Strengthening Your First Line of Defense: Leadership Strategies for Claims Review in Today’s Audit Environment
Insights from Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education, Pathway Health In today’s regulatory environment, nursing home leaders cannot afford to take a passive approach to claims review. CMS has intensified external audit activity—from Targeted Probe and Educate (TPE) reviews to RAC audits—and organizations are seeing significant...
Fall in L.O.V.E. with Compliance: A Valentine’s-Themed Reminder for Care Leaders
February brings Valentine’s Day, a season focused on care, commitment, and connection, values that also sit at the heart of regulatory compliance in post-acute and long-term care. While compliance isn’t always viewed as exciting, it plays a vital role in protecting residents, supporting staff, and strengthening organizational stability. This month, we’re reframing compliance through the...
Hot Topic: Responding to the Latest CMS Special Focus Facility (SFF) Program Update – Falls
Insights from Nancy Foss, RN, BSN, Director of Regulatory and Consulting Services – Pathway Health Recent breaking news from CMS (QSO) signals an important shift in survey and quality priorities: falls—particularly falls with major injury—are moving to the forefront of regulatory scrutiny, with direct implications for survey outcomes, enforcement actions, and Special Focus Facility (SFF) oversight....
Insights & Resources for Infection Prevention Control
As a foundational element of safe, high-quality, and compliant care, Infection Prevention Control (IPC) should be considered at every stage of the healthcare continuum, especially in long-term care. At its core, IPC ensures resident safety, staff protection, and operational resilience in an era where evolving pathogens, emerging public health threats, and shifting regulatory expectations continue...
Infection Control in Nursing Homes: Why F880 Remains the Top Citation — and How Leaders Can Build a Stronger Program
Insights from Nancy Foss, Director of Regulatory and Consulting Services The Leadership ImperativeFor today’s long-term care leaders, infection control is more than a regulatory checkbox — it’s a cornerstone of resident safety, operational stability, and survey success. Yet, CMS F880 – Infection Prevention & Control remains one of the most frequently cited deficiencies nationwide. Even...
CMS SNF Validation Audits Are Here: What Leaders Need to Know and How to Prepare
Insights from: Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education The Audit Era Is Here — and It’s Personal for SNF LeadersIf you’ve been in long-term care for any length of time, you’ve seen CMS evolve from trusting our data to verifying every keystroke. That evolution became official in September 2025, when...
Leading Proactively: Responding to the Latest OIG Findings on the CMS Special Focus Facility (SFF) Program
Insights from Nancy Foss, RN, BSN, Director of Regulatory and Consulting Services – Pathway Health The Office of Inspector General’s (OIG) October 2025 Data Snapshot confirms what many leaders in long-term care already know — the Special Focus Facility (SFF) Program, designed to rehabilitate persistently underperforming nursing homes, is struggling to achieve sustained improvement. According...
Staying Survey-Ready: Regulatory Preparation & Response in Assisted Living Facilities
For assisted living facilities, regulatory compliance is crucial in ensuring that residents receive safe, high-quality care every day. Surveys can happen at any time, and preparation makes the difference between a stressful scramble and a confident, well-organized response. At Pathway Health, our senior living consultants provide on-site and off-site consultation services tailored to specific clinical...
Considerations & Resources for Respiratory Illness Season
Infection prevention and control (IPC) remains a top priority in long-term care (LTC) facilities. With aging populations, high-risk residents, and communal living environments, organizations must remain vigilant to protect residents and staff from seasonal respiratory illnesses, emerging pathogens, and healthcare-associated infections. Beyond compliance, today’s leaders must embrace IPC as a cornerstone of organizational wellness and...
Driving Excellence in Skilled Nursing: Strengthening MDS Accuracy for Compliance, Quality, and Resident Outcomes
Insights from: Scott Heichel, RN, RAC-MT, RAC-CTA, DNS-CT, IPCO, QCP, ICC – Director of Reimbursement and Education Why MDS Accuracy Matters More Than EverToday’s skilled nursing environment is under unprecedented scrutiny. A recent OIG report found that 43% of resident falls with major injury and hospitalization were not reported in Minimum Data Set (MDS) assessments. These...
