Kelly Simonelli, Author at LW Consulting, Inc.

Navigating the Latest CMS Surveyor Guidance Updates: Mental Health Disorders

UncategorizedBy Kelly Simonelli May 1, 2025

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…

Ensuring Your Moderate Level of Service Meets the Coding Criteria

UncategorizedBy Kelly Simonelli April 23, 2025

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…

Understanding Minimum Data Set (MDS) Validation

UncategorizedBy Kelly Simonelli April 15, 2025

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,…