Kelly Simonelli

What Can You Do if You Are Targeted as a Special Focused Facility?

It is challenging being a Skilled Nursing Facility (SNF) in 2024! Not that it has ever been easy, but there are so many regulations, and the increased challenges of staffing and infection control since COVID and the PHE have really raised the bar. The Centers for Medicare & Medicaid Services (CMS) monitors quality issues and has devised a terminology for those facilities deemed high risk with a history of serious quality issues. These facilities are…

The Schizophrenia Diagnosis in a Skilled Nursing Facility

There is so much going on in the Long Term Care (LTC) market in 2024 related to Centers for Medicare and Medicaid (CMS) initiatives it is easy to overlook one or think that it is complete.  This might be the case with the CMS roll out of audits to monitor accurate coding and documentation of the diagnosis of schizophrenia. CMS initiated these audits, announced on January 18, 2023, in QSO-23-05-NH, in an attempt to identify…

Does Your Documentation Support a MAC Request?

The Centers for Medicare and Medicaid (CMS) has rolled out many initiatives since the Public Health Emergency ended in May of 2023.  One initiative in specific is the Skilled Nursing Facility (SNF) 5-Claim Probe and Educate Review. If you still have not seen or heard about it, and you operate a SNF, you will! The Transmittal 12037 outlines the specific probe audit.  The purpose of the audit is to lower the SNF improper payment rate.…