Archived Posts

Increasing Reimbursement in Long Term Care
Posted by LTCS on November 14, 2015

Director of Nursing BookThere are many ways the MDS coordinator can increase the reimbursement level of the facility. While quality of care is the top priority, working to get the top level of payment that is justifiably due for services is of the utmost importance. Increased funds produce more resources for care. 

Know the Federal and State Regulations. MDS data and documentation out of compliance due to errors or lateness risk having assessments being paid at the default rate, the lowest rate of payment. 

Be familiar with the documentation requirements of skilled care. Knowing the requirements of skilled care provides opportunities to spot residents falling into higher reimbursement levels upon admission or when the level of needed care changes. Making sure the required documentation is in place assures that the facility will be paid for those services. 

Know the criteria for RUG IV categories. Many elements of the MDS effect the RUG IV categories, and being familiar with them will help spot aspects of care that might otherwise be overlooked. 

Use Grace Days to capture a higher RUG IV score. One of the reasons the Grace Days exist is to enable the facility to capture services for higher reimbursement. Work with the Therapy departments to set the ARD to capture higher Rehabilitation categories. 

Monitor residents for changes that could alter the level of care. Scheduling Significant Change assessments when they are needed not only keeps the Care Plan appropriate for the resident’s needs, but it can also capture higher payment rates do to the increased need for care. Read the 24 Hour reports, attend Stand-up meetings, and examine the Physician’s telephone orders daily to catch changes.  

Schedule assessments to capture higher RUG IV categories. Although Quarterly assessments can be no later than 92 days of the completion date of the last assessment, it is perfectly legitimate to schedule them earlier than the 92 days.

Preventing Pressure Ulcers
Posted by LTCS on June 11, 2013

Skin Care Treatment to Prevent Pressure UlcersIn 2004, about 11% of long term care residents had pressure ulcers, and Stage 2 pressure ulcers were the most common, according to a report from CDC, The Centers for Disease Control.

Other findings from the report include:

Pressure ulcers are more likely to develop in residents under 64 years of age or who have been in the facility for less than one year.

20% of residents with a recent weight loss develop pressure ulcers.

Only 35% of residents with a Stage 2 pressure ulcer or higher receive special wound care services – a surprisingly high rate of practice not in accordance with the clinical practice guidelines.

Section M, Skin Conditions

Do Your Staff Members Know Resident Rights?
Posted by LTCS on June 7, 2013

Two Nurses and Post Fall Assessment and Investigation Restorative Nursing Care PlansResidents, family members, significant others, state ombudsmen, and state surveyors are all familiar with resident rights. Make sure your staff members are as much aware of them and honor them in their daily practices. 

Sometimes staff members can become too task oriented when the work load increases or when there are staffing problems. They can begin to focus more on just getting basic care accomplished and lose sight of essential resident rights. 

Keep staff members aware of resident rights by giving frequent inservices, referring to resident rights during staff meetings, and associating care tasks with resident rights during reports.

Coding Section Q of the MDS, Participation and Goal Setting
Posted by LTCS on June 6, 2013

Home Health Care Nurse and Home Health Nursing Care PlansThe intent of section Q is to record the participation of the resident, family and/or significant others in the assessment, and to identify the resident’s long term and over-all goals. 

Interdisciplinary team members should engage the resident during the assessment in order to determine the resident’s expectations and perspective, and ask the resident to consider his or her current clinical status, expectations regarding improvement or worsening, and social supports. 

If goals have not already been stated directly by the resident and documented since admission, ask the resident directly about what his or her expectation is regarding the outcome of this nursing home admission and expectations about returning to the community. 

Q Participation in Assessment and Goal Setting