March 15, 2017


Wearing your favorite green clothes or accessories for this particular holiday is common, sharing a pint of green beer is considered festive, but actually ‘turning’ green can be a whole different game changer.

There are several instances when your skin and even your blood can become green. For instance, many people have worn jewelry that have caused their skin to become green. It is due to the copper in the metal. When people sweat, it reacts with the copper resulting in the corrosion of copper, hence salt compounds are created. The salt of copper is green.

Another example of greenish skin is due to anemia. An iron deficiency can cause the green tint. On the other side, if you take an iron supplement, your stools can turn green due to a significant effect on the digestive system. Same goes if you eat large quantities of leafy green vegetables or high doses of certain antibiotics, or lots of licorice jelly beans (but you didn’t hear that from me).

It has also been noted that blood has turned green after taking higher than prescribed doses of sumatriptan.

The most dangerous notations of green skin is organ failure, which requires due diligence when recognizing any discoloration of your skin.


So enjoy your corned beef and cabbage or your green beer but never dismiss this symptom if it presents without obvious explanation.



February 21, 2017

You Can’t Beat a Healthy Heart


 February is not just about red hearts and candy, it is also Heart Awareness month. So just how aware are you about your ticker?

Did you know that the typical adult heart will beat 31 million times in a single year?

Did you know that a heart attack in a woman is less obvious than a man’s heart attack? A woman is more likely to have nausea, indigestion, and shoulder aches rather than the hallmark chest pain.

Did you know that laughter really is the best medicine? A good belly laugh can send 20% more blood flowing through your entire body.

Did you know that Monday mornings are the prime time for a heart attack? The level of a stress hormone called cortisol peaks early in the day. When this happens, cholesterol plaque that has built up in the arteries can rupture and block the flow of blood to the heart. And with the rise in blood pressure and increased heart rate from the stress of returning to work after the weekend, it becomes the perfect recipe for a Monday morning heart attack.

Did you know that the first pacemakers plugged into a wall outlet?

Did you know that your heart can be older than your actual age? If you are curious, take the heart quiz at:

So what’s the best way to take care of this precious organ? ♥

Eat less salt

Control your weight

Quit smoking

Monitor your cholesterol & blood pressure

Be active


Heart disease is the leading cause of death for men and women in the United States. Every year, 1 in 4 deaths are caused by heart disease.

You may not be able to prevent it from being broken, but you can prevent it from withering out before its due.

February 14, 2017

My broken(S26.022) heart led me to the love of my life

It wasn’t unusual for me to feel tired (R53.82)…I’m a woman. I’m accustomed to juggling 5 plates at one time, but today just felt different. This fatigue (R53.83) felt heavier. I’ll take a long-overdue nap and bounce right back, I thought, but then the sweating (R61) and nausea (R11.0) started. No nap for me, the chest pain (I20.9) redirected my entire busy day.

I immediately took an aspirin (Z79.82) and dialed 911. In minutes, my house was bombarded with people. While EMS worked on getting my heart beat back (I46.9), I saw the sweetest face looking down on me telling me I was going to be okay. I reached for his hand, I was so scared (F43.0)

The next several hours were a whirlwind. The angiogram revealed blockage (I25.119) and surgery was imminent. Thankfully, my brilliant doctors repaired the damage (I21.02) and I came out of it with a life-saving scar (L90.5 & Z95.1).

In the days that followed, I had friends and family come to visit and beautiful flowers and cards filled my room. As I sat eating my heart-healthy oatmeal, a stranger walked in with the sweetest face. I couldn’t place him at first, but he seemed to know me…sorta.

“You look much better than you did the first time we met,” he said with a boyish grin.

I must have looked confused (F41.0).

“I’m one of the fireman who came to your house a few days ago. I just wanted to check and see how you were doing.”

My ‘new’ heart began to pound (I49.9). He was the one who held my hand and insisted everything would be okay.

I invited him to sit. We chatted for an hour. Knowing I needed my rest, he politely said his goodbyes. I drifted off to sleep, thinking of the fireman with the sweet face.

That evening my door opened and there he stood, holding 2 meal trays with a red rose on top of them.

“What is this?” I asked.

“Well, it’s our first Valentines dinner,” he proclaimed.

I had no idea what day it was and was completely caught off guard (R41.0)

He handed me the rose and unveiled a scrumptious delicacy of bland chicken, steamed vegetables and I note that read ‘NO SALT’.

He took the note and drew a heart around the words.

“We’ll have to remember this on our next date…no salt allowed.” (E87.1)

I smiled sheepishly, “So you think there will be a next date, huh?”

And he was right. We spent 32 more Valentines Day’s together, and with each one we’d point to my lovely scar and celebrate the heart attack (I25.2) that brought us together.

December 29, 2016

We’d Like to Avoid PCR, Like the Plague, However…

We’re all hoping, of course, that it will not happen, but it looks like CMS has the intention of spreading the ‘plague’ called Pre-Claim Review (PCR) into other states, including Florida (slated for April 1) and Texas (date to be determined). This plague got its start in Illinois. Illinois providers, through a painful process of trial and error, have mostly survived by changing processes and improving their immunity.

It is time to ‘vaccinate’ against the new plague with training of all staff regarding the PCR process and getting back to the basics of Medicare Home Health eligibility and payment. Now, more than ever, nurses and other clinicians need to perfect their assessment skills and adequately complete the OASIS.  It is imperative that the staff responsible for obtaining face-to-face documentation and recertification statements, etc are up-to-date on the expectations. CMS will be sending letters out to physicians regarding the process, so you will probably need to provide further education as the education provided by CMS will have a cooling effect.

As CMS has explained, the PCR process is voluntary, however it is important to know that if you decide to bypass the PCR process your documentation will still be reviewed, and even if it is adequate, your episode payment will be reduced by 25%.  You cannot appeal this decision, nor may you pass on the cost to the patient!

If you participate in the PCR, you will receive a decision of ‘affirmed,’ ‘partially affirmed,’ or ‘non-affirmed.’ In the beginning, your charts will likely be either partially affirmed or non-affirmed. PalmettoGBA (or other MAC, depending on the agency’s location) will provide a complete list of the missing or inadequate documentation, so that the agency can mitigate the errors.

Download the Pre-Claim Review guide located on the CMS website.

Don’t let your agency be unprepared for Pre-Claim Review.  This process is NOT just for billing people. You will need someone (or more than one someone) on your staff responsible for gathering the documentation and reviewing it for sufficiency, then responding to the MAC reviewer. That person needs to be the one who knows the home health rules and documentation standards the best.

So, maybe we avoid the plague of PCR…there are lesser diseases out there that can damage your agency, like ZPIC audits and Probe and Educate audits. Any improvements that can be made in your processes and documentation can improve your immunity.

Need assistance in the educational aspects or process development? Selman-Holman & Associates, LLC is the expertise you need to work through this plague and build your immunity. Contact us at 214.550.1477 or or

December 27, 2016

What is the most frequently asked question regarding the transition to OASIS-C2? You need this answer today!

The most frequently asked question regarding OASIS-C2 is…when do we start using it? The easy answer—January 1! But it’s not so easy. CMS has verified that the transition will take place according to the M0090 date. Selman-Holman has developed the tool to assist you in this transition. (Click here to access tool).


Just remember, if an assessment is started on the OASIS-C1 format, but it not completed until January 1 or later, the OASIS-C2 items will need to be completed.


Selman-Holman & Associates, LLC, CodePro University and CoDR—Coding Done Right wish you all a Happy, Healthy and Prosperous New Year!