PPS documentation

  1. PPS is coming fast to our facility, I am a DNS in a long term facility, How can we assure correct and timely documentation that is required for reimbursement? What are other facilities doing to educate your nurses as to the importance of timely and accurate documentation, what have you found that motivates them to do it consistenly, and what type of disciplinary action occurs when they don't comply?

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  2. 18 Comments

  3. by   pietem
    Also a DNS in New Hampshire. Very difficult for all of us. Have attended PPS seminars and have been meeting with my nurses to emphasize the importance of proper documentation. Need to make them realize that their documentation is not only important for good patient care and continuity but that inaccurate documentation will result in loss of funds, loss of money to be able to buy supplies, loss of money to be able to hire adequate staff. It is a real nightmare but nurses for the first time have to think money. They have to learn to work smarter and not harder. Look at all your areas of documentation and cut out all areas that lead to duplication which could cause errors and confusion. Good Luck !!
  4. by   Cindy Johnston
    Please excuse my ignorance: what do PPS and DNS stand for? I am acutely interested because I have just taken a staff RN position in a residential health care facility and it is likely that I will soon be promoted because of a planned retirement...I need to learn as much as possible as fast as possible about MDS's etc. ANY info that would be helpful to me will be greatly appreciated !
    Thanks, have a great day.
  5. by   ebbarton
    Buffy---
    PPS means prospective payment system
    DNS usually means Director of Nursing Services
    Lood on the net at www.ltc.casemix.com for a discussion group of MDS coordinators and others interested in the pps processes. You'll also see "RAI" a lot on that site--means Resident Assessment Instrument--a basic data set and assessment tool mandated by HCFA for the process. It's a whole world of it's own. I've been "doing it" (functioning as the RN Assessment Coordinator) for a long time, and it's more complicated and demanding than most administrators and many DONs realize. Hire a smart, experience, non-flappable RN, PAY HER/HIM well, do not assign clinical duties or extra jobs to him/her, and pray that he/she catches on and has a good time at it.

    Would be happy to talk to you more about this any time you like.
  6. by   karol
    Hi, I am new to this bulletin board and have
    enjoyed the messages so far. I tried the url
    ltc.casemix.com twice and I keep getting the message that they can't locate it. I would really be interested in finding it and any others that anybody else has on the subject. I also agree that who ever has to do the mds and so forth are going to need enough time to keep them done and accurate. And accurate documentation is a must. Even the aids documentation is going to be important.
    karol
  7. by   ebbarton
    Karol:
    Try "Long Term Care Minimum Data Set 2.o" or try MDS in you search engine, that's how I found the LTC Case Mix site which includes a discussion group that is invaluable to me as MDS nurse in a LTC facility.
    Also try e-mailing the discussion group at
    "cmdg@ltc-casemix.com" without the quotation marks (my editing to set the address off from the message. Or try me at sundayschild@earthlink.net if you get stuck. Or if you just want to talk.
    Looking forward to hearing from you.
  8. by   newmjo
    if you go to http://www.hcfa.gov
    you will find a medicare section..go there and you can download the entire pps manual...seems like all future updates and info from hcfa will be posted on this site for downloading, you need adobe acrobat reader, but can download it free from the medicare site before you do the downloading. I have gone so far as to reproduce the 2.0 form, just the parts i need, really and paste it on paper, draw lines, make a flow sheet for use all 3 shifts for 7 days...use this to substiantiate my documentation, make it part of the chart...or keep in seperate file...my form came to 2-2 sided pages, i highlight the sections i need them to work on...pretty neat and they have some idea of what i need to know for the thing i spend somuch time doing. Also have created two interventions for medicare a residents for daily documentation, we are computerized, i guess you can tell. these are one of the two things you need to document against daily for M/Care part A. these are the skilled nursing services i use...1. Management and evaluation of patient care plans and 2. observatio and assessment of patients condition.....got the wording and explanation right from M/Care seminar booklet. sorry this is so long...joyce in NJ
  9. by   Debbie RN
    i was just about to answer as well, that documentation needs to be real specific to the care plan problem, and identified needs, much like problem charting. We started problem charting in our facility, and also condition management by daily flow sheets only for our medicare patients, much like in the hospital for acute medical floors. There are many ways of problem charting, but you've got to keep it to the point, so we use PIE, problem, intervention, evaluation. You can get lots of daily flow sheets from many sources and modify them for your facility,(what you think suits your specialty of patients) and then have a printer print them off for you, they look very professional that way. Remember, that Medicare is not changing the guidelines for required charting, so this way of charting really keeps in line what your nurses need to chart. ALSO, remember, your nurses have a lot more work to do with PPS, and now MDS 5 day assessments, so keep the documentation to the point, and significant. MOST IMPORTANTLY, if you make any significant changes in your documentation system, make sure that you have a system for measuring and evaluating the change(s). As Director of Nursing I do frequent chart reviews. I hope this helps..........Debbie RN CDON/LTC
  10. by   Acutecat
    Hi, I was wondering as an assessment RN Coordinator, do you have any involvement with the UR process and/or the TAR process. Or do you focus on MDS specifically. I am a Nurse Manager 116 bed medi/medi SNF and my assessment coordinator is part time lacks direction, and we have had numerous deferred TAR's due to this. I would love to talk to you further. I appreciate anything you may have/want to share.
    Thanks! If I somehow post this wrong or leave something out please bear with me (first time user)!!
    Cathy RN, Nurse Manager, SNF
    Last edit by Acutecat on Nov 21, '05
  11. by   Bird2
    Quote from Buffy
    PPS is coming fast to our facility, I am a DNS in a long term facility, How can we assure correct and timely documentation that is required for reimbursement? What are other facilities doing to educate your nurses as to the importance of timely and accurate documentation, what have you found that motivates them to do it consistenly, and what type of disciplinary action occurs when they don't comply?
    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.
  12. by   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!
  13. by   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.
  14. 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

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