New Surveyor Guidance is in effect and indicates that mental health disorders in nursing home facilities need to be diagnosed by a medical practitioner. Evidence-based criteria and professional standards, such as the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), must be used and supported by documentation in the resident’s medical record. Diagnoses such as Schizophrenia and schizoaffective disorder require supporting documentation such as a DSM assessment, like all other mental
LW Consulting, Inc. (LWCI) is a recognized leader in providing compliance, reimbursement, operational, and clinical consulting solutions across the full continuum of healthcare delivery.
We are an Independent Review Organization (IRO), performing audits under Corporate Integrity Agreements (CIA), and an expert resource to providers, attorneys, and government agencies in ensuring organizations meet the myriad of guidelines, requirements, and statutes that regulate the delivery of healthcare services. We also provide interim staffing for post-acute care providers.
Today’s compliance and risk management challenges require innovative solutions.
LWCI has the expertise and experience to achieve them.
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Our team includes compliance professionals, reimbursement experts, RNs, therapists, auditor-coders, and consulting physicians. Many team members possess numerous industry certifications.
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Independent Review Organization (IRO)
We often work with attorneys for providers in negotiating with the MACs, the OIG, federal prosecutors, US Attorneys and State Agencies in evaluating medical necessity, coding and billing procedures, and negotiating the adjudication of potential overpayment, denials, and disputed claims.
LW Consulting, Inc. uniquely blends its comprehensive knowledge of the healthcare industry with a proven ability to work as a partner with healthcare attorneys. We understand the ebb and flow of the legal process. We are flexible, responsive, and complete our work when and where it is needed.
Latest Posts
Does your documentation match your moderate level of service billed? With the changes implemented by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS), it is very important to make sure your documentation matches the level of service you are billing. Many providers are finding themselves billing more moderate level of service visits now than they did previously under the old guidelines. Criteria for Code Selection To achieve a moderate level of service, at
April 15, 2025
Understanding Minimum Data Set (MDS) Validation
The Minimum Data Set (MDS) is a federally mandated assessment used in Medicare or Medicaid-certified nursing homes to evaluate a resident’s functional abilities and healthcare needs. The MDS incorporates standardized elements, coding categories, and vital health indicators. Validating the MDS is an essential step for skilled nursing facilities (SNFs) that is sometimes bypassed. The validation process ensures the accuracy of the data submitted to the Centers for Medicare & Medicaid Services (CMS). The MDS coordinator,
