LTC Clarified: Weekly News, Insights & Connections

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 Five-Star rating, validate QRP compliance, and reduce survey risk. The challenge? Knowing which reports to review and how often to run them.

Spring Break is around the corner! Let Proactive's team keep the MDS department running smoothly during staff vacations, leaves of absence and short or long term vacancies. We have the systems and expertise you need to ensure MDS compliance and reimbursement accuracy--and you're only billed for actual service hours provided with no minimums.

Q: Why is nursing documentation one of the biggest risks in medical review?

FEBRUARY: Check out these upcoming webinars!

MARCH: Check out these upcoming March webinars!

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 LUPA, and why does it matter so much?

In the News

CDC Updates Nursing Homes Resources for Sepsis and Respiratory Pathogens

The CDC provided updated resources as part of the Viral Respiratory Pathogens Toolkit for Nursing Homes including an updated Fact Sheet as well as a Sepsis Prevention Assessment Tool.

SNF Part B Therapy Coding Alert – Effective 3/1/26

Effective March 1, 2026, UnitedHealthcare Medicare Advantage will begin enforcing denials based on its interpretation of ICD-10-CM Excludes 1 guidelines across all claim types, including SNF Part B.

For therapists, this directly impacts diagnosis selection on the therapy POC, which flows to the UB04 claim form. A common example is reporting:

• R26.2 – Difficulty Walking
• R26.81 – Unsteadiness on Feet

These codes fall under Excludes 1 and generally should not be reported together on the same claim. When both are selected on the POC and flow to the UB-04, the claim may be at risk for denial.

Select the single most clinically appropriate gait diagnosis that best reflects the skilled need being addressed. Diagnosis selection at evaluation may impact payment; therefore, a triple check process is essential. 

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