critically/) - Recorded webinar from 6/17/2026
- [Engaging the IDT Troops in Fall Management - LIVE Webinar Registration](https://proactiveltcexperts.com/product/engaging-the-idt-troops-in-fall-management-live-webinar-registration/) - This product will register one individual for the July 8th webinar beginning at 2:30PM EST.
- [Addressing Fall Root Causes with Targeted Interventions - LIVE Webinar Registration](https://proactiveltcexperts.com/product/addressing-fall-root-causes-with-targeted-interventions-live-webinar-registration-copy/) - This product will register one individual for the July 1st webinar beginning at 2:30PM EST.
- [MDS Orientation (August 25-27)](https://proactiveltcexperts.com/product/mds-orientation/) - Register for the virtual MDS Orientation Training August 25-27.
- [Savvy Social Services](https://proactiveltcexperts.com/product/savvy-social-services/) - Thursday, October 15 9:00 a.m. – 4:00 p.m. CENTRAL TIME Proactive Solutions Center members can access this training at a discounted rate!
- [Medicare Bootcamp Virtual Workshop](https://proactiveltcexperts.com/product/medicare-bootcamp-virtual-workshop/) - Virtual Workshop on Tuesday, October 6 9:00 a.m. - 4:00 p.m. Eastern Time
- [QAPI Tactics for Sustaining Positive Outcomes - LIVE Webinar Registration](https://proactiveltcexperts.com/product/qapi-tactics-for-sustaining-positive-outcomes-live-webinar-registration/) - This product will register one individual for the July 22nd webinar beginning at 2:30PM EST.
- [ICD-10 CM Coding Refresher for Skilled Nursing Facilities](https://proactiveltcexperts.com/product/icd-10-cm-coding-refresher-for-skilled-nursing-facilities/) - Wednesday, September 30 8:30AM to 4:00PM CST
- [Fall Prevention Program Reboot](https://proactiveltcexperts.com/product/fall-prevention-program-reboot/) - This product will register one individual for all 6 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Strategies for Workforce Retention (Full Series Purchase)](https://proactiveltcexperts.com/product/strategies-for-workforce-retention-full-series-purchase/) - This product will register one individual for all 4 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Growing New Nurse Leaders](https://proactiveltcexperts.com/product/growing-new-nurse-leaders/) - This session will provide actionable insights and resources to bolster retention of nursing staff and other healthcare professionals.
- [Welcome to the World of Dietary! LTC Refresher Course](https://proactiveltcexperts.com/product/welcome-to-the-world-of-dietary-ltc-refresher-course/) - This product will register one individual for the virtual workshop on June 25 from 11:00 a.m. - 3:30 p.m. Eastern.
- [Payroll-Based Journal (PBJ) Mastery for Skilled Nursing Facilities](https://proactiveltcexperts.com/product/payroll-based-journal-pbj-mastery-for-skilled-nursing-facilities/) - Virtual Workshop on Wednesday, August 19 9:00 a.m. - 4:00 p.m. Eastern Time
- [Restorative Nursing: Live Workshop Purchase](https://proactiveltcexperts.com/product/restorative-nursing-full-series-purchase/) - This product will register one individual for the live session on Wednesday, August 5 from 10:00 a.m. – 4:45 p.m. Eastern Time.
- [Survey Prep & Understanding Post-Survey Elements (Full Series Purchase)](https://proactiveltcexperts.com/product/survey-prep-understanding-full-series-purchase/) - Includes recordings for all 8 sessions of the Survey Prep & Understanding Post-Survey Elements webinar series.
- [ICD.10-CM for Beginners](https://proactiveltcexperts.com/product/icd-10-cm-for-beginners/) - This webinar workshop is scheduled for August 12 & 13 from 8:30 – 3:30 CENTRAL TIME each day.
- [Beneficiary Notices Guideline Tool](https://proactiveltcexperts.com/product/beneficiary-notices-guideline-tool/) - Access Proactive’s complimentary quick guide to accurate use of Beneficiary Notices. Updated 2026.
- [Infection Preventionist Workshop for Skilled Nursing Facilities](https://proactiveltcexperts.com/product/infection-preventionist-workshop-for-skilled-nursing-facilities/) - September 16 & 17 9:00 a.m. - 2:30 p.m. CST each day Proactive Solutions Center members can access this training at a discounted rate!
- [Quality Measure Deep Dive](https://proactiveltcexperts.com/product/quality-measure-deep-dive/) - This product will register one individual for all 7 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Home Health Leadership Training Program](https://proactiveltcexperts.com/product/home-health-leadership-training-program/) - Register for the virtual training April 15 from 9 a.m. - 4 p.m. CST.
- [Roadmap to 5-Star Wins](https://proactiveltcexperts.com/product/roadmap-to-5-star-wins/) - This product will register one individual for all 6 sessions of this webinar series. Webinars will begin at 2:30PM EST.
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- [Skin and Wound Essentials Workshop](https://proactiveltcexperts.com/product/skin-and-wound-essentials-workshop/) - Virtual Workshop on Thursday, March 5 10:00 a.m. - 2:30 p.m. Central Time
- [Advanced MDS Accuracy: Accelerating QM, SNF QRP, and VPN Performance](https://proactiveltcexperts.com/product/advanced-mds-accuracy-accelerating-qm-snf-qrp-and-vpn-performance/) - January 28 & 29 8:00 a.m. - 2:30 p.m. EST each day Proactive Solutions Center members can access this training at a discounted rate!
- [TEAM MDS! Insights & Coaching for Quality Coding and PDPM Success (Full Series Purchase)](https://proactiveltcexperts.com/product/team-mds-insights-coaching-for-quality-coding-and-pdpm-success-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [DON Playbook: Skills for Today’s LTC Nurse Leader (Full Series Purchase)](https://proactiveltcexperts.com/product/don-playbook-skills-for-todays-ltc-nurse-leader-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Survey & Clinical Risk Management (Full Series Purchase)](https://proactiveltcexperts.com/product/survey-clinical-risk-management-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Compliance & Ethics Program Risk Assessment Essentials](https://proactiveltcexperts.com/product/compliance-ethics-program-risk-assessment-essentials/) - This session reviews key components of an effective SNF Compliance & Ethics Program with emphasis on conducting a facility Risk Assessment to drive development of the facility-specific Compliance Work Plan.
- [F686 - Treatment/Services to Prevent & Heal Pressure Ulcers](https://proactiveltcexperts.com/product/f686-treatment-services-to-prevent-heal-pressure-ulcers/) - This session will provide a comprehensive overview of the regulations, common deficiencies, and effective strategies to prevent and treat pressure ulcers.
- [Driving Staff Engagement for Better Performance & Outcomes](https://proactiveltcexperts.com/product/driving-staff-engagement-for-better-performance-outcomes/) - This session will provide actionable insights and resources to bolster retention of nursing staff and other healthcare professionals.
- [Turnover - Root Cause Analysis for Nursing Homes](https://proactiveltcexperts.com/product/turnover-root-cause-analysis-for-nursing-homes/) - This session examines staff turnover in nursing homes through the lens of root cause analysis.
- [Hot Topics in LTC Fraud & Abuse](https://proactiveltcexperts.com/product/hot-topics-in-ltc-fraud-abuse/) - This session reviews recent SNF/long term care industry False Claims Act activity and settlements related to allegations of fraud and abuse with discussion of the risk management implications for QAPI and Compliance and Ethics Programs.
- [F550 - Resident Rights/Exercise of Rights](https://proactiveltcexperts.com/product/f550-resident-rights-exercise-of-rights/) - This session will provide an overview of the regulations, common compliance issues, and strategies to ensure residents can exercise their rights.
- [Disputing Deficiencies Successfully Through IDR, IIDR and Administrative Law Hearing Processes](https://proactiveltcexperts.com/product/disputing-deficiencies-successfully-through-idr-iidr-and-administrative-law-hearing-processes/) - Virtual Workshop on Thursday, November 13 10:00 a.m. - 1:00 p.m. Central Time
- [Strategies for Successful IDR/IIDR & Administrative Law Hearings](https://proactiveltcexperts.com/product/strategies-for-successful-idr-iidr-administrative-law-hearings/) - This session will review the regulatory requirements and process for an IDR/IIDR and Administrative Law Hearing.
- [F677 – ADL Care Provided for Dependent Residents](https://proactiveltcexperts.com/product/f677-adl-care-provided-for-dependent-residents-2/) - This session will cover the requirements, common compliance issues, and best practices for ADL care.
- [After the Survey: Plan of Correction & DPoC](https://proactiveltcexperts.com/product/after-the-survey-plan-of-correction-dpoc/) - This session will review what to expect after the survey, including the CMS requirements for the Plan of Correction (PoC) and Directed Plan of Correction (DPoC) and strategies for effective development of these remedies.
- [Preparing Your Team for Survey Success](https://proactiveltcexperts.com/product/preparing-your-team-for-survey-success/) - This session will review tips and strategies for preparing your facility team for survey success, including methods for team compliance rounds and meetings.
- [Department-Specific Survey Expectations](https://proactiveltcexperts.com/product/department-specific-survey-expectations/) - This session will review tips and strategies for preparing your facility team for survey success, including methods for team compliance rounds and meetings.
- [Communication Practices](https://proactiveltcexperts.com/product/communication-practices/) - This session in the Reducing Litigation Risk series will address essentials in post-acute care clinical communication practices.
- [Summary of October 1, 2025 MDS Changes](https://proactiveltcexperts.com/product/summary-of-october-1-2025-mds-changes/) - Access Proactive’s complementary summary of the MDS changes effective 10/1/2025. .
- [F609 - Reporting of Alleged Violations](https://proactiveltcexperts.com/product/f609-reporting-of-alleged-violations/) - This session will cover the regulatory requirements, common issues, and best practices for timely and accurate reporting.
- [Addressing Obstacles During the Survey](https://proactiveltcexperts.com/product/addressing-obstacles-during-the-survey/) - This session will review potential obstacles that may develop during the survey process and provide tips and strategies for how to overcome those obstacles.
- [Week-by-Week Action Plan for Year-Round Survey Readiness](https://proactiveltcexperts.com/product/week-by-week-action-plan-for-year-round-survey-readiness/) - FULL SERIES PURCHASE: This session will review an 8-week Survey Readiness Plan and accompanying tools to guide the facility in year-round survey readiness.
- [Policies & Procedures](https://proactiveltcexperts.com/product/policies-procedures/) - This session in the Reducing Litigation Risk series will review guidelines for facility policy and procedure development, policy review/revision, and effective strategies for implementation.
- [Leveraging Technology and Data Analytics to Drive Quality Outcomes](https://proactiveltcexperts.com/product/leveraging-technology-and-data-analytics-to-drive-quality-outcomes/) - The session will highlight practical tools, iQEIS Reports, and the importance of integrating data into daily quality improvement processes.
- [F695 - Respiratory/Tracheostomy Care and Suctioning](https://proactiveltcexperts.com/product/f695-respiratory-tracheostomy-care-and-suctioning-live-webinar-registration/) - This session will discuss the regulations, common compliance issues, and practical strategies for delivering effective respiratory care.
- [Quality Reporting and Its Impact on Reimbursement](https://proactiveltcexperts.com/product/quality-reporting-and-its-impact-on-reimbursement/) - Participants will gain an understanding of how SNFs collect and submit data to CMS, including the deadlines and submission requirements and monitor for compliance with the requirements under the 2014 IMPACT ACT.
- [Optimizing Reimbursement in Skilled Nursing Facilities](https://proactiveltcexperts.com/product/optimizing-reimbursement-in-skilled-nursing-facilities/) - Participants will gain an understanding of the importance of flexibility with Medicare assessment scheduling and the importance gathering timely accurate assessment data for optimal reimbursement.
- [Developing a Facility-Specific Work Plan for 5-Star Improvement](https://proactiveltcexperts.com/product/developing-a-facility-specific-work-plan-for-5-star-improvement/) - This session will focus on developing a work plan to improve your 5-Star Rating.
- [5-Star Work Plans A to Z (6-Part Package)](https://proactiveltcexperts.com/product/5-star-work-plans-a-to-z-6-part-package/) - This series examines the three domains of the CMS 5-Star Quality Rating System: Health Inspections, Staffing and Quality Measures including how the rating is calculated and analyzing your data with a focus on developing a work plan to improve or maintain 5-Star Status.
- [Medicare Advantage and Managed Care](https://proactiveltcexperts.com/product/medicare-advantage-and-managed-care/) - This session explores the evolving landscape of Medicare Advantage and Managed Care in skilled nursing facilities.
- [Medication Management](https://proactiveltcexperts.com/product/medication-management/) - This session will review the regulatory requirements and standards of care for effective medication management.
- [Documentation & Coding Accuracy](https://proactiveltcexperts.com/product/documentation-coding-accuracy/) - This session will focus on the critical relationship between thorough clinical documentation and accurate Minimum Data Set (MDS) coding to ensure appropriate reimbursement.
- [Understanding Reimbursement Systems](https://proactiveltcexperts.com/product/understanding-reimbursement-systems/) - Participants will learn how reimbursement is calculated, and what operational strategies for accurate and timely reimbursement.
- [Sustaining Clinical Excellence for Long-Term QM Improvement](https://proactiveltcexperts.com/product/sustaining-clinical-excellence-for-long-term-qm-improvement/) - Participants will learn data-driven methods to set quality improvement goals, develop effective interventions to enhance quality of care, and achieve sustainable outcomes.
- [Perspectives—A Behavioral Health Workshop](https://proactiveltcexperts.com/product/perspectives-a-behavioral-health-workshop/) - Tuesday, August 26th 8:30 a.m. - 4:00 p.m. Central Time Proactive Solutions Center members can access this training at a discounted rate!
- [Enhancing Functional Outcomes](https://proactiveltcexperts.com/product/enhancing-functional-outcomes/) - This course will provide strategies for enhancing functional outcomes through best practices, resident-centered care, and interdisciplinary collaboration.
- [Preventing Adverse Events to Enhance QMs](https://proactiveltcexperts.com/product/preventing-adverse-events-to-enhance-qms/) - This presentation will provide attendees with practical strategies to prevent adverse events and optimize care delivery.
- [Managing Chronic Conditions for Better QMs](https://proactiveltcexperts.com/product/managing-chronic-conditions-for-better-qms/) - This course provides strategies to address common chronic conditions such as diabetes, heart disease, COPD, and dementia, emphasizing best practices, resident-centered care, and interdisciplinary collaboration.
- [Introduction to Quality Measures (QMs)](https://proactiveltcexperts.com/product/introduction-to-quality-measures-qms/) - Learn the fundamentals of QM calculations, common challenges, and practical strategies to improve scores.
- [Clinical Excellence in Care Planning and Assessments](https://proactiveltcexperts.com/product/clinical-excellence-in-care-planning-and-assessments/) - This session explores how clinical excellence in care planning and assessment directly drives improvements in Quality Measures (QMs).
- [Managing Changes in Resident Condition](https://proactiveltcexperts.com/product/managing-changes-in-resident-condition/) - This session will review key issues around changes in conditions in post-acute care settings.
- [F761 - Label/Store Drugs and Biologicals](https://proactiveltcexperts.com/product/f761-label-store-drugs-and-biologicals/) - This session will cover the regulatory requirements, frequent compliance issues, and strategies for maintaining safe and organized medication storage.
- [Elopement](https://proactiveltcexperts.com/product/elopement/) - This session of the Reducing Litigation Risk series will explore essential components for elopement management including, but not limited to identifying, evaluating, intervening, and monitoring elopement risk management.
- [Capturing Accurate Reimbursement (Full Series Purchase)](https://proactiveltcexperts.com/product/capturing-accurate-reimbursement-full-series-purchase/) - This product will register one individual for all 6 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [F656 – Develop & Implement Comprehensive Care Plans](https://proactiveltcexperts.com/product/f656-develop-implement-comprehensive-care-plans/) - Master the development and implementation of comprehensive care plans with a focus on F656.
- [Achieving Dept. Collaboration & Great Customer Service](https://proactiveltcexperts.com/product/achieving-dept-collaboration-great-customer-service/) - This session will discuss specific tips and strategies for promoting effective teamwork and collaboration and boosting team morale while avoiding common traps that interfere with team success.
- [QAPI Program Refresh](https://proactiveltcexperts.com/product/qapi-program-refresh/) - Virtual Workshop on Thursday, May 29th 8:30AM to 4:00PM CST
- [Department-Specific Survey Success](https://proactiveltcexperts.com/product/department-specific-survey-success/) - This session will discuss specific tips and strategies for staying survey ready throughout the year, and for following a schedule that will help to concentrate on survey focus areas and issues. Sample tools will be provided/reviewed.
- [Conducting Meaningful Meetings](https://proactiveltcexperts.com/product/conducting-meaningful-meetings/) - This session will discuss specifics for efficient and productive team meetings that will maximize effective communication while promoting team morale and collaboration.
- [Advanced Action Planning for Administrators](https://proactiveltcexperts.com/product/advanced-action-planning-for-administrators-2/) - This session will discuss specifics for success in the Administrator position by exploring the details of the day-to-day facility operations.
- [Falls & Accidents](https://proactiveltcexperts.com/product/falls-accidents/) - This session will review the elements of a successful accident/fall management program including the components of what constitutes an “unavoidable” fall or accident, intervention considerations and documentation strategies.
- [Helpful Housekeeping & Maintenance](https://proactiveltcexperts.com/product/helpful-housekeeping-maintenance/) - This session will discuss specifics for success as a Housekeeping Director and Maintenance Director by exploring specific aspects of both departments.
- [F684 - Quality of Care](https://proactiveltcexperts.com/product/f684-quality-of-care-2/) - Delve into the key aspects of providing high-quality care under F684.
- [Driving QMs Through Clinical Excellence (Full Series Purchase)](https://proactiveltcexperts.com/product/driving-qms-through-clinical-excellence-full-series-purchase/) - This product will register one individual for all 6 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Roles and Responsibilities of the Capable Infection Preventionist](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-roles-and-responsibilities-of-the-capable-infection-preventionist/) - RECORDED WEBINAR DOWNLOAD: This session will discuss the essential roles and responsibilities of the IP, essential skills for being an effective IP, and resources and training available to support IPs.
- [Developing an Exceptional Infection Control & Prevention Program](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-developing-an-exceptional-infection-control-prevention-program/) - RECORDED WEBINAR DOWNLOAD: This session will discuss strategies for developing and managing the facility infection prevention and control program.
- [Competency in Epidemiology of Infectious Diseases & Basic Microbiology for the Infection Preventionist](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-competency-in-epidemiology-of-infectious-diseases-basic-microbiology-for-the-infection-preventionist/) - RECORDED WEBINAR DOWNLOAD: This session will discuss the epidemiology of infectious diseases and basic microbiology concepts that are important for IP professionals to understand.
- [Competency in Infectious Diseases Common in Post-Acute Care Settings](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-competency-in-infectious-diseases-common-in-post-acute-care-settings/) - RECORDED WEBINAR DOWNLOAD: This session will discuss infectious diseases that are common in the post-acute care setting with strategies for managing these disease processes.
- [Competency in Multidrug Resistant Organisms (MDRO) for the Infection Preventionist](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-competency-in-multidrug-resistant-organisms-mdro-for-the-infection-preventionist/) - RECORDED WEBINAR DOWNLOAD: This session will discuss the identification and practical application of control measures for multidrug resistant organisms (MDROs)
- [Conducting Skillful IPC Program Surveillance](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-conducting-skillful-ipc-program-surveillance/) - RECORDED WEBINAR DOWNLOAD: This session will discuss the role of surveillance in the IPC program and how to conduct surveillance activities.
- [Antibiotic Stewardship for the Infection Preventionist](https://proactiveltcexperts.com/product/antibiotic-stewardship-for-the-infection-preventionist/) - RECORDED WEBINAR DOWNLOAD: This session will discuss the importance of antibiotic stewardship in nursing facilities.
- [Root Cause Analysis](https://proactiveltcexperts.com/product/root-cause-analysis/) - RECORDED WEBINAR DOWNLOAD: This session will discuss IP’s role in quality assurance performance improvement (QAPI) and how to use root cause analysis process for a performance improvement project.
- [Equipping Staff Infection Control Focused Training & Competency Assessments](https://proactiveltcexperts.com/product/infection-control-focused-training-competency-assessments/) - RECORDED WEBINAR DOWNLOAD: This session will discuss IP’s role as a staff educator and how to develop an effective infection control focused training and competency assessment program.
- [Expert Outbreak Management for the Infection Preventionist](https://proactiveltcexperts.com/product/expert-outbreak-management-for-the-infection-preventionist/) - RECORDED WEBINAR DOWNLOAD: This session will discuss IP’s role in investigating, preventing, and control outbreaks.
- [Cleaning & Disinfecting for the Infection Preventionist](https://proactiveltcexperts.com/product/cleaning-disinfecting-for-the-infection-preventionist/) - RECORDED WEBINAR DOWNLOAD: This session will discuss IP’s role in incorporating cleaning and disinfecting practices into the facility IPC program.
- [Astute Survey Preparedness & Application of Infection Control Regulatory Requirements](https://proactiveltcexperts.com/product/astute-survey-preparedness-application-of-infection-control-regulatory-requirements/) - RECORDED WEBINAR DOWNLOAD: This session will discuss IP’s role in survey preparedness and prevention of common infection control citations.
- [Designs for Well-Rounded Dietary Departments](https://proactiveltcexperts.com/product/designs-for-well-rounded-dietary-departments-2/) - This session will discuss specifics for success as a Dietary Director by exploring specific aspects of the Dietary department within the facility.
- [Strategies for Activities and Social Services](https://proactiveltcexperts.com/product/strategies-for-activities-and-social-services-2/) - This session will discuss specifics for success as an Activities Director and Social Services Director by exploring these roles in the life of residents.
- [MDS Orientation (For LAIN Members)](https://proactiveltcexperts.com/product/mds-orientation-for-lain-members/) - Register for the next virtual MDS Orientation Training at the discounted rate for LAIN Members! Discover all training details at https://proactiveltcexperts.com/mds-orientation/
- [Department Details for the DON](https://proactiveltcexperts.com/product/department-details-for-the-don/) - This session will discuss specifics for success in the DON position by exploring the details of the day-to-day nursing operations.
- [Incident Management](https://proactiveltcexperts.com/product/incident-management/) - This session will guide facility staff through the step-by-step process of incident management including resident assessment needs, important notifications, and implementing an appropriate response to the investigation findings.
- [F812 – Food Procurement, Storage, Preparation & Service](https://proactiveltcexperts.com/product/f812-food-procurement-storage-preparation-service/) - Ensure your facility's food service operations meet the highest standards of safety and sanitation.
- [CMS Revised Surveyor Guidance](https://proactiveltcexperts.com/product/cms-revised-surveyor-guidance/) - This 2-hour webinar recording will provide an in-depth review of the significant revisions to the LTC survey process
- [Strategies for Activities and Social Services](https://proactiveltcexperts.com/product/strategies-for-activities-and-social-services/) - This will register one individual for the Strategies for Activities and Social Services session on March 26.
- [Incident Investigations](https://proactiveltcexperts.com/product/incident-investigations/) - In this second session of the Litigation Risk series, the detailed components of a comprehensive investigation process will be explored.
- [Dynamic DON Workshop](https://proactiveltcexperts.com/product/dynamic-don-full-series-purchase/) - Register for the virtual workshop on March 31 and April 1. The workshop will take place from 11:00 a.m. - 2:15 p.m. CENTRAL TIME each day.
- [Quality Measure Domain: Part 1](https://proactiveltcexperts.com/product/quality-measure-domain-part-1/) - This session will focus on the Quality Measure component of the 5-Star Rating System.
- [F880 – Infection Prevention & Control](https://proactiveltcexperts.com/product/f880-infection-prevention-control/) - Strengthen your facility’s infection control program by understanding the critical elements of F880.
- [Secrets of a Great Department Head](https://proactiveltcexperts.com/product/secrets-of-a-great-department-head/) - FULL SERIES PURCHASE: This will register one individual for all 8 sessions of the Secrets of a Great Department Head webinar series.
- [5-Star Staffing Rating](https://proactiveltcexperts.com/product/5-star-staffing-rating/) - This session will focus on the Staffing component of Nursing Home Compare’s 5-Star Rating System.
- [5-Star Overview and Health Inspection Domain](https://proactiveltcexperts.com/product/5-star-overview-and-health-inspection-domain/) - Description This series examines the three domains of the CMS 5-Star Quality Rating System: Health Inspections, Staffing and Quality Measures including how the rating is calculated and analyzing facility data with a focus on developing a work plan to improve or maintain 5-Star Status. Common obstacles to 5-Star status will be discussed with tips and
- [Swing Bed Success: MDS Essentials](https://proactiveltcexperts.com/product/swing-bed-success-mds-essentials-2/) - Non-CAH Swing Beds: Grow your MDS knowledge with this 8-hour virtual training!
- [LTC Provider Lawsuit Primer](https://proactiveltcexperts.com/product/ltc-provider-lawsuit-primer/) - DOWNLOAD: Learn how to assess risks and implement effective safeguards to avoid citations related to accident hazards.
- [F689 - Free of Accident Hazards/Supervision/Devices](https://proactiveltcexperts.com/product/f689-free-of-accident-hazards-supervision-devices/) - DOWNLOAD: Learn how to assess risks and implement effective safeguards to avoid citations related to accident hazards.
- [Supportive Documentation for Skilled Care Justification](https://proactiveltcexperts.com/product/supportive-documentation-for-skilled-care-justification/) - DOWNLOAD: This presentation is designed to empower healthcare professionals with the essential skills and knowledge to create comprehensive and accurate documentation that ensures the delivery of person-centered and effective ADL care for residents. Webinar recorded October 2024 This presentation aims to empower healthcare professionals in SNFs/NFs to provide the highest quality of care while maintaining the integrity and accuracy of their documentation.
- [Wound Care Treatment-Management Best Practices](https://proactiveltcexperts.com/product/wound-care-treatment-management-best-practices/) - #post_excerptThis fourth presentation in the 6-part series will provide an overview of best practices for effective wound care treatment and management. Treatment protocols and techniques will be discussed along with guidelines for when to make changes to the treatment modality in place.
- [Key Elements of Care Planning for Wound Care](https://proactiveltcexperts.com/product/key-elements-of-care-planning-for-wound-care/) - DOWNLOAD: This session explores the significant impact that advance directives, informed consent, and end-of-life can care have on behavioral health and psychosocial well-being. In this third presentation in a 6-part series, insights will be shared into the key elements of wound-related care planning. Tips and strategies will be discussed for effectively addressing resident wounds without excess duplication of interventions, and best practices for keeping wound care plans current and up-to-date as the wound heals.
- [Immediate Jeopardy Risk: Nutrition & Hydration](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-nutrition-hydration/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent change in condition related immediate jeopardy citations. In this session, we will delve into the critical issue of nutrition and hydration in nursing homes. We'll explore strategies to prevent nutrition and hydration related citations.
- [Wound MDS Coding & CAA Documentation Essentials](https://proactiveltcexperts.com/product/wound-mds-coding-caa-documentation-essentials/) - DOWNLOAD: This session explores the significant impact that advance directives, informed consent, and end-of-life can care have on behavioral health and psychosocial well-being. This second presentation in a 6-part series provides insight into wound-related MDS coding requirements, as well as the vital components for wound CAA documentation. Common pitfalls and wound coding errors will be explored with tips for avoiding them.
- [Advance Directives, Consent, and End of Life Care](https://proactiveltcexperts.com/product/advance-directives-consent-and-end-of-life-care/) - DOWNLOAD: This session explores the significant impact that advance directives, informed consent, and end-of-life can care have on behavioral health and psychosocial well-being.
- [Behavioral Management Programs](https://proactiveltcexperts.com/product/behavioral-management-programs/) - DOWNLOAD: This session will provide comprehensive strategies for developing and implementing behavior management programs in the LTC setting.
- [Supportive Documentation for ADL Care, Declines, and Restorative Nursing](https://proactiveltcexperts.com/product/supportive-documentation-for-adl-care-declines-and-restorative-nursing/) - DOWNLOAD: This presentation is designed to empower healthcare professionals with the essential skills and knowledge to create comprehensive and accurate documentation that ensures the delivery of person-centered and effective ADL care for residents. Webinar recorded October 2024
- [Substance Use Disorder (SUD)](https://proactiveltcexperts.com/product/substance-use-disorder-sud/) - DOWNLOAD: This session will review the characteristics of this disease, along with identifying who is at risk, what substances are included, intervention strategies, and how it impacts Long Term Care.
- [Immediate Jeopardy Risk: Competent Nursing Staff](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-competent-nursing-staff/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent change in condition related immediate jeopardy citations.
- [Trauma Informed Care](https://proactiveltcexperts.com/product/trauma-informed-care/) - DOWNLOAD: This session will explore the principles and implementation of trauma-informed care in the long-term care (LTC) setting.
- [Reducing Litigation Risk for SNF & AL (Full Series Purchase)](https://proactiveltcexperts.com/product/reducing-litigation-risk-for-snf-al-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Survey Smart: LTC Deficiency Trends & Solutions (Full Series Purchase)](https://proactiveltcexperts.com/product/survey-smart-ltc-deficiency-trends-solutions-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Mental Health Conditional & Successful Care Planning for Resident Well-Being](https://proactiveltcexperts.com/product/mental-health-conditional-successful-care-planning-for-resident-well-being/) - DOWNLOAD: This session provides an overview of mental health conditions commonly encountered in nursing facilities (NF) and outlines strategies for successful care planning to enhance resident well-being.
- [QAPI Systematic Analysis & Systemic Action](https://proactiveltcexperts.com/product/qapi-systematic-analysis-systemic-action/) - DOWNLOAD: The final session explores systemic analysis and action within the QAPI context, including systems thinking, root cause analysis, and evaluating corrective actions.
- [Developing & Implementing a QAPI Program (6-Session Package)](https://proactiveltcexperts.com/product/developing-implementing-a-qapi-program-full-series-purchase/) - FULL SERIES PURCHASE: All 6 sessions of the Developing & Implementing a QAPI Program webinar series.
- [QAPI Performance Improvement Projects](https://proactiveltcexperts.com/product/qapi-performance-improvement-projects/) - DOWNLOAD: This session focuses on developing effective corrective actions, considerations for establishing PIPs, and sustaining improvements over time within a QAPI framework.
- [QAPI Feedback, Data Systems & Monitoring](https://proactiveltcexperts.com/product/qapi-feedback-data-systems-monitoring/) - DOWNLOAD: Participants will explore strategies for utilizing feedback, establishing data systems, and monitoring processes within a QAPI framework.
- [QAPI Governance & Leadership](https://proactiveltcexperts.com/product/qapi-governance-leadership/) - DOWNLOAD: This session delves into the governance and leadership aspects of QAPI, including governing body responsibilities, forming leadership teams, and understanding key roles within the QAA committee.
- [QAPI Program Design & Scope](https://proactiveltcexperts.com/product/qapi-program-design-scope/) - DOWNLOAD: Participants will learn about designing and defining the scope of a QAPI program, including creating a supportive culture, laying program foundations, and conducting self-assessments.
- [Fundamental Components of a QAPI Program](https://proactiveltcexperts.com/product/fundamental-components-of-a-qapi-program/) - DOWNLOAD: This session explores the foundational elements of a Quality Assurance and Performance Improvement (QAPI) program, covering the fundamentals, regulatory requirements, and survey expectations.
- [Behavioral Health & Psychosocial Well-Being (Full Series Purchase)](https://proactiveltcexperts.com/product/behavioral-health-psychosocial-well-being-full-series-purchase/) - FULL SERIES PURCHASE: This will register one individual for all 6 sessions of the Behavioral Health & Psychosocial Well-Being webinar series.
- [Psychotropic Medications: Best Practices in LTC](https://proactiveltcexperts.com/product/psychotropic-medications-best-practices-in-ltc/) - DOWNLOAD: This session provides an overview of classifications of psychotropic medications commonly prescribed in LTC and strategies to monitor their appropriate use to improve quality and maintain regulatory compliance.
- [Supportive Documentation for Respiratory Care](https://proactiveltcexperts.com/product/supportive-documentation-for-respiratory-care/) - DOWNLOAD: This presentation is tailored to equip healthcare professionals with an understanding of regulatory requirements, enhanced communication skills, and practical approaches to creating supportive documentation that ensures the delivery of high-quality respiratory care for residents.
- [Wound Management: Beyond Skin Deep (Full Series Purchase)](https://proactiveltcexperts.com/product/wound-management-beyond-skin-deep-full-series-purchase/) - FULL SERIES PURCHASE: This will register one individual for all 6 sessions of the Wound Management webinar series.
- [Immediate Jeopardy Risk: Changes in Condition](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-changes-in-condition/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent change in condition related immediate jeopardy citations.
- [Immediate Jeopardy Risk: Pressure Ulcers](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-pressure-ulcers/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent pressure ulcer related immediate jeopardy citations.
- [Immediate Jeopardy Risk: Medication Errors](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-medication-errors/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent medication error related immediate jeopardy citations.
- [Supportive Documentation for Nutrition & Hydration Services](https://proactiveltcexperts.com/product/supportive-documentation-for-nutrition-hydration-services/) - DOWNLOAD: This presentation is designed to equip healthcare professionals with the essential skills and knowledge needed to create supportive and thorough documentation for individuals at risk for or experiencing impaired nutrition/hydration status.
- [Supportive Documentation for Pressure Ulcer Prevention & Management](https://proactiveltcexperts.com/product/supportive-documentation-for-pressure-ulcer-prevention-management/) - DOWNLOAD: This presentation is designed to equip healthcare professionals with the essential skills and knowledge needed to create supportive and thorough documentation for individuals with actual or at risk for pressure ulcers.
- [Abuse & Neglect Program Checkup (6-Session Package)](https://proactiveltcexperts.com/product/abuse-neglect-program-checkup-full-series-purchase/) - SERIES PACKAGE: Purchase all 6 sessions of the Abuse & Neglect Program Checkup webinar series.
- [Retrospective Study of Abuse & Neglect IJ Deficiencies & Plans of Correction](https://proactiveltcexperts.com/product/retrospective-study-of-abuse-neglect-ij-deficiencies-plans-of-correction/) - DOWNLOAD: This session will review past cited IJ deficiencies for abuse and neglect and the Plans of Correction for those deficiencies. Discussion will include tips and strategies for best practices for prevention of the cited tags.
- [Abuse Incident & Response Management](https://proactiveltcexperts.com/product/abuse-incident-response-management/) - DOWNLOAD: This session will review the regulatory requirements for responding to allegations of abuse and will discuss tips and strategies for how to effectively manage and document that response.
- [Investigating Allegations of Abuse](https://proactiveltcexperts.com/product/investigating-allegations-of-abuse/) - DOWNLOAD: This session will review the regulatory requirements for investigating allegations of abuse and will discuss tips and strategies for how to document this information.
- [Capacity to Consent to Sexual Activity](https://proactiveltcexperts.com/product/capacity-to-consent-to-sexual-activity/) - DOWNLOAD: This session will review the regulatory requirements for determining capacity to consent to sexual activity and will discuss tips and strategies for how to determine and document this information.
- [Abuse & Neglect Reporting Requirements](https://proactiveltcexperts.com/product/abuse-neglect-reporting-requirements/) - DOWNLOAD: This session will review the Abuse and Neglect Reporting Requirements and demonstrate tools that can be used for this purpose.
- [Abuse & Neglect Policies and Training Compliance](https://proactiveltcexperts.com/product/abuse-neglect-policies-and-training-compliance/) - DOWNLOAD: This session will review the key components to include in the facility Abuse and Neglect Policy, and the critical elements and frequency for training compliance.
- [Facility Assessment Tool](https://proactiveltcexperts.com/product/facility-assessment-tool/) - UPDATED JUNE 2024! This pdf fill-in-the-blank tool provides a user friendly method for compliance with the Facility Assessment completion requirement. The tool includes a combination of checklist worksheets, fill-in-the blank resource tables, and narrative response fill in items. View Sample and Table of Contents
- [Supportive Documentation for End of Life Care](https://proactiveltcexperts.com/product/supportive-documentation-for-end-of-life-care/) - DOWNLOAD: This presentation is crafted to assist healthcare professionals with the essential skills and knowledge needed to provide comprehensive and compassionate documentation during the final stages of life.
- [Supportive Documentation for Dialysis Care](https://proactiveltcexperts.com/product/supportive-documentation-for-dialysis-care/) - DOWNLOAD: This presentation is tailored to equip healthcare professionals in SNFs with the essential skills and knowledge needed to create comprehensive and accurate documentation for individuals undergoing dialysis.
- [Supportive Documentation for Elopement Risk & Incidents](https://proactiveltcexperts.com/product/supportive-documentation-for-elopement-risk-incidents/) - DOWNLOAD: This presentation is designed to equip healthcare professionals with the essential skills and knowledge needed to create supportive and thorough documentation for managing elopement risk and incidents.
- [Supportive Documentation for Pain Management](https://proactiveltcexperts.com/product/supportive-documentation-for-pain-management/) - DOWNLOAD: This presentation is designed to equip healthcare professionals with the essential skills and knowledge needed to create supportive and thorough documentation for individuals experiencing pain.
- [Immediate Jeopardy Risk: Cardio-Pulmonary Resuscitation (CPR)](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-cardio-pulmonary-resuscitation-cpr/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent CPR related immediate jeopardy citations.
- [Immediate Jeopardy Risk: Infection Control](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-infection-control/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent infection control related immediate jeopardy citations.
- [Immediate Jeopardy Risk: Quality of Care](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-quality-of-care/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent quality of care related immediate jeopardy citations.
- [Immediate Jeopardy Risk: Abuse & Neglect](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-abuse-neglect/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent abuse and neglect related immediate jeopardy citations.
- [Dynamic DON 6-Session Webinar Package](https://proactiveltcexperts.com/product/dynamic-don-6-session-webinar-package/) - RECORDED WEBINAR: This session will focus on Risk Management including: The regulatory requirements; key functions and role of the DON in oversight and addressing risk areas; staff training objectives; and implementation strategies with case examples.
- [Cultural Competency Toolkit](https://proactiveltcexperts.com/product/cultural-competency-tool-kit/) - This toolkit is intended to supplement or enhance current SNF/NF educational programs to meet the intent of the new requirements.
- [A Day in the Life of a DON](https://proactiveltcexperts.com/product/a-day-in-the-life-of-a-don/) - RECORDED WEBINAR: This session will provide an overview of daily responsibilities and expectations as we examine a day in the life of an effective DON.
- [Risk & Human Resource Management](https://proactiveltcexperts.com/product/risk-human-resource-management/) - RECORDED WEBINAR: This session will focus on Risk Management and Human Resources including: The requirements and key components; responsibilities and role of the DON in oversight & addressing risk areas and HR Management; staff training objectives; hiring/firing & disciplinary action guidance; & staffing sources and employee retention.
- [Survey Readiness for the DON](https://proactiveltcexperts.com/product/survey-readiness-for-the-don/) - RECORDED WEBINAR: This session will focus on Survey Readiness: Key components for being survey ready every day; tools and resources for survey readiness; staff training priorities; and health inspection implementation strategies with case examples
- [QAPI for the DON](https://proactiveltcexperts.com/product/qapi-for-the-don/) - RECORDED WEBINAR: This session will discuss the components of Quality Assurance and Performance Improvement (QAPI) and the DON’s role and responsibilities for QAPI.
- [MDS & Medicare Essentials](https://proactiveltcexperts.com/product/mds-medicare-essentials/) - RECORDED WEBINAR: This session will focus on how the DON can effectively oversee the RAI/MDS processes to ensure accuracy of assessments, care planning, Medicare reimbursement and resident outcomes.
- [Leadership & Management and Essential Resources](https://proactiveltcexperts.com/product/leadership-management-and-essential-resources/) - RECORDED WEBINAR: This session will discuss the leadership and management skills and essential resources for the DON.
- [The Proficient Infection Preventionist (Full series purchase)](https://proactiveltcexperts.com/product/the-proficient-infection-preventionist-full-series-purchase-2/) - FULL SERIES PURCHASE: This will register one individual for all 8 sessions of the Infection Preventionist webinar series.
- [5-Star QMs – Antipsychotic Use](https://proactiveltcexperts.com/product/5-star-qms-antipsychotic-use/) - This session will review the antipsychotics quality measures that impact the Quality Measure component of the Nursing Home Compare Five-Star Quality Rating system.
- [LTC Supervisor Skill Building: Full Series Purchase](https://proactiveltcexperts.com/product/ltc-supervisor-skill-building-full-series-purchase/) - This product will register one individual for all 4 sessions of this webinar series. Webinars will take place on May 15, 22, 29 and June 5 beginning at 2:30PM EST.
- [Getting Together: Meetings That Work (4-Part Package)](https://proactiveltcexperts.com/product/getting-together-meetings-that-work-full-series-purchase/) - DOWNLOAD: Purchase all 4 sessions of the Meetings That Work webinar series.
- [You Might Be An Administrator If... (6-Part Package)](https://proactiveltcexperts.com/product/you-might-be-an-administrator-if-6-part-package/) - DOWNLOAD includes all 6 sessions in the You Might Be An Administrator If... webinar series.
- [Assessing Fall Risk Using Evidence Based Practice](https://proactiveltcexperts.com/product/winning-the-fall-prevention-battle-assessing-fall-risk-using-evidence-based-practice/) - RECORDED WEBINAR DOWNLOAD - This session will review best practices for fall risk assessment with an emphasis on identifying those risk factors that may be proactively addressed with appropriate, preventative interventions.
- [Analyzing the Fall Event—Critical Steps After a Fall](https://proactiveltcexperts.com/product/winning-the-fall-prevention-battle-analyzing-the-fall-event-critical-steps-after-a-fall/) - RECORDED WEBINAR DOWNLOAD - This session will cover effective management of a fall event, post-fall assessment standards, and effective analysis of fall incidents to identify root causes and develop an appropriate responsive action plan to avoid similar falls in the future. Best practices related to fall scene investigation, conducting post-fall huddles and team meetings, and applying root cause analysis will be reviewed. Documentation and communication expectations following fall events will be discussed, as well as considerations for QA monitoring activities.
- [Frontline Strategies for Fall Prevention: Environmental Measures, Activities Programs & Promoting Safe Movement](https://proactiveltcexperts.com/product/winning-the-fall-prevention-battle-frontline-strategies-for-fall-prevention-environmental-measures-activities-programs-promoting-safe-movement/) - RECORDED WEBINAR DOWNLOAD - This session focuses on applying effective measures to improve environmental safety, implement strong activities programs as a component of fall prevention efforts, and promote safe movement in the long-term care environment. The role of targeted programs that facilitate sustained functioning including Restorative Nursing Programs will be discussed.
- [Conquering Falls Through Effective Care Planning](https://proactiveltcexperts.com/product/conquering-falls-through-effective-care-planning/) - RECORDED WEBINAR DOWNLOAD - This session focuses on effective care planning for fall prevention using an interdisciplinary approach with an emphasis on addressing resident goals, preferences and fall risk factors.
- [Targeted Interventions Based on Risk Factors - Part 1](https://proactiveltcexperts.com/product/targeted-interventions-based-on-risk-factors-part-1/) - RECORDED WEBINAR DOWNLOAD - This session focuses on applying effective, person-centered fall prevention interventions based on resident specific risk factors and fall history.
- [Targeted Interventions Based on Risk Factors - Part 2](https://proactiveltcexperts.com/product/targeted-interventions-based-on-risk-factors-part-2/) - RECORDED WEBINAR DOWNLOAD - In this second of a 2-part discussion of intervention planning, cognitive, psychosocial and environmental risk factors and interventions to address them will be reviewed including dementia, depression, fear of falls, and promoting optimal sleep health.
- [Moving the Falls Program Forward Through Staff Training & Engagement Activities](https://proactiveltcexperts.com/product/moving-the-falls-program-forward-through-staff-training-engagement-activities/) - RECORDED WEBINAR DOWNLOAD - This session focuses on implementing effective fall prevention staff training programs and best practices for engaging staff in the fall prevention program.
- [Ruling MDS 3.0 Assessment and Completion](https://proactiveltcexperts.com/product/mds-mastermind-insights-for-mds-coding-and-reimbursement-accuracy-ruling-mds-3-0-assessment-and-completion/) - RECORDED WEBINAR DOWNLOAD - As step one of ensuring MDS 3.0 accuracy, differentiating between assessment types and completion requirements is key. As the introductory session, this webinar will provide an overview of MDS 3.0 Assessment types and scheduling requirements with special focus on the Significant Change in Status Assessment, Interim Payment Assessment and Interrupted Stay policy.
- [Becoming an MDS Genius: Rooting Out Common Coding Errors](https://proactiveltcexperts.com/product/mds-mastermind-becoming-an-mds-genius-rooting-out-common-coding-errors/) - RECORDED WEBINAR DOWNLOAD - Attendees will gain insight into common MDS 3.0 coding errors and areas of opportunity for increasing assessment accuracy for care planning and reimbursement. Best practices to enhance supportive documentation to reflect resident conditions and services will be emphasized. Auditing and monitoring activities will be reviewed with specific strategies for providers to drive program improvement.
- [Masterly Assessment and Reporting of Self-Care and Mobility](https://proactiveltcexperts.com/product/mds-mastermind-masterly-assessment-and-reporting-of-self-care-and-mobility/) - RECORDED WEBINAR DOWNLOAD - This session will review MDS items in sections G and GG used to report functional, self-care, and mobility status and goals. The intent of and differences between these sections will be reviewed with emphasis on assessment processes and supporting documentation for Admission and Interim GG performance items which are used to determine the PT, OT, and Nursing Function Scores under PDPM.
- [Becoming a CAA and Care Planning Maestro](https://proactiveltcexperts.com/product/mds-mastermind-becoming-a-caa-and-care-planning-maestro/) - RECORDED WEBINAR DOWNLOAD - Are your care plans comprehensive, timely, and person-centered? Who is involved in the care planning process? In this session, we'll review how to achieve effective care planning through an Interdisciplinary Team approach by bridging the gap between MDS Care Area Assessments and planning care around the resident's goals and preferences.
- [Achieving PDPM Success (Part 1)](https://proactiveltcexperts.com/product/mds-mastermind-achieving-pdpm-success-part-1/) - RECORDED WEBINAR DOWNLOAD - This session will provide part 1 of the Patient Driven Payment Model (PDPM) review. Attendees will be refreshed on the logistics of the PT, OT, and SLP components of the model as well as become better prepared to promote and ensure MDS and ICD.10 coding efficiency. Emphasis of this session will be understanding the payment model and the impact on interdisciplinary team operations with strategies to succeed.
- [Achieving PDPM Success (Part 2)](https://proactiveltcexperts.com/product/mds-mastermind-achieving-pdpm-success-part-2/) - RECORDED WEBINAR DOWNLOAD - This session will provide part 2 of the Patient Driven Payment Model (PDPM) review. Attendees will be refreshed on the logistics of the Nursing and NTA components of the model as well as become better prepared to promote and ensure MDS and ICD.10 coding efficiency. Emphasis of this session will be understanding the payment model and the impact on interdisciplinary team operations with strategies to succeed.
- [Expert Quality Measure Management](https://proactiveltcexperts.com/product/mds-mastermind-expert-quality-measure-management/) - RECORDED WEBINAR DOWNLOAD - This session will review Quality Measures, applicable definitions, and how each Five-Star MDS-based measure is calculated with a focus on ways in which facilities can monitor and improve their Five-Star rating through the Quality Measure domain.
- [Surmounting Survey & Audit Preparedness](https://proactiveltcexperts.com/product/surmounting-survey-audit-preparedness/) - RECORDED WEBINAR DOWNLOAD - This session will provide tips and strategies for successfully managing the survey process from the MDS perspective and suggestions for staying “audit ready” throughout the year.
- [Nursing Staffing and Payroll Based Journal and Arbitration Requirements](https://proactiveltcexperts.com/product/nursing-staffing-and-payroll-based-journal-and-arbitration-requirements/) - LIVE WEBINAR DOWNLOAD: This education session will explain the updates and changes of the regulations and guidance, with an emphasis on developing actions plans for achieving compliance related to the updates and changes related to Nursing Staffing and Payroll Based Journal and Arbitration Requirements.
- [Resident Rights; Abuse, Neglect, & Exploitation; Admission, Transfer, and Discharge Requirements](https://proactiveltcexperts.com/product/resident-rights-abuse-neglect-admission-transfer-and-discharge-requirements/) - LIVE WEBINAR DOWNLOAD: This education session will explain the updates and changes of the regulations and guidance related to Resident Rights; Abuse, Neglect, & Exploitation; and Admission, Transfer, and Discharge Requirements, with an emphasis on developing actions plans for achieving compliance related to the updates and changes.
- [Quality of Life & Quality of Care; Trauma Informed Care; Physician Services; Behavioral Health; Pharmacy Services; Food and Nutrition Requirements](https://proactiveltcexperts.com/product/quality-of-life-trauma-informed-care-physician-services-behavioral-health-pharmacy-services-food-and-nutrition-requirements/) - LIVE WEBINAR DOWNLOAD: This education session will explain the updates and changes of the regulations and guidance, with an emphasis on developing actions plans for achieving compliance related to the updates and changes related to Quality of Life & Quality of Care; Trauma Informed Care; Physician Services; Behavioral Health; Pharmacy Services; Food and Nutrition Requirements.
- [QAPI, Infection Control; Physical Environment Requirements](https://proactiveltcexperts.com/product/qapi-infection-control-physical-environment-requirements/) - LIVE WEBINAR DOWNLOAD: This education session will explain the updates and changes of the regulations and guidance, with an emphasis on developing actions plans for achieving compliance related to the updates and changes related to QAPI, Infection Control; Physical Environment Requirements.
- [Compliance & Ethics; Training Requirements; Psychosocial Outcome Severity Guide Requirements](https://proactiveltcexperts.com/product/compliance-training-requirements-psychosocial-outcome-severity-guide-requirements/) - LIVE WEBINAR DOWNLOAD: This education session will explain the updates and changes of the regulations and guidance, with an emphasis on developing actions plans for achieving compliance related to the updates and changes related to Compliance & Ethics; Training Requirements; Psychosocial Outcome Severity Guide Requirements.
- [Overview of Survey Process and Current Survey Trends](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-fundamentals-of-defense-part-1-falls-pressure-ulcers-wrongful-death-copy/) - RECORDED WEBINAR DOWNLOAD - This session will review the long-term care survey process and current survey trends across the nation, with an emphasis on strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to promote survey success.
- [F880 Infection Control & F884 NHSN Reporting](https://proactiveltcexperts.com/product/survey-success-avoiding-top-citations-f880-infection-control-f884-nhsn-reporting/) - RECORDED WEBINAR DOWNLOAD - This session will review the #1 top citations nationally, F880 Infection Control & F884 NHSN Reporting, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top cited deficiency.
- [F812 Food Procurement](https://proactiveltcexperts.com/product/survey-success-f812-food-procurement/) - RECORDED WEBINAR DOWNLOAD - This session will review the #2 top citation nationally, F812 Food Procurement, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top-cited deficiency.
- [F761 Label/Store Drugs & Biologicals](https://proactiveltcexperts.com/product/survey-success-avoiding-top-citations-f761-label-store-drugs-biologicals/) - RECORDED WEBINAR DOWNLOAD - This session will review the #3 top citation nationally, F761 Label/Store Drugs & Biologicals, with an emphasis on strategies to avoid this top citation through discussion on: actual citation examples and reviews of immediate jeopardy citations, strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & implementing survey preparedness activities to prevent this top-cited deficiency.
- [F689 Free of Accident Hazards/Supervision/Devices](https://proactiveltcexperts.com/product/survey-success-avoiding-top-citations-f689-free-of-accident-hazards-supervision-devices/) - RECORDED WEBINAR DOWNLOAD – This session will review the #4 top citation nationally, F689 Free of Accident Hazards/Supervision/ Devices, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top cited deficiency.
- [F656 Develop/Implement Comprehensive Care Plan](https://proactiveltcexperts.com/product/survey-success-avoiding-top-citations-5-top-citation-f656-develop-implement-comprehensive-care-plan/) - This session will review the #5 top citation nationally, F656 Develop/Implement Comprehensive Care Plan, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top cited deficiency.
- [F684 Quality of Care](https://proactiveltcexperts.com/product/f684-quality-of-care/) - This session will review the #6 top citation nationally, F684 Quality of Care, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top cited deficiency.
- [F677 ADL Care Provided for Dependent Residents](https://proactiveltcexperts.com/product/f677-adl-care-provided-for-dependent-residents/) - This session will review the #7 top citation nationally, F677 ADL Care Provided for Dependent Residents, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top cited deficiency.
- [F695 Respiratory/Tracheostomy Care & Suctioning](https://proactiveltcexperts.com/product/f695-respiratory-tracheostomy-care-suctioning/) - This session will review the #8 top citation nationally, F695 Respiratory/Tracheostomy Care & Suctioning, with an emphasis on strategies to avoid this top citation through discussion on: Actual citation examples and reviews of immediate jeopardy citations, Strategies for successfully managing the survey process & understanding the critical element pathways used to guide surveyor investigations, & Implementing survey preparedness activities to prevent this top cited deficiency.
- [F686 Treatment/Services to Prevent/Heal Pressure Ulcer](https://proactiveltcexperts.com/product/f695-respiratory-tracheostomy-care-suctioning-copy/) - RECORDED WEBINAR: This session will review the #9 top citation nationally, F686 Treatment/Services to Prevent/Heal Pressure Ulcer, with an emphasis on strategies to avoid this top citation through discussion
- [§483.10 Resident Rights Requirements](https://proactiveltcexperts.com/product/§483-10-resident-rights-requirements/) - This session will provide an overview of the Resident Rights regulations at §483.10, with an emphasis on the review the most commonly cited Resident Rights Requirements.
- [§483.15 Admission Transfer and Discharge Requirements](https://proactiveltcexperts.com/product/§483-15-admission-transfer-and-discharge-requirements/) - This session will provide an overview of the Admission Transfer and Discharge regulations at §483.15, with an emphasis on the review the most commonly cited Admission Transfer and Discharge Requirements.
- [§483.12 Freedom from Abuse, Neglect & Exploitation](https://proactiveltcexperts.com/product/§483-12-freedom-from-abuse-neglect-exploitation/) - This session will provide an overview of the Freedom from Abuse, Neglect, and Exploitation regulations at §483.12, with an emphasis on the review the most commonly cited Freedom Abuse, Neglect, and Exploitation Requirements.
- [§483.20 Resident Assessment & §483.21 Comprehensive Person-Centered Care Plan Requirements](https://proactiveltcexperts.com/product/§483-20-resident-assessment-§483-21-comprehensive-person-centered-care-plan-requirements/) - DOWNLOAD: This session will provide an overview of the Resident Assessment and Comprehensive Person-Centered Care Plans regulations at §483.20 and §483.21, with an emphasis on the review the most commonly cited resident assessment and comprehensive care plan requirements.
- [§483.24 Quality of Life Requirements](https://proactiveltcexperts.com/product/§483-24-quality-of-life-requirements/) - DOWNLOAD: This session will provide an overview of the Quality of Life regulations at §483.24, with an emphasis on the review the most commonly cited Quality of Life requirements.
- [§483.25 Quality of Care Requirements](https://proactiveltcexperts.com/product/§483-25-quality-of-care-requirements/) - DOWNLOAD: This session will provide an overview of the Quality of Care regulations at §483.25, with an emphasis on the review the most commonly cited Quality of Care requirements.
- [§483.30 Physician Services & §483.35 Nursing Service Requirements](https://proactiveltcexperts.com/product/§483-30-physician-services-§483-35-nursing-service-requirements/) - DOWNLOAD: This session will provide an overview of the Physician Services regulations at §483.30 and the Nursing Services regulations at §483.35, with an emphasis on the review the most commonly cited Physician and Nursing Services requirements.
- [§483.40 Behavioral Health Service Requirements](https://proactiveltcexperts.com/product/§483-40-behavioral-health-service-requirements/) - DOWNLOAD: This session will provide an overview of the Behavioral Health Services regulations at §483.40, with an emphasis on the review the most commonly cited Behavioral Health Services requirements.
- [§483.45 Pharmacy Services Requirements](https://proactiveltcexperts.com/product/§483-45-pharmacy-services-requirements/) - DOWNLOAD: This session will provide an overview of the Pharmacy Services regulations at §483.45, with an emphasis on the review the most commonly cited Pharmacy Services requirements.
- [§483.50 Laboratory Radiology and Other Diagnostic Services & §483.55 Dental Services](https://proactiveltcexperts.com/product/§483-60-laboratory-radiology-and-other-diagnostic-services-§483-55-dental-services/) - DOWNLOAD: This session will provide an overview of the Laboratory Radiology and Other Diagnostic Services at §483.50 & Dental Services regulations at §483.55, with an emphasis on the review the most commonly cited requirements in these areas.
- [§483.60 Food and Nutrition Services](https://proactiveltcexperts.com/product/§483-60-food-and-nutrition-services/) - DOWNLOAD: This session will provide an overview of the Food and Nutrition Services regulations at §483.60, with an emphasis on the review the most commonly cited requirements related to Food and Nutrition Services.
- [Department Details for the DON](https://proactiveltcexperts.com/product/mission-possible-department-details-for-the-don/) - This session will discuss specifics for success in the DON position by exploring the details of the day-to-day nursing operations.
- [Approaches for Activities](https://proactiveltcexperts.com/product/mission-possible-approaches-for-activities/) - This session will discuss specifics for success as an Activities Director by exploring specific aspects of the activity department role in the life of residents.
- [Strategies for Social Services](https://proactiveltcexperts.com/product/strategies-for-social-services/) - This session will discuss specifics for success as a Social Services Director by exploring specific aspects of the Social Services department within the facility.
- [Thriving Therapy Departments](https://proactiveltcexperts.com/product/thriving-therapy-departments/) - This session will discuss strategies for the Rehabilitation Services Department leader to facilitate systems and processes to achieve and maintain a Thriving Therapy Department.
- [Designs for Well-Rounded Dietary Departments](https://proactiveltcexperts.com/product/designs-for-well-rounded-dietary-departments/) - This session will discuss specifics for success as a Dietary Director by exploring specific aspects of the Dietary department within the facility.
- [Hints & Helps for Housekeeping](https://proactiveltcexperts.com/product/hints-helps-for-housekeeping/) - This session will discuss specifics for success as a Housekeeping Director by exploring specific aspects of the Housekeeping department within the facility.
- [Mechanisms for Successful Maintenance Departments](https://proactiveltcexperts.com/product/mechanisms-for-successful-maintenance-departments/) - This session will discuss specifics for success as a Maintenance Director by exploring specific aspects of the Maintenance department within the facility.
- [Meaningful Meetings](https://proactiveltcexperts.com/product/meaningful-meetings/) - This session will discuss specifics for efficient and productive team meetings that will maximize effective communication while promoting team morale and collaboration.
- [Advanced Action Planning for Administrators](https://proactiveltcexperts.com/product/advanced-action-planning-for-administrators/) - This session will discuss specifics for success in the Administrator position by exploring the details of the day-to-day facility operations.
- [Steering Survey Success](https://proactiveltcexperts.com/product/steering-survey-success/) - This session will discuss specific tips and strategies for staying survey ready throughout the year, and for following a schedule that will help to concentrate on survey focus areas and issues. Sample tools will be provided/reviewed.
- [Departmental Collaboration & Teamwork](https://proactiveltcexperts.com/product/departmental-collaboration-teamwork/) - This session will discuss specific tips and strategies for promoting effective teamwork and collaboration and boosting team morale while avoiding common traps that interfere with team success.
- [Customer Service Concepts for the Crew](https://proactiveltcexperts.com/product/customer-service-concepts-for-the-crew/) - This session will discuss specific tips and strategies for promoting facility wide focus on customer service at all levels of staff interactions. Concepts for achieving customer service goals will be shared along with examples of staff exercises for successful customer interactions.
- [LTC Litigation Briefing](https://proactiveltcexperts.com/product/ltc-litigation-briefing/) - This session will provide an overview of the current workforce demographics and trends, as well as innovative and proven methods to address workforce challenges. Actionable steps and ideas to inform recruitment and retention strategies will be discussed.
- [ABCs of QRP and VBP](https://proactiveltcexperts.com/product/abcs-of-qrp-and-vbp/) - This session will review the ins and outs of the SNF Value-Based Purchasing (VBP) & Quality Reporting Program (QRP). Emphasis of this session will be on the impact of VBP and QRP on facility operations with strategies for developing an action plan to guide successful outcomes.
- [Survey School in Session](https://proactiveltcexperts.com/product/survey-school-in-session/) - This session will review major current survey trends across the nation with an emphasis on specific strategies for successfully managing the survey process & responding to negative survey outcomes. Emphasis will be on the top tags for annual and complaint surveys with extensive examination of Immediate Jeopardy citations.
- [A Day in the Life of an Awesome Administrator](https://proactiveltcexperts.com/product/a-day-in-the-life-of-an-awesome-administrator-webinar-registration/) - This session will provide an overview of certain daily responsibilities and expectations as we take a look at a day in the life of an Administrator.
- [Easing Workforce Woes](https://proactiveltcexperts.com/product/easing-workforce-woes/) - This session will provide an overview of the current workforce demographics and trends, as well as innovative and proven methods to address workforce challenges. Actionable steps and ideas to inform recruitment and retention strategies will be discussed.
- [Regulatory Essentials and Survey Management for Activities](https://proactiveltcexperts.com/product/regulatory-essentials-and-survey-management-for-activities/) - DOWNLOAD: This first session will focus on the regulatory essentials for the activities department along with strategies for successful survey management.
- [MDS, Care Planning & Documentation Requirements for Activities](https://proactiveltcexperts.com/product/mds-care-planning-documentation-requirements-for-activities/) - DOWNLOAD: This second session will focus on Section F MDS Coding, CAA development, Care Planning and Documentation Requirements.
- [Required Components of the Activity Program](https://proactiveltcexperts.com/product/required-components-of-the-activity-program/) - DOWNLOAD: This third session will focus on the development of an individualized, person-centered activity program, that is based on the Activity Assessment and Comprehensive Care Plan.
- [Designing and Formatting the Activity Program](https://proactiveltcexperts.com/product/designing-and-formatting-the-activity-program/) - DOWNLOAD: This fourth session will focus on determining the appropriate format for activity programming that is designed to meet the individual needs of each resident, whether it be large group, small group, individual, independent, self-directed, or 1-1 sessions.
- [Immediate Jeopardy Risk: Elopement](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-elopement/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent elopement-related immediate jeopardy citations.
- [Immediate Jeopardy Risk: Falls & Accidents](https://proactiveltcexperts.com/product/immediate-jeopardy-risk-elopement-copy/) - DOWNLOAD: Learn how to assess the risk and implement effective safeguards to prevent falls and other accident-related immediate jeopardy citations.
- [Supportive Documentation for Behavioral Health and Mental Illness](https://proactiveltcexperts.com/product/supportive-documentation-for-behavioral-health-and-mental-illness-live-webinar-registration/) - DOWNLOAD: This presentation is designed to equip healthcare professionals with the essential skills and knowledge required to create supportive and nuanced documentation for individuals with behavioral health needs.
- [Supportive Documentation for Falls & Accidents](https://proactiveltcexperts.com/product/supportive-documentation-for-falls-accidents/) - DOWNLOAD: This presentation is designed to equip healthcare professionals with the essential skills and knowledge needed to create supportive and thorough documentation in the event of falls and accidents.
- [MDS Ripple Effect on Reimbursement](https://proactiveltcexperts.com/product/mds-ripple-effect-on-reimbursement/) - DOWNLOAD: This course will detail documentation requirements to support key components of the PDPM including accurate assignment of ICD.10 diagnosis codes, functional status as coded in section GG and the other key sections of the MDS that impact payment.
- [MDS Influence on QM](https://proactiveltcexperts.com/product/mds-influence-on-qm/) - DOWNLOAD: This session will review Quality Measure revisions, applicable definitions, and changes to how each MDS-based measure is calculated with a focus on ways in which facilities can improve quality outcomes with a QAPI driven approach to the data.
- [MDS Influence on SNF QRP](https://proactiveltcexperts.com/product/mds-influence-on-snf-qrp/) - DOWNLOAD: During this session we will provide an overview of the recent changes and detail the impact of key MDS data elements on the SNF QRP program.
- [MDS 5-Star Factors](https://proactiveltcexperts.com/product/mds-5-star-factors/) - DOWNLOAD: Many of the Quality Measures that are utilized in the Five Star Rating system were calculated based either directly or indirectly through risk adjustments on data from Section G. The Quality Measure domain will be undergoing a significant overhaul with this change over. This course will provide an overview of the impact of these changes.
- [Documentation in Depth: Full Series Purchase](https://proactiveltcexperts.com/product/documentation-in-depth-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Activities That Work - 4-Part Webinar Package](https://proactiveltcexperts.com/product/activities-that-work-4-part-webinar-package/) - DOWNLOAD: This 4-part webinar series will provide in-depth review of the regulatory requirements and survey tips/strategies for Activities team members as well as inspirations and concepts for building effective, person-centered and worthwhile activities programs.
- [MDS 5-Star Factors (Live Webinar Registration)](https://proactiveltcexperts.com/product/mds-5-star-factors-live-webinar-registration/) - This product will register one individual for the MDS 5-Star Factors webinar on February 28. Webinars will begin at 2:30PM EST.
- [The Impact of the MDS: Full Series Purchase](https://proactiveltcexperts.com/product/impact-of-the-mds-full-series-purchase/) - This product will register one individual for all 5 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Deconstructing Immediate Jeopardy & High Risk Tags: Full Series Purchase](https://proactiveltcexperts.com/product/deconstructing-immediate-jeopardy-high-risk-tags-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [The Main Attraction: Activities that Work (Full series purchase)](https://proactiveltcexperts.com/product/the-main-attraction-activities-that-work-full-series-purchase/) - FULL SERIES PURCHASE: This will register one individual for all 4 sessions of the Activities that Work webinar series.
- [§483.45 Pharmacy Services Requirements (LIVE Webinar Registration)](https://proactiveltcexperts.com/product/§483-45-pharmacy-services-requirements-live-webinar-registration/) - DOWNLOAD: This will register one individual for the live webinar on Tuesday, September 12 @ 2:30p ET.
- [Restorative Nursing: Restorative Nursing Foundations - Program Fundamentals](https://proactiveltcexperts.com/product/restorative-nursing-restorative-nursing-foundations-program-fundamentals/) - This product will register one individual for session 1 of the 6-part Restorative Nursing webinar series that will take place on April 7, 2022 at 2:30PM EST.
- [Restorative Nursing: Implementing a Successful Restorative Program and Overcoming Common Barriers](https://proactiveltcexperts.com/product/restorative-nursing-implementing-a-successful-restorative-program-and-overcoming-common-barriers/) - This product will register one individual for session 2 of the 6-part Restorative Nursing webinar series that will take place on April 14, 2022 at 2:30PM EST.
- [Restorative Nursing: Restorative Reimbursement - Systems for MDS Coding & Case Mix Accuracy](https://proactiveltcexperts.com/product/restorative-nursing-restorative-reimbursement-systems-for-mds-coding-case-mix-accuracy/) - This product will register one individual for session 3 of the 6-part Restorative Nursing webinar series that will take place on April 21, 2022 at 2:30PM EST.
- [Restorative Nursing: Restorative Staff Training & Competencies](https://proactiveltcexperts.com/product/restorative-nursing-restorative-staff-training-competencies/) - This product will register one individual for session 4 of the 6-part Restorative Nursing webinar series that will take place on April 28, 2022 at 2:30PM EST.
- [Restorative Nursing: Restorative Care Planning and IDT Roles](https://proactiveltcexperts.com/product/restorative-nursing-restorative-care-planning-and-idt-roles/) - This product will register one individual for session 5 of the 6-part Restorative Nursing webinar series that will take place on May 5, 2022 at 2:30PM EST.
- [Restorative Nursing: Restorative Documentation, Periodic Evaluation, and Quality Assurance Strategies](https://proactiveltcexperts.com/product/restorative-nursing-restorative-documentation-periodic-evaluation-and-quality-assurance-strategies/) - This product will register one individual for session 6 of the 6-part Restorative Nursing webinar series that will take place on May 12, 2022 at 2:30PM EST.
- [Reimbursement Refresher: Thriving Under PDPM: Essentials of a Successful PDPM Program](https://proactiveltcexperts.com/product/reimbursement-refresher-thriving-under-pdpm-essentials-of-a-successful-pdpm-program/) - This product will register one individual for session 1 of the 4-part Reimbursement Refresher webinar series that will take place on July 8, 2021 at 2:00PM EST.
- [Reimbursement Refresher: Medicaid CMI Accuracy: Overcoming Common Pitfalls](https://proactiveltcexperts.com/product/reimbursement-refresher-medicaid-cmi-accuracy-overcoming-common-pitfalls/) - This product will register one individual for session 2 of the 4-part Reimbursement Refresher webinar series that will take place on July 15, 2021 at 2:00PM EST.
- [Reimbursement Refresher: Medical Review Ready! Preparing for Success Under Payer Audits](https://proactiveltcexperts.com/product/reimbursement-refresher-medical-review-ready-preparing-for-success-under-payer-audits/) - This product will register one individual for session 3 of the 4-part Reimbursement Refresher webinar series that will take place on July 22, 2021 at 2:00PM EST.
- [Reimbursement Refresher: Managed Care Contracting & the Providers Role in Value-Based Payment](https://proactiveltcexperts.com/product/reimbursement-refresher-managed-care-contracting-the-providers-role-in-value-based-payment/) - This product will register one individual for session 4 of the 4-part Reimbursement Refresher webinar series that will take place on August 5, 2021 at 2:00PM EST.
- [Winning the Fall Prevention Battle 8-Part Package](https://proactiveltcexperts.com/product/winning-the-fall-prevention-battle-8-part-package/) - RECORDED WEBINAR DOWNLOAD - This 8-part series guides the interdisciplinary team through the elements of an effective falls prevention program. Sessions focus on assessment strategies that guide targeted risk-based interventions, responding to a fall event, and promoting a fall prevention environment.
- [Deep Dive into Federal Regulations: Full Series Purchase](https://proactiveltcexperts.com/product/deep-dive-into-federal-regulations-full-series-purchase/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [Mission Possible - SNF Department Head Briefing: Full Series Purchase](https://proactiveltcexperts.com/product/mission-possible-snf-department-head-briefing-full-series-purchase-copy/) - This product will register one individual for all 12 sessions of this webinar series. Webinars will begin at 2:30PM EST.
- [SNF Compliance 101 & Program Manual Contents](https://proactiveltcexperts.com/product/snf-compliance-101-program-manual-contents/) - RECORDED WEBINAR DOWNLOAD: This session serves as the foundation for future sessions in the SNF CompliancePro Primer series.
- [Spread the Word! Compliance Training and Promotion](https://proactiveltcexperts.com/product/spread-the-word-compliance-training-and-promotion/) - RECORDED WEBINAR DOWNLOAD: This session reviews strategies for promoting compliance and the compliance and ethics program throughout the organization.
- [Current Hot Topics in Compliance](https://proactiveltcexperts.com/product/current-hot-topics-in-compliance/) - RECORDED WEBINAR DOWNLOAD: This session reviews key components of an effective SNF Compliance & Ethics Program with emphasis on conducting a facility Risk Assessment to drive development of the facility-specific Compliance Work Plan.
- [Compliance Core Activities: Committee Functions, Auditing & Monitoring](https://proactiveltcexperts.com/product/compliance-core-activities-committee-functions-auditing-monitoring/) - RECORDED WEBINAR DOWNLOAD: This session addresses core activities of an effective Compliance and Ethics Program in the SNF/LTC/AL setting including operation of a compliance committee and implementation of auditing and monitoring functions.
- [Avoiding Facility Assessment Failures](https://proactiveltcexperts.com/product/avoiding-facility-assessment-failures/) - This product will register one individual for the You Might be an Administrator If... webinar on January 17th. The webinar will begin at 2:30PM EST.
- [Compliance Core Activities: Reporting Systems & Compliance Investigations with Case Studies](https://proactiveltcexperts.com/product/promoting-the-program-reporting-systems-staff-training/) - RECORDED WEBINAR DOWNLOAD: This session addresses core activities of an effective compliance and ethics program in the SNF/LTC/AL setting including best practices for meeting standards related to implementing and publicizing a reporting system that allows anonymous reporting of violations without fear of retribution, processes for ensuring the integrity of reported data and for responding with reasonable steps to address potential issues including conducting investigations.
- [Compliance Operations: Board Oversight, QAPI Integration & Record Keeping](https://proactiveltcexperts.com/product/compliance-for-the-board-qapi-integration-documentation-record-keeping/) - RECORDED WEBINAR DOWNLOAD: This session reviews key operational processes for facilitating compliance program targets of preventing and detecting violations of laws/regulations, fraud, and abuse, and integrating systems to promote quality care.
- [SNF Compliance Pro Primer (6-Part Package)](https://proactiveltcexperts.com/product/snf-compliance-pro-primer-6-part-package/) - RECORDED WEBINAR DOWNLOAD: This session reviews key operational processes for facilitating compliance program targets of preventing and detecting violations of laws/regulations, fraud, and abuse, and integrating systems to promote quality care.
- [Quality Measure Domain: Part 2](https://proactiveltcexperts.com/product/quality-measure-domain-part-2/) - This session will focus on the Long-Stay Quality Measures that impact your 5-Star Rating.
- [Quality Measure Domain: Part 3](https://proactiveltcexperts.com/product/quality-measure-domain-part-3/) - This session will focus on the Short-Stay Quality Measures that impact your 5-Star Rating
- [Restorative Training Project with Customization](https://proactiveltcexperts.com/product/restorative-training-project-with-customization-for-schlegel-villages/) - Restorative Training Project with Customization for Schlegel Villages.
- [F636-F642 - Resident Assessments & Accuracy of Assessments](https://proactiveltcexperts.com/product/f-tag-review-series-resident-assessments-accuracy-of-assessments-f636-f642/) - This sessions reviews F636-F642 Resident Assessments & Accuracy of Assessments
- [F550 - Dignity and Respect of Individuality](https://proactiveltcexperts.com/product/f-tag-review-series-dignity-and-respect-of-individuality-f550/) - This session reviews F550 - Dignity and Respect of Individuality
- [Bowel/Bladder Incontinence, Catheter, UTI F690](https://proactiveltcexperts.com/product/f-tag-review-series-bowel-bladder-incontinence-catheter-uti-f690/) - This session reviews F690 - Bowel/Bladder Incontinence, Catheter, and UTI
- [Trauma-Informed Care Competency Toolkit](https://proactiveltcexperts.com/product/trauma-informed-care-tool-kit/) - Revised for 2019 - This tool-kit is intended to assist facilities in meeting the Trauma Informed Care Requirements of Participation and in demonstrating competency based training in this area.
- [SNF-NF Staff & Department Competency Checklist](https://proactiveltcexperts.com/product/snf-nf-staff-department-competency-checklist/) - This editable Excel Workbook is intended to act as a guide for completing the recommended training by department and provides a convenient method of documenting staff training completion with the level of competency.
- [Achieving 5-Star Success - Live Workshop](https://proactiveltcexperts.com/product/achieving-5-star-success-live-workshop/) - This will register one (1) individual for the live workshop on Thursday, December 8th.
- [MDS Mastermind 8-Part Package](https://proactiveltcexperts.com/product/mds-mastermind-8-part-package/) - RECORDED WEBINAR DOWNLOAD - This session will provide tips and strategies for successfully managing the survey process from the MDS perspective and suggestions for staying “audit ready” throughout the year.
- [PDPM Physician Toolkit](https://proactiveltcexperts.com/product/pdpm-physician-toolkit/) - The PDPM Physician Toolkit provides the essential information and query process tools providers need to know to effectively partner with SNFs in caring for Medicare residents under PDPM.
- [PDPM Skilled Nursing Charting Guidelines](https://proactiveltcexperts.com/product/pdpm-skilled-nursing-charting-guidelines/) - This resource provides PDPM Skilled Nursing Charting Guidelines for condition/service specific NTA items and by Clinical Category with actual skilled documentation examples. This toolkit also includes our NEW complimentary on-demand webinar: Promoting MDS Accuracy During the COVID-19 Pandemic.
- [Hospital PDPM Quick Guide and Hospital to SNF Discharge PDPM Documentation Checklist](https://proactiveltcexperts.com/product/hospital-pdpm-quick-guide-and-hospital-to-snf-discharge-pdpm-documentation-checklist/) - This checklist offers your admission team a quick resource to guide conversations with hospital discharge planners regarding the SNF reimbursement changes under PDPM and the impact on documentation and coding requirements.
- [Behavioral Health and Person Centered Care Competency Toolkit](https://proactiveltcexperts.com/product/behavioral-health-and-person-centered-care-tool-kit/) - This Tool-kit is intended to supplement or enhance current SNF/NF educational programs to meet the intent of the new requirements.
- [Restorative Nursing Competency Toolkit](https://proactiveltcexperts.com/product/restorative-nursing-tool-kit/) - This Tool-kit is intended to supplement or enhance current SNF/NF educational programs for Restorative Nursing Programs to meet the intent of the new Requirements of Participation for competency based training.
- [Interim Payment Assessment (IPA) Toolkit](https://proactiveltcexperts.com/product/interim-payment-assessment-ipa-tool-kit/) - Resources related to the PDPM Interim Payment Assessment (IPA)
- [Cultivating LTC Leaders 12-Part Package](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-12-part-package/) - RECORDED WEBINAR DOWNLOAD - This session reviews key SNF/long term care industry lawsuits, False Claims Act activity and settlements from 2021 with discussion on the implications for compliance and risk management.
- [Live Webinar Registration: F686 Treatment/Services to Prevent/Heal Pressure Ulcers](https://proactiveltcexperts.com/product/live-webinar-registration-f686-treatment-services-to-prevent-heal-pressure-ulcers/) - This purchase will register one (1) individual for the live session on 10/4/2022 at 2:30PM Eastern.
- [Standards of Care 12-Part Package](https://proactiveltcexperts.com/product/standards-of-care-12-part-package/) - RECORDED WEBINAR DOWNLOAD - This 12-month webinar series focuses on nursing facility systems of care and managing common conditions treated in the LTC setting.
- [Incontinence, UTIs, Catheters](https://proactiveltcexperts.com/product/incontinence-utis-catheters/) - RECORDED WEBINAR DOWNLOAD - This session will review regulatory requirements and best practices for systems related to nutrition and hydration, and strategies for reducing weight loss in LTC facilities.
- [Nutrition, Hydration & Weight Loss](https://proactiveltcexperts.com/product/nutrition-hydration-weight-loss/) - RECORDED WEBINAR DOWNLOAD - This session will review regulatory requirements and best practices for systems related to nutrition and hydration, and strategies for reducing weight loss in LTC facilities.
- [End of Life Care - Hospice & Palliative Services](https://proactiveltcexperts.com/product/end-of-life-care-hospice-palliative-services/) - RECORDED WEBINAR DOWNLOAD - This session will review regulatory requirements and best practices related to end-of-life care.
- [Pain Identification & Management](https://proactiveltcexperts.com/product/pain-identification-management/) - RECORDED WEBINAR DOWNLOAD - This session will review regulatory requirements and best practices for identifying, monitoring and managing pain, with focus on standards of care and staff competency focus areas
- [Fundamentals of Defense 2-Part Webinar Package](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-fundamentals-of-defense-part-1-falls-pressure-ulcers-wrongful-death/) - RECORDED WEBINAR DOWNLOAD - This session will review regulatory requirements and best practices for defending care in fall, infection control/COVID-19 outbreak and related wrongful death cases. Forms and resources for assessing, monitoring and managing falls and infections will be provided, along with tips and strategies for management of COVID-19 outbreaks.
- [Unpacking the RoP Interpretive Guidance 5-Session Package](https://proactiveltcexperts.com/product/unpacking-the-rop-interpretive-guidance-5-session-package/) - LIVE WEBINAR DOWNLOAD: This education series will explain the updates and changes of the regulations and guidance, with an emphasis on developing action plans for achieving compliance related to the updates and changes. Purchase all 5 sessions at a discounted rate!
- [Year-End PDPM Updates and 2021 Policy Changes](https://proactiveltcexperts.com/product/12-year-end-pdpm-updates-and-2021-policy-changes/) - This session of the PDPM Master Class Series will focus on recent updates to PDPM from The Center for Medicare and Medicaid Services (CMS) and potential policy changes for providers for fiscal year 2021. Updated regulatory guidance and Resident Assessment Instrument (RAI) specifications will be reviewed with recommendations for successful provider implementation.
- [Essentials & Roles of the Interdisciplinary Team in Assessment & Coding for Reimbursement Accuracy](https://proactiveltcexperts.com/product/mds-pdpm-proficiency-series-essentials-roles-of-the-interdisciplinary-team-in-assessment-coding-for-reimbursement-accuracy/) - RECORDED WEBINAR DOWNLOAD - As the introductory session, this webinar will provide an overview of the 5 PDPM components and set the stage for the remaining sessions in the series.
- [Assessing Cognition, Mood, & Behaviors (Sections B, C, D, E)](https://proactiveltcexperts.com/product/mds-pdpm-proficiency-series-assessing-cognition-mood-behaviors-sections-b-c-d-e/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar will review MDS items in sections B, C, D, and E that impact the SLP and Nursing Components under PDPM.
- [Assessing Self Care & Mobility (MDS Sections G and GG)](https://proactiveltcexperts.com/product/mds-proficiency-series-assessing-self-care-mobility-mds-sections-g-and-gg/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour webinar will review MDS items in sections G and GG used to report functional, self-care, and mobility status and goals.
- [Rehabilitative & Restorative Services (MDS Sections H and O)](https://proactiveltcexperts.com/product/mds-proficiency-series-rehabilitative-restorative-services-mds-sections-h-and-o/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar will review MDS items in sections H and O used to report Restorative Nursing Services which may impact the Nursing component under PDPM and Therapy provision with emphasis on group and concurrent therapy considerations and restorative nursing program requirements.
- [Nursing, Nutritional, & NTA Services (MDS Sections H, J, K, M, and O)](https://proactiveltcexperts.com/product/nursing-nutritional-nta-services-mds-sections-h-j-k-m-and-o/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour webinar will review services reported in MDS sections H, J, K, M, and O that impact the Nursing, SLP, and NTA components under PDPM.
- [Clinical Category and Comorbid Conditions (MDS Sections I and J)](https://proactiveltcexperts.com/product/mds-pdpm-proficiency-series-clinical-category-and-comorbid-conditions-mds-sections-i-and-j/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour webinar will review MDS items in sections I and J used to determine the resident’s Clinical Category which directly impacts the PT, OT, and SLP case mix groups as well as comorbidities that can further impact the SLP and NTA components under PDPM.
- [Managed Care Contracting & the Providers Role in Value-Based Payment](https://proactiveltcexperts.com/product/reimbursement-refresher-managed-care-contracting-the-providers-role-in-value-based-payment-2/) - RECORDED WEBINAR DOWNLOAD - This session reviews Managed Care Organization updates and strategies for effective MCO contract management including navigating different reimbursement methods, implementing systems for successful operations from admission to discharge, and clean billing practices. Additionally, provider considerations for Value-Based Payments in Managed Care are discussed.
- [MDS PDPM 6-Session Package](https://proactiveltcexperts.com/product/mds-pdpm-6-session-package/) - This 6 session webinar series provides MDS section-by-section coding guidance under PDPM and insights for optimal data collection, supportive documentation, and consistent coding accuracy.
- [Operational Strategies for Success Under PDPM](https://proactiveltcexperts.com/product/moving-mountains-series-operational-strategies-for-success-under-pdpm-ahca-affiliates/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar will review key operational strategies for successful implementation of the Patient Driven Payment Model effective October 1, 2019 through a panel presented by experts in SNF operations and clinical reimbursement.
- [Phase 3: Trauma Informed and Culturally Competent Care](https://proactiveltcexperts.com/product/moving-mountains-series-phase-3-trauma-informed-and-culturally-competent-care-ahca/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour session will assist SNF providers in understanding the new requirements related to trauma informed & culturally competent care. A review of regulatory requirements regarding trauma informed and culturally competent care with an analysis of the interpretive guidance related to this requirement will be emphasized.
- [Phase 3: Implementing Staff Training & Competency Programs](https://proactiveltcexperts.com/product/moving-mountains-series-phase-3-implementing-staff-training-competency-programs-ahca-affiliates/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour session will assist SNF providers in developing an effective implementation of competency based staff development and training programs.
- [Phase 3: What to Expect](https://proactiveltcexperts.com/product/f-tag-review-series-phase-3-what-to-expect/) - An overview of the Phase 3 RoP that will go into effect on Nov. 28, 2019 will be discussed, with an emphasis on developing actions plans for achieving compliance with the upcoming Phase 3 RoP.
- [PDPM: Understanding PDPM & Developing Your Facility Action Plan](https://proactiveltcexperts.com/product/pdpm-understanding-pdpm-developing-your-facility-action-plan/) - This webinar will review fundamentals of the Patient Driven Payment Model (PDPM) effective October 1, 2019 for SNF Part A reimbursement. Emphasis of this session will be on understanding the payment model and the impact on interdisciplinary team operations with strategies for developing a step wise facility action plan to guide a successful transition.
- [Phase 3: Implementing an Effective QAPI Program](https://proactiveltcexperts.com/product/moving-mountains-series-phase-3-implementing-an-effective-qapi-program/) - This 1.25 hour webinar focuses on the fundamentals of QAPI and incorporating the 5 QAPI elements into existing continuous quality improvement (CQI) facility quality programs. Self-assessment for goal setting, the QAPI written plan, policies and procedures, and leadership's role in accountability for QAPI programs are emphasized.
- [Phase 3: Implementing an Effective SNF Compliance & Ethics Program](https://proactiveltcexperts.com/product/moving-mountains-series-phase-3-implementing-an-effective-snf-compliance-ethics-program/) - This 1.25-hour webinar reviews SNF Compliance and Ethics Program requirements effective with phase 3 of the Requirements of Participation on November 28, 2019. This session emphasizes developing or updating the SNF Compliance and Ethics Program to meet all required phase 3 components per the final rule. Guidance on effective day to day implementation strategies and operating the program will be provided. A program implementation checklist and risk assessment tool is also shared with participants. This session is worth 1.5 CE credits. Once purchased instructions for submitting the post test for NAB credit for certificate issuance will be provided.
- [Phase 3: SNF Quality Reporting QRP & SNF Value Based Purchasing VBP Programs](https://proactiveltcexperts.com/product/moving-mountains-series-phase-3-snf-quality-reporting-qrp-snf-value-based-purchasing-vbp-programs-ahca-affiliates/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar reviews fundamentals of the SNF Value Based Purchasing (VBP) & Quality Reporting Program (QRP). Emphasis of this session is on understanding both the VBP and QRP and the impact on interdisciplinary team operations with strategies for developing an action plan to guide a successful transition. This session is worth 1.5 CE credits. Once purchased instructions for submitting the post test for NAB credit for certificate issuance will be provided.
- [PDPM: Developing ICD-10 Expertise for Effective Coding of Clinical Categories & Non-Therapy Ancillary](https://proactiveltcexperts.com/product/moving-mountains-series-pdpm-developing-icd-10-expertise-for-effective-coding-of-clinical-categories-non-therapy-ancillary-ahca-affiliates/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar focuses on best practices for ICD 10 coding accuracy in preparation for transition to the Patient Driven Payment Model (PDPM).
- [PDPM: Rehab Program Transitions and Provider Insights for PT, OT, and SLP Services](https://proactiveltcexperts.com/product/moving-mountains-series-pdpm-rehab-program-transitions-and-provider-insights-for-pt-ot-and-slp-services/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar reviews strategies for successfully managing rehabilitation programs through the shift in reimbursement from a focus on therapy service time delivered to the patient driven payment model which emphasizes resident characteristics.
- [PDPM: Triple Check Process and Billing Accuracy](https://proactiveltcexperts.com/product/moving-mountains-series-pdpm-triple-check-process-and-billing-accuracy-la/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour webinar recorded on 10/2/19 reviews best practices to decrease potential billing errors and promote accurate reimbursement for PDPM claims through internal interdisciplinary auditing processes. Key roles of interdisciplinary team members in completion of a collaborative triple check process and key data collection, billing, and monitoring process pertinent to PDPM will be emphasized.
- [Thriving Under PDPM – Essentials of a Successful PDPM Program](https://proactiveltcexperts.com/product/reimbursement-refresher-thriving-under-pdpm-essentials-of-a-successful-pdpm-program-2/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session will share insights on trends identified in over 2000 PDPM coding and documentation audits along with CMS findings noted in the proposed rule with a focus on industry billing trends, lessons learned, and best practice applications for SNF Medicare Program operations. Common missed opportunities and specific strategies for providers to drive program improvement in these areas will be discussed with case studies. Insights into internal auditing & process improvements to reduce missed opportunities and improve medical review success will be emphasized.
- [Medical Review Ready! Preparing for Success Under Payer Audits](https://proactiveltcexperts.com/product/reimbursement-refresher-medical-review-ready-preparing-for-success-under-payer-audits-2/) - RECORDED WEBINAR DOWNLOAD - Is your facility prepared for the expected uptick in payer audits? This session provides an overview of trends in medical review, and common Medicare and Managed Care denial trends with case studies. Proactive measures to reduce risk and improve outcomes under payer audits will be covered. The fundamentals of a strong documentation program to support billed services will be emphasized.
- [Medicaid CMI Accuracy: Overcoming Common Pitfalls](https://proactiveltcexperts.com/product/reimbursement-refresher-medicaid-cmi-accuracy-overcoming-common-pitfalls-2/) - RECORDED WEBINAR DOWNLOAD - The nursing facility case mix system identifies resource needs of the residents based on identification of acuity variances. This training session will focus on common issues in Medicaid case mix accuracy including coding, supportive documentation gaps and missed opportunities. Reimbursement experts will review strategies for identifying facility oversights and improving systems for capturing appropriate reimbursement.
- [Something Seems Off – Identifying Changes in Condition](https://proactiveltcexperts.com/product/standards-of-care-something-seems-off-identifying-changes-in-condition/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices for identifying, communicating, and monitoring changes in condition to ensure optimal resident outcomes and reduce hospitalizations. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Fall Prevention & Management](https://proactiveltcexperts.com/product/standards-of-care-fall-prevention-management/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices for identifying fall risk, determining and implementing fall management interventions, and conducting an in-depth root cause analysis when a fall occurs. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Reducing Infections in Long-Term Care Facilities](https://proactiveltcexperts.com/product/standards-of-care-reducing-infections-in-long-term-care-facilities/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices for reducing infection rates and managing outbreaks with a focus on standards of care, staff competency focus areas, and critical nursing assessment principles. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Care of the Dialysis Recipient](https://proactiveltcexperts.com/product/standards-of-care-care-of-the-dialysis-recipient/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices specific to the resident receiving in-house or offsite dialysis with guidance on pre- and post-treatment monitoring protocols. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Breathe Easy – Respiratory Care and Services](https://proactiveltcexperts.com/product/standards-of-care-breathe-easy-respiratory-care-and-services/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices for the provision of respiratory care and services including oxygen therapy, tracheostomy and ventilator care, and MDI and nebulizer administration. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Skin/Wound Care, Pressure Ulcer Prevention](https://proactiveltcexperts.com/product/standards-of-care-skin-wound-care-pressure-ulcer-prevention/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices for assessing skin, preventing, identifying and treating wounds, and monitoring changes in skin condition to ensure optimal resident outcomes. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Depression, Anxiety, and Trauma-Informed Care](https://proactiveltcexperts.com/product/standards-of-care-depression-anxiety-and-trauma-informed-care/) - RECORDED WEBINAR DOWNLOAD - This 1-hour webinar will review regulatory requirements and best practices for managing depression and anxiety in the LTC setting and implementing a trauma-informed care approach. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Dementia Care, Behavioral Health, Antipsychotic Reduction](https://proactiveltcexperts.com/product/standards-of-care-dementia-care-behavioral-health-antipsychotic-reduction/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session will review regulatory requirements and best practices for dementia and behavioral health care and strategies for reducing antipsychotics through non-pharmacological interventions. Through lecture and case study analysis we will identify critical nursing assessment and documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Build & Implement Crucial PDPM Policies](https://proactiveltcexperts.com/product/pdpm-master-class-series-build-implement-crucial-pdpm-policies-ahca/) - RECORDED WEBINAR DOWNLOAD - This introductory session of the PDPM Master Class Series includes an in-depth discussion of the importance of developing and implementing key skilled nursing facility (SNF) policies and procedures to ensure compliance under PDPM.
- [Getting the PDPM Initial PPS Assessment Right! Best Practices for Pre-admission, Admission & Days 1-8](https://proactiveltcexperts.com/product/pdpm-master-class-series-getting-the-pdpm-initial-pps-assessment-right-best-practices-for-pre-admission-admission-days-1-8/) - RECORDED WEBINAR DOWNLOAD - This session of the PDPM Master Class Series will focus on best practices for data collection from pre-admission screening through day eight of the SNF stay.
- [Applying Dollar Values to PDPM Characteristics & Avoiding Top Missed Opportunities with Case Studies](https://proactiveltcexperts.com/product/pdpm-master-class-series-applying-dollar-values-to-pdpm-characteristics-avoiding-top-missed-opportunities-with-case-studies/) - RECORDED WEBINAR DOWNLOAD - This session of the PDPM Master Class Series will focus on the financial implications of coding (or failing to code) various PDPM characteristics through a review of high-risk variables impacting PDPM reimbursement.
- [Effective Meetings for PDPM (UR/Medicare, Clinical, Triple Check)](https://proactiveltcexperts.com/product/pdpm-master-class-series-effective-meetings-for-pdpm-ur-medicare-clinical-triple-check/) - RECORDED WEBINAR DOWNLOAD - This session of the PDPM Master Class Series will review how daily clinical, Medicare, and triple-check meeting processes can be updated to ensure ongoing resident-centered assessment and identification of changes under PDPM.
- [Staff Development & Core Competency Essentials](https://proactiveltcexperts.com/product/pdpm-master-class-series-staff-development-core-competency-essentials/) - RECORDED WEBINAR DOWNLOAD - This session of the PDPM Master Class Series will review essential competencies for PDPM success including, but not limited to, ICD-10 coding, Section GG assessment, and MDS coding with special focus on nursing clinical competencies to identify, assess, and manage Nursing and NTA conditions and services.
- [Care Planning for the Complex Resident Under PDPM](https://proactiveltcexperts.com/product/pdpm-master-class-series-care-planning-for-the-complex-resident-under-pdpm/) - This session of the PDPM Master Class Series will review regulatory requirements related to Baseline and Comprehensive care planning with focus on developing effective person-centered care plans that address complex care and services provided.
- [PDPM Quality Assurance and Outcomes Tracking](https://proactiveltcexperts.com/product/pdpm-master-class-series-pdpm-quality-assurance-and-outcomes-tracking/) - This session of the PDPM Master Class Series will focus on critical patient outcomes monitoring and recommended measures of quality assurance for PDPM.
- [Addressing PDPM Medical Review Risks in the SNF Compliance & Ethics Workplan](https://proactiveltcexperts.com/product/pdpm-master-class-series-addressing-pdpm-medical-review-risks-in-the-snf-compliance-ethics-workplan/) - This session of the PDPM Master Class Series will focus on PDPM Medical Review risks for providers and key strategies to address those risks in the Compliance and Ethics Work Plan.
- [Advancing Clinical Capabilities and Care Delivery](https://proactiveltcexperts.com/product/pdpm-master-class-series-advancing-clinical-capabilities-and-care-delivery/) - This session of the PDPM Master Class Series will review considerations for advancing clinical capabilities and care delivery under PDPM. Focus of this webinar will be on strengthening or developing care delivery processes by way of
- [SNF QAPI Fundamentals](https://proactiveltcexperts.com/product/snf-qapi-fundamentals/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [Phase 3 Next Steps for the Infection Preventionist](https://proactiveltcexperts.com/product/moving-mountains-series-phase-3-next-steps-for-the-infection-preventionist-ahca-affiliates/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour session will assist SNF providers in understanding the new requirements related to Infection Preventionists.
- [Skilled Nursing Supportive Documentation for PDPM](https://proactiveltcexperts.com/product/moving-mountains-series-skilled-nursing-supportive-documentation-for-pdpm-ahca/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour webinar focuses on skilled nursing documentation requirements and best practices as it relates to the new Medicare payment model- PDPM. The webinar will include review of skilled level of care criteria with an emphasis on skilled nursing services and documentation to support the skilled stay.
- [MDS Coding Precision & PDPM Audit Processes](https://proactiveltcexperts.com/product/moving-mountains-series-mds-coding-precision-pdpm-audit-processes/) - RECORDED WEBINAR DOWNLOAD - This 1.25 hour webinar will focus on MDS coding accuracy and review processes to ensure appropriate reporting of information and supportive documentation under the new Medicare payment model- PDPM.
- [Legal Aspects of Documentation](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-legal-aspects-of-documentation/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session will review regulatory requirements and best practices for completing legally sound documentation that supports the facility met the standard of care. Through lecture and mock deposition analysis, we will identify critical legal and AHIMA documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Mastering the LTC Survey Process 2-Part Webinar Package](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-mastering-the-ltc-survey-process-2-part-webinar-package/) - RECORDED WEBINAR DOWNLOAD - This 2-part webinar package overviews the Long-term Care Survey Process including guidelines for determining Immediate Jeopardy and survey procedures. Forms and resources for survey success will be addressed throughout. New and seasoned leaders will solidify knowledge surrounding the survey process as a foundation to successful survey outcomes.
- [SNF Compliance Program Essentials of the Facility Risk Assessment and Work Plan](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-snf-compliance-program-essentials-of-the-facility-risk-assessment-and-work-plan/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session reviews key components of an effective SNF Compliance & Ethics Program with emphasis on conducting a facility Risk Assessment to drive development of the facility-specific Compliance Work Plan. A sample Risk Assessment template will be provided, as well as examples of prioritizing facility-specific risks and establishing targeted work plan goals and program activities. New and seasoned leaders will develop skill in operationalizing critical Risk Assessment and Work Plan development steps as part of the SNF Compliance & Ethics Program.
- [Policies and Procedures - Should you have a policy for everything?](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-policies-and-procedures-should-you-have-a-policy-for-everything/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session will review regulatory requirements and best practices for developing, revising, and implementing facility policies and procedures. Through lecture and case study analysis, we will identify essential aspects of care for policies and procedures, as well as critical aspects to include in policy and procedure development along with documentation principles to apply in your daily practical operations to promote resident well-being and minimize potential risks.
- [Driving Excellence Through QAPI](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-driving-excellence-through-qapi/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session will provide guidance for incorporating QAPI principles into existing facility continuous quality improvement (CQI) activities. Self-assessment for goal setting, QAPI written plan, policies, and leadership’s role in accountability for QAPI programs with case examples of Performance Improvement Projects will be reviewed.
- [Internal Investigations](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-internal-investigations/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session will review best practices for conducting a thorough and detailed internal investigation in response to accidents/incidents, and allegations of abuse, misappropriation, or staff misconduct with sample tools for investigation tracking and reporting.
- [The Operator’s Guide to Understanding the (Tremendous!) Impact of the MDS](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-the-operators-guide-to-understanding-the-tremendous-impact-of-the-mds/) - RECORDED WEBINAR DOWNLOAD - This 1-hour session This session overviews how MDS data is used for reimbursement, monitoring quality of care, and informing consumers about nursing home characteristics compared to peers with guidance for monitoring data for compliance, payment accuracy and quality outcomes.
- [Achieving Objectives Through People: Topics in Human Resources](https://proactiveltcexperts.com/product/achieving-objectives-through-people-topics-in-human-resources/) - RECORDED WEBINAR DOWNLOAD - This session reviews critical issues in Human Resources for long term care leaders with emphasis on conducting interviews, hiring, disciplinary action, termination and legal issues, as well as nursing home staffing, defining staff roles/responsibilities and delegation of duties. New and seasoned leaders will develop skills in implementing best practices for effective and compliant Human Resources operations.
- [Lessons from the Headlines](https://proactiveltcexperts.com/product/cultivating-ltc-leaders-lessons-from-the-headlines/) - RECORDED WEBINAR DOWNLOAD - This session reviews key SNF/long term care industry lawsuits, False Claims Act activity and settlements from 2021 with discussion on the implications for compliance and risk management.
- [What We’ve Learned: Insights into Successful Providers from the First Year of PDPM](https://proactiveltcexperts.com/product/what-weve-learned-insights-into-successful-providers-from-the-first-year-of-pdpm/) - This session of the PDPM Master Class Series will focus on lessons learned and operational best practices derived from the experiences of providers achieving successful outcomes under PDPM in areas such as, but not limited to: census stability and admission practices, interdisciplinary operations, coding accuracy, clinical quality, and financial outcomes.
- [PDPM Insights: Reimbursement Accuracy through Targeted Auditing & Monitoring Systems](https://proactiveltcexperts.com/product/pdpm-insights-reimbursement-accuracy-through-targeted-auditing-monitoring-systems/) - This 1-hour session takes a deep dive into how MDS coding accuracy and supportive documentation play a starring role in Medicare reimbursement. During this session, we will review common coding errors and supportive documentation vulnerabilities while focusing on essential auditing and monitoring considerations to promote accuracy and clean claims. Webinar will take place on August 5th at 2:00PM Eastern.
- [Mastering the Infection Control Focused Survey Process](https://proactiveltcexperts.com/product/mastering-the-infection-control-focused-survey-process/) - RECORDED WEBINAR DOWNLOAD - This session overviews the Focused Infection Control Survey Process including guidelines for conducting FIC surveys, survey procedures, enhanced enforcement actions, and common citations.
- [2-Part ICD-10 Training](https://proactiveltcexperts.com/product/2-part-icd-10-training/) - This recorded webinar covers SNF common coding errors, clinical documentation for coding specificity, IDT coding systems best practices, PDPM coding impact, principal diagnosis I-0020B, reporting additional diagnoses, sequencing, clinical category mapping, and PDPM case examples.
- [PDPM Master Class: 12-Part Webinar Package](https://proactiveltcexperts.com/product/pdpm-master-class-12-part-webinar-package/) - RECORDED WEBINAR DOWNLOAD - This 12-part webinar series focuses on developing mastery of the skills required to successfully lead clinical reimbursement excellence under PDPM.
- [Skilled Medicare Documentation: Supporting Skilled Nursing Services During a Pandemic](https://proactiveltcexperts.com/product/skilled-medicare-documentation-supporting-skilled-nursing-services-amidst-a-pandemic/) - RECORDED WEBINAR DOWNLOAD - This webinar will include brief overview of skilled level of care criteria with deep dive into skilled nursing services and documentation to support the skilled stay. Attendees will receive documentation examples for various case scenarios, including skilled services related to COVID-19 condition
- [To Skill or Not to Skill: Making the Decision on COVID+ and Other Skilled Scenarios - PART 1](https://proactiveltcexperts.com/product/to-skill-or-not-to-skill-making-the-decision-on-covid-and-other-skilled-scenarios/) - RECORDED WEBINAR DOWNLOAD - The webinar will include review of skilled level of care criteria with an emphasis on skilled nursing services and documentation to support the skilled stay, including considerations for skilling COVID residents including the role of therapy skilled services during the PHE.
- [COVID-19: Preparing for and Responding to an Outbreak](https://proactiveltcexperts.com/product/covid-19-preparing-for-and-responding-to-an-outbreak/) - This session will focus on critical steps that are necessary to minimize the spread of COVID-19 and manage residents who test positive for COVID-19. Attendees will gain insight for best practices for preparing for and responding to an outbreak based on guidance from CDC and CMS, as well as lessons learned from consulting with nursing facilities experiencing COVID-19 outbreaks.
- [Phase 3 RoP Training Package](https://proactiveltcexperts.com/product/phase-3-rop-training-package/) - These on-demand training sessions from Proactive’s regulatory experts, provide the guidance you need to achieve compliance with the phase 3 Requirements of Participation. Sessions are available for immediate viewing and ongoing access within your organization.
- [Promoting MDS Accuracy During the COVID-19 Pandemic](https://proactiveltcexperts.com/product/promoting-mds-accuracy-during-the-covid-19-pandemic/) - RECORDED WEBINAR DOWNLOAD - This session will focus on MDS items likely impacted by the suspected or confirmed presence of COVID-19 infection. Attendees will gain insight for best practices for accurate coding to support the conditions and services delivered to residents, and apply best practices for supportive documentation based on RAI guidelines.
- [10 Webinars - Whole Series - OHCA Member - 5-Star Insights](https://proactiveltcexperts.com/product/5-star-insights-ohca-member-whole-series/) - This product will register an OHCA member for the whole 5-Star Insights – Achieve 5-Star in 2020 Webinar Series (10 Webinars). *Please note your member ID number is required
- [10 Webinars - Whole Series - OHCA NonMember - 5-Star Insights](https://proactiveltcexperts.com/product/5-star-insights-ohca-nonmember-whole-series/) - This product will register an OHCA NonMember for the whole 5-Star Insights – Achieve 5-Star in 2020 Webinar Series (10 Webinars).
- [February 21 - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/february-21-ohca-member-mds-pdpm-proficiency-series/) - This product will register an OHCA member for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. *Please note your member ID number is required. Date: February 21, 2020 Course: Nursing, Nutritional, & NTA Services (Sections J, K, M, O) – including dietary
- [Section GG Webinar](https://proactiveltcexperts.com/product/f-tag-review-series-section-gg-webinar/) - This Section GG webinar provides insight into changes which correlate with new QMs and how section GG is used in the PDPM.
- [Falls & Restraint Reduction: Analyzing 5-Star Falls with Major Injury & Physical Restraint Quality Measures – Applying QAPI Principles to Reduce Falls, Physical Restraint Use, and Improve Fall with Major Injury Quality Measures](https://proactiveltcexperts.com/product/f-tag-review-series-falls-restraint-reduction-analyzing-5-star-falls-with-major-injury-physical-restraint-quality-measures-applying-qapi-principles-to-reduce-falls-physical-restraint/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [February 14 - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/february-14-ohca-member-mds-pdpm-proficiency-series/) - This product will register an OHCA member for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. *Please note your member ID number is required. Date: February 14, 2020 Course: Rehabilitative & Restorative Services (Sections H, O) – including therapy, restorative
- [February 14 - OHCA NonMember - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/february-14-ohca-nonmember-mds-pdpm-proficiency-series/) - This product will register an OHCA NonMember for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. Date: February 14, 2020 Course: Rehabilitative & Restorative Services (Sections H, O) – including therapy, restorative
- [February 7 - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/february-7-ohca-member-mds-pdpm-proficiency-series/) - This product will register an OHCA member for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. *Please note your member ID number is required. Date: February 7, 2020 Course: Assessing Self-Care & Mobility (Sections G, GG) – including therapy
- [February 7 - OHCA NonMember - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/february-7-ohca-nonmember-mds-pdpm-proficiency-series/) - This product will register an OHCA NonMember for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. Date: February 7, 2020 Course: Assessing Self-Care & Mobility (Sections G, GG) – including therapy
- [January 31 - OHCA NonMember - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/january-31-ohca-nonmember-mds-pdpm-proficiency-series/) - This product will register an OHCA NonMember for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. Date: January 31, 2020 Course: Assessing Cognition, Mood & Behaviors (Sections B, C, D, E) – including social services
- [January 31 - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/january-31-ohca-member-mds-pdpm-proficiency-series/) - This product will register an OHCA member for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. *Please note your member ID number is required. Date: January 31, 2020 Course: Assessing Cognition, Mood & Behaviors (Sections B, C, D, E) – including social services
- [January 24 - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/january-24-ohca-member-mds-pdpm-proficiency-series/) - This product will register an OHCA member for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. *Please note your member ID number is required. Date: January 24, 2020 Course: Clinical Category and Comorbid Conditions (Sections I, J)
- [January 24 - OHCA NonMember - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/january-24-ohca-nonmember-mds-pdpm-proficiency-series/) - This product will register an OHCA NonMember for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. Date: January 24, 2020 Course: Clinical Category and Comorbid Conditions (Sections I, J)
- [January 17 - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/january-17-ohca-member-mds-pdpm-proficiency-series/) - This product will register an OHCA member for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. *Please note your member ID number is required. Date: January 17, 2020 Course: PDPM Essentials & Roles of the Interdisciplinary Team in Assessment & Coding for Reimbursement Accuracy
- [6 Webinars - Whole Series - OHCA Member - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/mds-pdpm-proficiency-series-ohca-member-whole-series/) - This product will register an OHCA member for the whole MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series (6 Webinars). *Please note your member ID number is required.
- [January 17 - OHCA NonMember - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/january-17-ohca-nonmember-mds-pdpm-proficiency-series/) - This product will register an OHCA NonMember for the following MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series Webinar. Date: January 17, 2020 Course: PDPM Essentials & Roles of the Interdisciplinary Team in Assessment & Coding for Reimbursement Accuracy
- [6 Webinars - Whole Series - OHCA NonMember - MDS PDPM Proficiency Series](https://proactiveltcexperts.com/product/mds-pdpm-proficiency-series-ohca-nonmember-whole-series/) - This product will register an OHCA NonMember for the whole MDS PDPM Assessment, Coding & Systems Orientation & Proficiency Series (6 Webinars).
- [12 Webinars - Whole Series - OHCA Member - PDPM Master Class](https://proactiveltcexperts.com/product/pdpm-master-class-ohca-member-whole-series/) - This product will register an OHCA member for the whole PDPM Master Class series (12 Webinars). *Please note your member ID number is required. Save $120 and receive the recording of each session free when you purchase the entire series!
- [12 Webinars - Whole Series - OHCA NonMember - PDPM Master Class](https://proactiveltcexperts.com/product/pdpm-master-class-ohca-nonmember-whole-series/) - This product will register an OHCA NonMember for the whole PDPM Master Class series (12 Webinars). Save $120 and receive the recording of each session free when you purchase the entire series!
- [Webinar: Phase 3 Requirements of Participation Nitty Gritty: What Needs to be Done by Nov.28](https://proactiveltcexperts.com/product/phase-3-nitty-gritty-webinar/) - This 60 minute on-demand webinar session will provide clarification on what facilities must do to prepare this year and what can wait.
- [Webinar: PDPM Skilled Nursing Supportive Documentation for Skilled Level of Care](https://proactiveltcexperts.com/product/webinar-pdpm-skilled-nursing-supportive-documentation-for-skilled-level-of-care/) - RECORDED WEBINAR DOWNLOAD – This 1.25 hour webinar will focus on skilled nursing documentation requirements and best practices as it relates to PDPM.
- [Webinar: PDPM Ready! Supporting Section K for Rehab and Dietary](https://proactiveltcexperts.com/product/webinar-pdpm-ready-supporting-section-k-for-rehab-and-dietary/) - RECORDED WEBINAR DOWNLOAD – This 1-hour webinar recording includes a deep dive into MDS Section K and reviews appropriate procedures for identifying swallowing disorders, the need for a modified diet and supportive documentation to validate MDS coding.
- [Webinar: PDPM Essentials For Physicians & Pharmacy](https://proactiveltcexperts.com/product/webinar-pdpm-essentials-for-physicians-pharmacy/) - This one hour on-demand webinar will review essential information that Providers and Consulting Pharmacists need to know for successful support of skilled nursing facilities under the Patient Driven Payment Model (PDPM).
- [Webinar: 5-Star Ready! 2019 5-Star Quality Rating System Changes](https://proactiveltcexperts.com/product/5-star-ready-2019-5-star-quality-rating-system-changes/) - RECORDED WEBINAR DOWNLOAD - This 1.25-hour webinar recording focuses on exploring the April 2019 revisions to the three domains of the CMS 5 Star Quality Rating System: Health Inspections, Staffing, and Quality Measures.
- [Staffing: Analyzing 5-Star Data and Applying QAPI Principles to Improve Staffing Ratings/Retention](https://proactiveltcexperts.com/product/f-tag-review-series-staffing-analyzing-5-star-data-and-applying-qapi-principles-to-improve-staffing-ratings-retention/) - Driving 5-Star & This on-demand webinar reviews Staffing data and the impact on 5-Star Survey. Strategies for applying QAPI principles to improve 5 Star Survey outcomes are incorporated . - 2017 Webinar Series Recording.
- [SNF QAPI Fundamentals](https://proactiveltcexperts.com/product/driving-5-star-rop-implementation-through-a-qapi-approach-snf-qapi-fundamentals/) - Driving 5-Star &This on demand training reviews SNF QAPI (Quality Assurance Performance Improvement) Program Fundamentals - 2017 Webinar Series Recording.
- [Pressure Ulcers: Analyzing 5-Star Pressure Ulcer Quality Measures and Applying QAPI Principles to Improve Pressure Ulcer Quality Measures](https://proactiveltcexperts.com/product/f-tag-review-series-pressure-ulcers-analyzing-5-star-pressure-ulcer-quality-measures-and-applying-qapi-principles-to-improve-pressure-ulcer-quality-measures/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [Phase 2 RoP: What We Have Learned; Strategies Based on Survey Deficiencies](https://proactiveltcexperts.com/product/phase-2-rop-what-we-have-learned-strategies-based-on-survey-deficiencies/) - This on-demand webinar reviews phase 2 Requirements of Participation (RoP) that went into effect on Nov. 28, 2017 and reviews trends in survey tags cited related to non-compliance since that time. Strategies to maintain compliance will be discussed based on lessons learned.
- [Pain: Analyzing 5-Star Pain Quality Measures and Applying QAPI Principles to Improve Pain Quality Measure](https://proactiveltcexperts.com/product/f-tag-review-series-pain-analyzing-5-star-pain-quality-measures-and-applying-qapi-principles-to-improve-pain-quality-measure/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [Increase in ADL Help, Ability to Move Independently Worsened, & Improvement in Function: Analyzing 5-Star Functional Mobility Quality Measures and Applying QAPI Principles to Improve Functional Mobility Quality Measures](https://proactiveltcexperts.com/product/f-tag-review-series-increase-in-adl-help-ability-to-move-independently-worsened-improvement-in-function-analyzing-5-star-functional-mobility-quality-measures-and-applying-qapi-principles-to-impr/) - Driving 5-Star & This on-demand webinar reviews Increase in ADL Help, Ability to Move Independently Worsened, & Improvement in Function: Analyzing 5-Star Functional Mobility Quality Measures and Applying QAPI Principles to Improve Functional Mobility Quality Measures- 2017 Webinar Series Recording.
- [Health Inspections: Analyzing 5-Star Data and Applying QAPI Principles to Improve 5-Star Survey Results](https://proactiveltcexperts.com/product/f-tag-review-series-health-inspections-analyzing-5-star-data-and-applying-qapi-principles-to-improve-5-star-survey-results/) - Driving 5-Star & This on-demand webinar reviews the Health Inspection process, the impact on 5-Star Survey and applying QAPI principles to improve 5 Star Survey outcomes. - 2017 Webinar Series Recording.
- [Discharge to Community, Hospital Readmissions, and Emergency Room Visits: Analyzing 5-Star Quality Measures & Applying QAPI Principles to Improve Quality Measure Performance & Ensure Compliance with RoP Discharge Planning Requirements](https://proactiveltcexperts.com/product/f-tag-review-series-discharge-to-community-hospital-readmissions-and-emergency-room-visits-analyzing-5-star-quality-measures-applying-qapi-principles-to-improve-quality-measure-performance-ens/) - Driving 5-Star & This on-demand webinar reviews Discharge to Community, Hospital Readmissions, and Emergency Room Visits: Analyzing 5-Star Quality Measures & Applying QAPI Principles to Improve Quality Measure Performance & Ensure Compliance with RoP Discharge Planning Requirements- 2017 Webinar Series Recording.
- [Antipsychotics: Analyzing 5-Star Antipsychotic Quality Measures and Applying QAPI Principles to Improve Antipsychotic Quality Measures](https://proactiveltcexperts.com/product/f-tag-review-series-antipsychotics-analyzing-5-star-antipsychotic-quality-measures-and-applying-qapi-principles-to-improve-antipsychotic-quality-measures/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [Analyzing 5-star UTI and Catheter QMS and Applying QAPI Principles](https://proactiveltcexperts.com/product/f-tag-review-series-rop-infection-control-program-updates-and-urinary-tract-infections-catheter-use-analyzing-5-star-uti-and-catheter-quality-measures-and-applying-qapi-principles-to-impro/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [Admissions Process: Systems for Successful PDPM Transition](https://proactiveltcexperts.com/product/admissions-process-systems-for-successful-pdpm-transition/) - RECORDED WEBINAR DOWNLOAD - In this 1.5 CEU recorded webinar download, we discuss the systems and processes needed to obtain critical information to be successful at the start of a skilled stay under PDPM.
- [Abuse Prevention & Reporting](https://proactiveltcexperts.com/product/f-tag-review-series-abuse-prevention-reporting/) - Driving 5-Star & RoP Implementation Through a QAPI Approach - 2017 Webinar Series Recording.
- [Webinar: PDPM Transitional IPA: Getting it Right!](https://proactiveltcexperts.com/product/webinar-pdpm-transitional-ipa-getting-it-right/) - RECORDED WEBINAR DOWNLOAD – This webinar will focus on what you need to know for accurate completion of the mandatory transitional interim payment assessment (IPA) for current Medicare Part A beneficiaries continuing a SNF stay into October, including assessment data collection requirements and considerations for ARD scheduling.
- [Competency Sample Policy](https://proactiveltcexperts.com/product/competency-sample-policy/) - This editable Sample Policy is intended to serve as a guide to updating existing staff development/training policies and procedures to include competency based training principles.
- [Behavioral Management Resources](https://proactiveltcexperts.com/product/behavioral-management-resources/) - This resource kit is intended to supplement your current Behavior Management Program and provide additional tools to assist with assessing/monitoring behavioral health and developing individualized, person-centered care plan goals.

## Events

- [Optimizing IDT Systems & Collaboration](https://proactiveltcexperts.com/event/optimizing-idt-systems-collaboration/)
- [Savvy Social Services](https://proactiveltcexperts.com/event/savvy-social-services/)
- [Restorative Nursing Excellence: Revitalizing Programs and Restoring Function](https://proactiveltcexperts.com/event/restorative-nursing-excellence-revitalizing-programs-and-restoring-function/)
- [Medicare Bootcamp Virtual Workshop](https://proactiveltcexperts.com/event/medicare-bootcamp-virtual-workshop/)
- [Client-Only Webinar - 2027 Risk Outlook: Regulatory, Reimbursement & Quality Forecast](https://proactiveltcexperts.com/event/client-only-webinar-2027-risk-outlook-regulatory-reimbursement-quality-forecast/)
- [Client-Only Webinar - Budgeting for Compliance: Aligning Consulting, Staffing & Risk Mitigation](https://proactiveltcexperts.com/event/client-only-webinar-budgeting-for-compliance-aligning-consulting-staffing-risk-mitigation/)
- [Client-Only Webinar - 5-Star 2027 Starts Now: Year-End Moves That Drive Next Year’s Performance](https://proactiveltcexperts.com/event/client-only-webinar-5-star-2027-starts-now-year-end-moves-that-drive-next-years-performance/)
- [Client-Only Webinar - MDS Updates](https://proactiveltcexperts.com/event/client-only-webinar-mds-updates/)
- [Client-Only Webinar - Documentation Excellence: Protecting Your Facility in Survey and Legal Review](https://proactiveltcexperts.com/event/client-only-webinar-documentation-excellence-protecting-your-facility-in-survey-and-legal-review/)
- [Client-Only Webinar - Medical Review Preparedness](https://proactiveltcexperts.com/event/client-only-webinar-medical-review-preparedness/)
- [Client-Only Webinar - OIG + RAI Enforcement Risk](https://proactiveltcexperts.com/event/client-only-webinar-oig-rai-enforcement-risk/)
- [RAC-CT Certification Workshop](https://proactiveltcexperts.com/event/rac-ct-certification-workshop/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [MDS Orientation Training](https://proactiveltcexperts.com/event/mds-orientation-training-3/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [MDS Orientation Training](https://proactiveltcexperts.com/event/mds-orientation-training-2/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [ICD-10-CM for Beginners](https://proactiveltcexperts.com/event/icd-10-cm-for-beginners/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Infection Preventionist Virtual Workshop for Skilled Nursing Facilities](https://proactiveltcexperts.com/event/infection-preventionist-virtual-workshop-for-skilled-nursing-facilities/)
- [ICD-10 CM Coding Refresher for Skilled Nursing Facilities](https://proactiveltcexperts.com/event/icd-10-cm-coding-refresher-for-skilled-nursing-facilities/)
- [Payroll-Based Journal (PBJ) Mastery for Skilled Nursing Facilities](https://proactiveltcexperts.com/event/payroll-based-journal-pbj-mastery-for-skilled-nursing-facilities/)
- [Welcome to the World of Dietary](https://proactiveltcexperts.com/event/welcome-to-the-world-of-dietary/)
- [QAPI Tactics for Sustaining Positive Outcomes](https://proactiveltcexperts.com/event/qapi-tactics-for-sustaining-positive-outcomes/)
- [Care Planning Strategies for Achieving Success](https://proactiveltcexperts.com/event/care-planning-strategies-for-achieving-success/)
- [Engaging the IDT Troops in Fall Management](https://proactiveltcexperts.com/event/engaging-the-idt-troops-in-fall-management/)
- [Addressing Fall Root Causes with Targeted Interventions](https://proactiveltcexperts.com/event/addressing-fall-root-causes-with-targeted-interventions/)
- [Getting to the “Root” of the Fall with Root Cause Analysis](https://proactiveltcexperts.com/event/getting-to-the-root-of-the-fall-with-root-cause-analysis/)
- [Considering all the Evidence: Assessing Fall Risk Critically](https://proactiveltcexperts.com/event/considering-all-the-evidence-assessing-fall-risk-critically/)
- [Diving In to QRP](https://proactiveltcexperts.com/event/diving-in-to-qrp/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Smooth Sailing with VBP](https://proactiveltcexperts.com/event/smooth-sailing-with-vbp/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Survey Trends & Lessons Learned](https://proactiveltcexperts.com/event/survey-trends-lessons-learned/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [LTC Leadership: Coaching, Mentoring & Accountability](https://proactiveltcexperts.com/event/ltc-leadership-coaching-mentoring-accountability/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Behavioral Health & Trauma Informed Care](https://proactiveltcexperts.com/event/behavioral-health-trauma-informed-care/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [QM Intensive: Using Data to Drive Improvement](https://proactiveltcexperts.com/event/qm-intensive-using-data-to-drive-improvement/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Medication Management & Adverse Drug Event Prevention](https://proactiveltcexperts.com/event/medication-management-adverse-drug-event-prevention/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Emergency Preparedness & Facility Wide Safety Drills](https://proactiveltcexperts.com/event/emergency-preparedness-facility-wide-safety-drills/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Person Centered Care: Enhancing Resident Quality of Life](https://proactiveltcexperts.com/event/person-centered-care-enhancing-resident-quality-of-life/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [ICD.10 Coding and Sequencing Under PDPM](https://proactiveltcexperts.com/event/icd-10-coding-and-sequencing-under-pdpm/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Meetings, Reports & QAPI: Leveraging the IDT Process for MDS, PDPM, and Quality Success](https://proactiveltcexperts.com/event/meetings-reports-qapi-leveraging-the-idt-process-for-mds-pdpm-and-quality-success/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Ongoing Survey and Audit Preparedness](https://proactiveltcexperts.com/event/ongoing-survey-and-audit-preparedness/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Expert Quality Measure Management](https://proactiveltcexperts.com/event/expert-quality-measure-management/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [MDS & Reimbursement Impact](https://proactiveltcexperts.com/event/mds-reimbursement-impact/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Clarifying CAAs and Care Planning](https://proactiveltcexperts.com/event/clarifying-caas-and-care-planning/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Documentation Excellence for the DON](https://proactiveltcexperts.com/event/documentation-excellence-for-the-don/)
- [Avoiding the Top Clinical Deficiencies in Nursing](https://proactiveltcexperts.com/event/avoiding-the-top-clinical-deficiencies-in-nursing/)
- [Effective Rounding for the Interdisciplinary Team](https://proactiveltcexperts.com/event/effective-rounding-for-the-interdisciplinary-team/)
- [Understanding the MDS](https://proactiveltcexperts.com/event/understanding-the-mds/)
- [QAPI in Action: Building a Sustainable Quality Culture in Skilled Nursing Facilities](https://proactiveltcexperts.com/event/qapi-in-action-building-a-sustainable-quality-culture-in-skilled-nursing-facilities/)
- [Personnel Management: Disciplinary Processes, Termination, Managing Conflict & Retention](https://proactiveltcexperts.com/event/personnel-management-disciplinary-processes-termination-managing-conflict-retention/)
- [Leadership Lessons: Coaching, Accountability, and Building Strong Teams](https://proactiveltcexperts.com/event/leadership-lessons-coaching-accountability-and-building-strong-teams/)
- [Mastering Assessment and Reporting of Self-Care and Mobility/Coding in Section O & GG](https://proactiveltcexperts.com/event/mastering-assessment-and-reporting-of-self-care-and-mobility-coding-in-section-o-gg/) - Webinar time is based on the association through which you register. Click on the events website link above for more details.
- [Infection Prevention Leadership Oversight Strategies for Compliance and Performance](https://proactiveltcexperts.com/event/infection-prevention-leadership-oversight-strategies-for-compliance-and-performance/)

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- [2023 Deep Dive into Federal Regulations](https://proactiveltcexperts.com/product-category/2023-deep-dive-into-federal-regulations/)
- [2023 Administrator If...](https://proactiveltcexperts.com/product-category/2023-administrator-if/)
- [2025 5-Star Work Plans A to Z](https://proactiveltcexperts.com/product-category/2025-5-star-work-plans-a-to-z/)
- [2022 Compliance Webinar Series](https://proactiveltcexperts.com/product-category/2022-compliance-webinar-series/)
- [2023 Mission Possible Series](https://proactiveltcexperts.com/product-category/2023-mission-possible-series/)
- [2023 Infection Preventionist Webinar Series](https://proactiveltcexperts.com/product-category/2023-infection-preventionist-webinar-series/)
- [2023 Restorative Nursing Series](https://proactiveltcexperts.com/product-category/2023-restorative-nursing-series/)
- [2024 Webinar Series](https://proactiveltcexperts.com/product-category/2024-webinar-series/)
- [2024 Deconstructing IJ & High-Risk Tags](https://proactiveltcexperts.com/product-category/2024-deconstructing-ij-high-risk-tags/)
- [2024 Impact of the MDS](https://proactiveltcexperts.com/product-category/2024-impact-of-the-mds/)
- [2023 Activities Webinar Series](https://proactiveltcexperts.com/product-category/2023-activities-webinar-series/)
- [2024 Survey Prep & Understanding Post-Survey Elements](https://proactiveltcexperts.com/product-category/2024-survey-prep-understanding-post-survey-elements/)
- [2024 Documentation in Depth](https://proactiveltcexperts.com/product-category/2024-documentation-in-depth/)
- [2024 Abuse & Neglect Program Checkup Series](https://proactiveltcexperts.com/product-category/2024-abuse-neglect-program-checkup-series/)
- [2024 Developing & Implementing a QAPI Program Series](https://proactiveltcexperts.com/product-category/2024-developing-implementing-a-qapi-program-series/)
- [2024 Behavioral Health Series](https://proactiveltcexperts.com/product-category/2024-behavioral-health-series/)
- [2024 Wound Management Series](https://proactiveltcexperts.com/product-category/2024-wound-management-series/)
- [2025 Webinar Series](https://proactiveltcexperts.com/product-category/2025-webinar-series/)
- [2025 Survey Smart Webinar Series](https://proactiveltcexperts.com/product-category/2025-survey-smart-webinar-series/)
- [2025 Reducing Litigation Risk for SNF & AL Webinar Series](https://proactiveltcexperts.com/product-category/2025-reducing-litigation-risk-for-snf-al-webinar-series/)
- [2025 Dietary Workshop](https://proactiveltcexperts.com/product-category/2025-dietary-workshop/)
- [Free Resources](https://proactiveltcexperts.com/product-category/free-resources/)
- [2025 Secrets of a Great Department Head Webinar Series](https://proactiveltcexperts.com/product-category/2025-secrets-of-a-great-department-head-webinar-series/)
- [2025 Driving QMs Through Clinical Excellence](https://proactiveltcexperts.com/product-category/2025-driving-qms-through-clinical-excellence/)
- [IDR/IIDR](https://proactiveltcexperts.com/product-category/idr-iidr/)
- [2025 Capturing Accurate Reimbursement](https://proactiveltcexperts.com/product-category/2025-capturing-accurate-reimbursement/)
- [2025 Strategies for Workforce Retention Webinar Series](https://proactiveltcexperts.com/product-category/2025-strategies-for-workforce-retention-webinar-series/)
- [Social Services](https://proactiveltcexperts.com/product-category/social-services/)
- [2026 Webinar Series](https://proactiveltcexperts.com/product-category/2026-webinar-series/)

## Product tags

- [Facility Assessment Template](https://proactiveltcexperts.com/product-tag/facility-assessment-template/)
- [Requirements of Participation](https://proactiveltcexperts.com/product-tag/requirements-of-participation/)
- [RoP](https://proactiveltcexperts.com/product-tag/rop/)
- [SNF](https://proactiveltcexperts.com/product-tag/snf/)
- [5 Star](https://proactiveltcexperts.com/product-tag/5-star/)
- [Survey](https://proactiveltcexperts.com/product-tag/survey/)
- [Culture](https://proactiveltcexperts.com/product-tag/culture/)
- [Cultural](https://proactiveltcexperts.com/product-tag/cultural/)
- [Individualized](https://proactiveltcexperts.com/product-tag/individualized/)
- [Person Centered Care](https://proactiveltcexperts.com/product-tag/person-centered-care/)
- [Care Plan](https://proactiveltcexperts.com/product-tag/care-plan/)
- [Training](https://proactiveltcexperts.com/product-tag/training/)
- [Competency](https://proactiveltcexperts.com/product-tag/competency/)
- [Nursing](https://proactiveltcexperts.com/product-tag/nursing/)
- [CMI](https://proactiveltcexperts.com/product-tag/cmi/)
- [Functional Maintenance Program](https://proactiveltcexperts.com/product-tag/functional-maintenance-program/)
- [Restorative Program](https://proactiveltcexperts.com/product-tag/restorative-program/)
- [Infection Control](https://proactiveltcexperts.com/product-tag/infection-control/)
- [QAPI](https://proactiveltcexperts.com/product-tag/qapi/)
- [Dementia Care](https://proactiveltcexperts.com/product-tag/dementia-care/)
- [Behavior Management](https://proactiveltcexperts.com/product-tag/behavior-management/)
- [Webinar](https://proactiveltcexperts.com/product-tag/webinar/)
- [Discharge Planning](https://proactiveltcexperts.com/product-tag/discharge-planning/)
- [Facility Assessment](https://proactiveltcexperts.com/product-tag/facility-assessment/)
- [Reimbursement](https://proactiveltcexperts.com/product-tag/reimbursement/)
- [MDS](https://proactiveltcexperts.com/product-tag/mds/)
- [PDPM](https://proactiveltcexperts.com/product-tag/pdpm/)
- [Therapy](https://proactiveltcexperts.com/product-tag/therapy/)
- [Abuse](https://proactiveltcexperts.com/product-tag/abuse/)
- [Safety](https://proactiveltcexperts.com/product-tag/safety/)
- [Compliance](https://proactiveltcexperts.com/product-tag/compliance/)
- [Quality Measures](https://proactiveltcexperts.com/product-tag/quality-measures/)
- [ADL](https://proactiveltcexperts.com/product-tag/adl/)
- [Mobility](https://proactiveltcexperts.com/product-tag/mobility/)
- [QRP](https://proactiveltcexperts.com/product-tag/qrp/)
- [Rehospitalization Reduction](https://proactiveltcexperts.com/product-tag/rehospitalization-reduction/)
- [Readmission](https://proactiveltcexperts.com/product-tag/readmission/)
- [VBP](https://proactiveltcexperts.com/product-tag/vbp/)
- [Antispsychotics](https://proactiveltcexperts.com/product-tag/antispsychotics/)
- [behavioral health](https://proactiveltcexperts.com/product-tag/behavioral-health/)
- [Medication Management](https://proactiveltcexperts.com/product-tag/medication-management/)
- [Falls](https://proactiveltcexperts.com/product-tag/falls/)
- [Pressure Ulcers](https://proactiveltcexperts.com/product-tag/pressure-ulcers/)
- [Pain](https://proactiveltcexperts.com/product-tag/pain/)
- [Abuse Prevention](https://proactiveltcexperts.com/product-tag/abuse-prevention/)
- [Policies](https://proactiveltcexperts.com/product-tag/policies/)
- [Trauma Informed Care](https://proactiveltcexperts.com/product-tag/trauma-informed-care/)
- [Culturally Competent Care](https://proactiveltcexperts.com/product-tag/culturally-competent-care/)
- [F-Tag Series](https://proactiveltcexperts.com/product-tag/f-tag-series/)
- [Care Plans](https://proactiveltcexperts.com/product-tag/care-plans/)
- [Webinars](https://proactiveltcexperts.com/product-tag/webinars/)
- [Medical Review](https://proactiveltcexperts.com/product-tag/medical-review/)
- [PEPPER](https://proactiveltcexperts.com/product-tag/pepper/)
- [Dietary](https://proactiveltcexperts.com/product-tag/dietary/)
- [Toolkit](https://proactiveltcexperts.com/product-tag/toolkit/)
- [Resources](https://proactiveltcexperts.com/product-tag/resources/)
- [Resource](https://proactiveltcexperts.com/product-tag/resource/)
- [Comptency](https://proactiveltcexperts.com/product-tag/comptency/)
- [Quality](https://proactiveltcexperts.com/product-tag/quality/)

## Event Categories

- [Virtual Presentation](https://proactiveltcexperts.com/events/category/virtual-presentation/)
- [2026 Team MDS Webinar Series](https://proactiveltcexperts.com/events/category/2026-team-mds-webinar-series/)
- [2026 DON Playbook Webinar Series](https://proactiveltcexperts.com/events/category/2026-don-playbook-webinar-series/)
- [2026 Survey & Clinical Risk Management Webinar Series](https://proactiveltcexperts.com/events/category/2026-survey-clinical-risk-management-webinar-series/)
- [2026 QM Deep Dive Webinar Series](https://proactiveltcexperts.com/events/category/2026-qm-deep-dive-webinar-series/)
- [2026 Fall Prevention Program Reboot Webinar Series](https://proactiveltcexperts.com/events/category/2026-fall-prevention-program-reboot-webinar-series/)
- [Progress with Proactive Client-Only Webinar](https://proactiveltcexperts.com/events/category/progress-with-proactive-client-only-webinar/)