Medicare Charting - page 3

by mickeypat

36,814 Unique Views | 42 Comments

I have a question.... In your LTC facility how often do you document on your Medicare residents? What guidelines do you use? Do you do vitals on them every shift? At the facility I am currently working at we have to do... Read More


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    We do vitals q shift on all of our Medicare patients as well. Hospitals are having to discharge patients quicker and sicker these days. When we get them in LTC, they are sub-acute. Though most do great, re-coup and go home, a newly diagnosed CHF patient, for example, may show subtle signs of deterioration over a few shifts, that an astute case manager can pick up on and ask for orders to treat.
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    In the skilled facility I worked in we charted once a shift with a set of vitals. We were told our main focus in charting should be the problem that gave them the skilled care; we were also told NOT to chart on things like walking, mobility , etc as that was a PT thing and it could conflict with their charting causing reimbursement troubles.
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    Quote from husker_rn
    In the skilled facility I worked in we charted once a shift with a set of vitals. We were told our main focus in charting should be the problem that gave them the skilled care; we were also told NOT to chart on things like walking, mobility , etc as that was a PT thing and it could conflict with their charting causing reimbursement troubles.
    That is a really good idea. Our biggest problem is that our therapists (we contract out) use a two week flow sheet, so while their documentation is always being done, the sheet doesn't end up in the chart until some of the documentation is two weeks old. Not the best system if you ask me (which no one did ) and according to our area manager, I am the only one with a problem with it.
    ImAgypsy likes this.
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    Quote from cotjockey
    That is a really good idea. Our biggest problem is that our therapists (we contract out) use a two week flow sheet, so while their documentation is always being done, the sheet doesn't end up in the chart until some of the documentation is two weeks old. Not the best system if you ask me (which no one did ) and according to our area manager, I am the only one with a problem with it.
    'just to clarify...

    There is no regulation to have the clinical documentation to support skilled need be in the active medical record at the time of review. When a claim is denied, the contractor or FI will ask the provider to submit documents to prove skilled service. Therefore, the provider may retrieve these documents wherever they normally have it.

    Besides, when a claim calls for a medical review, the process will probably take place at least 6 weeks after the PPS/MDS was completed. Thus, a facility has plenty of time to gather all supporting documentations in one place if they so choose.
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    This is an unrelated aside....why do y'all feel the need to put (male) next to your name? Do we read your posts differently because you are a man? Nurses are nurses male or female and do we really need to differentiate on the basis of gender? When I was a little kid, there were 'women doctors.' Thank goodness now they are just doctors. When are we going to get over the 'male nurse' name tag?
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    When denials for Medicare are given out and the QIO is called by the family, the QIO calls the facility at anytime, day/night, ALL the info needs to be faxed ASAP to the QIO. It doesn't matter what day of the week it is.
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    Quote from noc4senuf
    When denials for Medicare are given out and the QIO is called by the family, the QIO calls the facility at anytime, day/night, ALL the info needs to be faxed ASAP to the QIO. It doesn't matter what day of the week it is.
    This is absolutely correct. You have however at least 2 days to notify the beneficiary that a skilled service is to be terminated. But before that even transpires, the therapy department must have notified the facility of the plan. Thus, a responsible provider will be collecting all the necessary documents, photocopied or faxed, whether they be required or not, before finally issuing the beneficiary notice.

    Quote from CapeCodMermaid
    This is an unrelated aside....why do y'all feel the need to put (male) next to your name? Do we read your posts differently because you are a man? Nurses are nurses male or female and do we really need to differentiate on the basis of gender? When I was a little kid, there were 'women doctors.' Thank goodness now they are just doctors. When are we going to get over the 'male nurse' name tag?
    LOL. I guess you’ll receive more replies if you posted it in the general discussion forum or blame Brian for having this as an option. I prefer not to indulge in a hokum.

    Let me share one thing, ‘tho. Did you know a cadaver brain of a man will sell more to a medical school lab than a woman’s? Yep, … because it’s “hardly used”!
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    Quote from capecodmermaid
    this is an unrelated aside....why do y'all feel the need to put (male) next to your name? do we read your posts differently because you are a man? nurses are nurses male or female and do we really need to differentiate on the basis of gender? when i was a little kid, there were 'women doctors.' thank goodness now they are just doctors. when are we going to get over the 'male nurse' name tag?
    call me weird (as i'll admit i am...) but i like to know who's a guy and who's a gal...though i'm not sure why! where i work, we still tend to say "you know, rich...the male nurse" when identifying him. but then, we may say "you know, judy....the long-haired blonde gal" in the same way. it's nice to have a guy or two around... a lot of our confused older ladies think they're doctors and will listen to the "male nurses"....we've exploited that on a few occasions (not telling the resident that he's a doctor, of course, but if goes into the room and asks mrs. smith nicely to take her medicine, she might do so for him when she just told me to go fly a kite......)



    oh...and it says "female" next to my name.....so it's just an identifier....
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    Don't forget, you can discharge the resident from therapy and keep 'em skilled on nursing.
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    Quote from CapeCodMermaid
    Don't forget, you can discharge the resident from therapy and keep 'em skilled on nursing.
    That's very true...but sometimes it's hard to explain to families that even though grandma has a foley catheter and can't feed herself, she doesn't qualify for "skilled nursing" as defined by Medicare....but she isn't well enough to go home without 24 hour care, either. Heck, the regs took me a while to figure out, so I can understand why our families are confused...and the $218/day bill is pretty tough to swallow, too. Of course, we encourage families to apply for MA and our population is about 70% medical assistance on any given day. I just don't think our government resources are going to be able to continue to handle the growing older population and their needs...but I've no clue as to what the answer is. Does anyone know how other countries are dealing with this?:deadhorse


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