[gto2002]

Hi all. I am an ADON in a 60 bed facility. 1/2 of our census is PPS. Here are some ideas on the charting. Our MDS coordinator looks at all the admission charts the day after (or Monday if w/e or Fri. admit) the pt. is admittled. She is in charge of putting the initial care plans in the chart. She also checks diagnosis, etc. We have a whole file drawer full of the common dignoses that come into the building. These sheets list the prblem and the items that the nurses need to assess and document on. In the front of the nurses notes section we place these in plastic protective covers. The nurse then knows exactly what to look for and document on. This has really helped with our documentation.

Our nurses are required to document on these residents each shift and assess and address the problem. We also keep all of our "skilled" residents in blue charts and our LTC residents in red charts to help the nurses easily identify the residents that require charting.

Hope this helps!

[Nascar nurse]

Ha Ha. Read the first line of the original post and thought "where the heck have YOU been that PPS is just coming to your facility".. . then looked at the date and realized that this is from 1998 . You all may want to start a whole new thread. Anyone up for talk of new RUG catagories! ?! I think I'm goona go be a CMS nurse so I can change the rules every other day.

[Acutecat]

I'm still trying to define my MDS Assessment Coordinator's role. Sounds nuts but true, she's part time, odd hours, took a class once and now knows it all. Fact: Deferred TAR's on regular basis due to poor assessment on initial? Need some help to develop a plan. (Other than firing current RN)!! Anyone got some idea's? I'm trying to recoup significant reimbursement revenue and prevent further problems. Thanks
Cathy

[Nascar nurse]

Originally Posted by Acutecat

I'm still trying to define my MDS Assessment Coordinator's role. Sounds nuts but true, she's part time, odd hours, took a class once and now knows it all. Fact: Deferred TAR's on regular basis due to poor assessment on initial? Need some help to develop a plan. (Other than firing current RN)!! Anyone got some idea's? I'm trying to recoup significant reimbursement revenue and prevent further problems. Thanks
Cathy

How big is your facility? What is a TAR (maybe we don't have this in my area or we use a different term?) I am surprised you MDS is only part time, is this why things aren't being done right.. just to much w/ too little time? You are right though, you can miss out on BIG time reimbursement if you have someone that does not know what they are doing. Not only that your quality indicators &/or quality measures, state survey, etc. could be all screwed up, Give me some more info and I will try to guide you a little or at least give you a better opinion.

[catlady]

Originally Posted by Acutecat

Thanks! If I somehow post this wrong or leave something out please bear with me (first time user)!!
Cathy RN, Nurse Manager, SNF

It's not technically wrong...but you revived a thread from seven years ago.

[Acutecat]

Hey all, our facility is a 116 bed Skilled Nursing Unit with a 5 bed acute unit,a 24 hr Emergency Room with a Physician onsite 24/7,Outpatient Services including, onsite X-ray, Lab and PT/OT. Our patient population consists of everything from Dementia/Alzheimers to Geri \Psych, and everything in between. Ages range from 22-103. Our pharmacist, Dietician and Speech Therapist are onsite 3x/wk (Our medications and food come from our sister hospital which is 16 miles away). I manage approx. 97 employees (RN's, LVN's and CNA's) who are dedicated to Skilled Nursing at an HPPD of 3.2, with our ancillary departments our total staff is about 150 employees. Our reimbursement is mostly from Outpatient Service's, our ED and our Acute Unit. We have recently consolidated w/our sister hospital bringing our SNF Reimbursement up to there rate (double what we were getting). A "TAR" is a Treatment Authorization Request we generate for reimbursement. I'm faced with a huge deficit issue, SOC issue's, Deferred TAR's from the State, charting problems....Blah blah and don't know quite how to begin to fix the problem. We aren't computer charting yet, but our current documentation process truly sucks. Need better resources!! or maybe new Job!!!!!

[Nascar nurse]

Hi. Sorry, I still don't get the whole "TAR" thing. I take it this is a state related issue that I don't have in my state. I am one of 2 MDS coordinators for my 90 bed SNF. (other RN only works 25-30 hours). We split the job - she mainly does the ICF residents, I do the medicare/PPS residents (usually around 25-30 w/ frequent turnover). I do all MDS's and medicare UR. I run the weekly PPS meeting and decide who stays covered w/ medicare and who needs to come off. I keep track of all required documentation, cert/recert/physician visits, etc for these residents. I also have to participate in the monthly UB medicare billing of all medicare residents. One of us does a documentation orientation w/ all new nurses and quarterly inservices w/ nursing staff. We also split restorative nurse duties. Our state reimburses us for all medicaid residents based on the case mix score and she pretty much keeps track of that since it involves the LTC residents. Hope this helps a little. Your job and facility sounds way complicated. Good luck.

[CapeCodMermaid]

Originally Posted by Bird2

Our charting is done on the computer so we review the Medicare charting daily. We can then educate the nurses on a daily basis r/t PPS charting. We also have therapy leave detailed typed notes at the nurses station and a weekly update from therapy to ensure that the nursing and therapy notes match. We have had far less denials doing the daily reviews.

Two things...how do you have time to review every Medicare chart daily? How many Med A's do you have? And how in the world do you convince therapy to give you notes? Our therapists say they only have to write a note once a week. If we ask them a question, we get told "it's in the chart"...sorry,sister, but I don't have time to search through your notes.

[Bird2]

Originally Posted by CapeCodMermaid

Two things...how do you have time to review every Medicare chart daily? How many Med A's do you have? And how in the world do you convince therapy to give you notes? Our therapists say they only have to write a note once a week. If we ask them a question, we get told "it's in the chart"...sorry,sister, but I don't have time to search through your notes.

We average 20-25 Med A's. Since the notes are in the computer we print them in 24 hour batches and review them during a daily Medicare meeting. The therapist is required to be in the meeting every morning. BTW they did whine at first but if the nursing staffs notes are to match what the therapist are charting then they just gotta be there and give input. We insisited that the therapist give us detailed notes such as what the resident needed for nursing to help the resident. So, in a nut shell every Med A pt has all nursing and therapy issues reviewed daily. It takes us approx 45 min. The next step that the therapist don't know yet is they will be required to attend all careplans for Med A and Med B pts. Hopefully this will happen by January. Won't we be popular!