Severity Adjustors
Z96.641 Presence of right artificial hip joint
Z95.1 CABG
Z89.611: Acquired absence of right leg above knee
What are allowable Z codes?
What is Texas?
Home set up, caregiver assist, social concerns prior to acute stay
What is Clinical Summary tab-ULS?
Outbound Call to Member- need to confirm Name, DOB, Address
What is HIPAA grid?
Case Manager informed you member admitted to the SNF facility
What is Confirm Member Admission
Ambulation 30' x 2 standing rest
What is 60'?
Best slice of cheese cake
What is cheesecake factory?
You completed a review and sent Predict Outcome report by email but have not yet had a discussion about it.
What is engagement tab- document yes shared Predict?
"For Auth 1234567, the information within the Clinical Note was changed/corrected to reflect the actual clinical documentation received from the provider to support the request."
What is Editing Clinical Documentation Work Instruction?
Only time 'Generate Outcome Report'
What is Admission review?
Any non-stageable wounds, per CMS/MDS guidelines
What is Medical Adjustor Pressure Wound IV?
The pet known as the "sweetest boy in the south"
Who is Tucker?
“Member appears to meet CMS Chapter 8 guidelines based on their need for daily skilled nursing services that can only be provided in a SNF, including “BID wound care for unstable Stage 3 Coccyx wound.”
What is example interim review Clinical Impression?
Yellow bar displayed next to uploaded clinicals
What is Validating member documents?
Last step in review to capture Clinical Notes
What is Export?
FCI- Primary dx: MI
PLOF: amb without AD in the home and occasionally uses SPC in the community, Independent with ADL/IADLs.
PMH: HTN, MVA 10 years ago with femur fracture.
What is 3?
This distance gets a couple of us in the room fired up
What is 26.2mi or 13.1mi?
Usually Skilled/Probably Skilled/Unlikely Skilled:
Foley Catheter
Wound Stage 1&2
General Daily Observation
What is Unlikely Skilled?
Comorbidities
Surgical Procedure
Isolation
CLOF-Oral Hygiene, Cognitive function
Dietary requirements
Nursing CMG
What is PDPM
Calculate first auth line, clone subsequent auth lines
What is CMGs?
FCI- Primary Dx: New Dx Parkinson's
PLOF: CGA with RW 75'
Comorbidities: Diabetes w/moderate to severe (decreased LE sensation) LE ulcers, visual impairments (diabetic retinopathy)
What is 4?
What is Mariah's Jeep?
d/t
w/
t/f
What is do not use list - Accepted Abbreviations for Clinicians
Resource for speak to aligning realistic discharge expectations
What is Applying the SNF Predict Outcome report?
Resolving medical needs
What is NOMNC review- prepping note for MD?