down coding?

  1. 0
    So, I was supposed to have Meyers and Stauffer in last week, but got postponed. My question is, do you guys down code for them (or the agency that comes in to try to take the tiny bit of money you get?, lol). If you have a hole on an ADL sheet do you automatically code a 3 instead of a 4, etc. Or do you code what you know the resident to be? I thought when we did an assessment we were supposed to code what we know to be true and accurate, not what might lose money at some point when the mds police come in?

    Get the hottest topics every week!

    Subscribe to our free Nursing Insights newsletter.

  2. 13 Comments...

  3. 2
    If I have 20 shifts of "dependent" and one hole in the ADL flow record, I code as extensive (because the RAI says to be dependent they must always be dependent for the entire 7 day lookback period). For EDS, you HAVE to be able to validate/support your coding and you can't support depend when you have missing documentation.

    All you can really do is educate, educate, educate. You have to make sure that everyone understands that it only takes one stupid coding to mess up the whole process.
    Bella'sMyBaby and crissrn27 like this.
  4. 3
    Interview the CNA who took care of the resident on the day/shift in question then enter the actual code based on that info.

    Omission happens. When a nurse forgot to sign a medication, we cannot automatically assume it wasn't given. Follow your facility's protocol in these situations.
    Last edit by Talino on May 17, '10
    edhcinc, crissrn27, and Nascar nurse like this.
  5. 2
    Quote from Talino
    Interview the CNA who took care of the resident on the day/shift in question then enter the actual code based on that info.

    Omission happens. When a nurse forgot to sign a medication, we cannot automatically assume it wasn't given. Follow your facility's protocol in these situations.

    I am assuming the OP is in Indiana (based on the use of Myers & Stauffers). Indiana is different my friend. Although the RAI clearly states that the MDS nurse can interview resident and staff and use this for coding, Myers and Stauffers (in Indiana) will not accept this documentation. I have tried to fight this before to no avail. They will only accept additional documentation if you would get the CNA to make a statement that they coded wrong and their answer should have been....

    Myers & Stauffers is Indiana's regulatory auditing agency for medicaid reimbursement and they have a whole additional set of guidelines of what it takes to validate coding for payment.

    Does any other state have Myers & Stauffers/EDS?
    Bella'sMyBaby and crissrn27 like this.
  6. 1
    i am not disputing the more stringent requirement/s imposed by some states. kudos to them! it is permitted by the regs.

    the original post refers to "hole/s" discovered while completing the mds. automatic downcoding is not a prudent recourse. mds assessors are compelled to obtain substantiated information to come up w/ an accurate assm't. the hole in the adl sheet is inadvertent and not unobtainable. the assessor should make an effort to interview the cna involved, fill in the hole (or document accdg. to your facility's protocol), then enter the appropriate code.

    do not code it as a "4", simply because you are fully aware of what the resident is capable of, and yet leave the "hole" unattended. that's where a facility gets dinged when the mds is being audited - the required documentation to support coding is amiss.
    crissrn27 likes this.
  7. 0
    Thanks guys, so I guess this one is controversial. I am in NC, btw. Still not sure how the process is supposed to work effectively (ie, assessment, raps, to careplan) if you are not coding what the resident actually is. Just doesn't make since to me.
  8. 0
    it is important to remember when submitting an mds it is you that are signing the information is correct, this is a legal document validated with your license. if a resident is total care for an adl you should write a note in the chart stating the discrepancy and document the adl level you observed. you can reference the nurse, cna or other persons if necessary. an auditing agency always can choose to pay a lower rug despite your coding with out you compromising your legal obligation. you should report on and keep track of issues reported to administration regarding documentation issues that resulted in lost revenue, how you tried to fix it and steps are being taken to prevent it happening again. responsibility of lost revenue if down coded by the agency falls to the responsibility of the charge nurse that did not sign the documentation off for the day.
  9. 0
    Quote from marisrn
    it is important to remember when submitting an mds it is you that are signing the information is correct, this is a legal document validated with your license. if a resident is total care for an adl you should write a note in the chart stating the discrepancy and document the adl level you observed. you can reference the nurse, cna or other persons if necessary. an auditing agency always can choose to pay a lower rug despite your coding with out you compromising your legal obligation. you should report on and keep track of issues reported to administration regarding documentation issues that resulted in lost revenue, how you tried to fix it and steps are being taken to prevent it happening again. responsibility of lost revenue if down coded by the agency falls to the responsibility of the charge nurse that did not sign the documentation off for the day.
    maybe i am misunderstanding you. i am not sure if you are referring to r2b, but all i am signing off there is that the mds is complete. i am not signing that it is accurate. i have other disciplines that complete their own sections of the mds.

    you can't take a 4 if there is no documentation to back it or if there is missed holes- you would have to go with a 3. even a restorative note doesn't work unless it specifically addresses the day in question(of missed holes) and all the areas are covered(adl-self performance-support). so your end of reference period notes are not enough because they are a summary. normally our restorative nurse will monitor for missed documentation and then go back and write a note for that day(late entry) and then add to caretracker as a late entry(after interviewing staff). like i said this has been our experience with umr- maybe other states are different.

    we continually educate the staff(our na do the coding of adls) and try to bring it on thier level as to the importance of documenting thier items. we try to show it in dollars as to what the missing documentation would do(lower rug score).
  10. 1
    Quote from marisrn
    if a resident is total care for an adl you should write a note in the chart stating the discrepancy and document the adl level you observed. you can reference the nurse, cna or other persons if necessary. an auditing agency always can choose to pay a lower rug despite your coding with out you compromising your legal obligation.


    our state auditors will not accept my note stating a discrepancy - i know this from unpleasant experiences. they will accept a note from the actual staff member that caused the original decrepency to occur & i get these most of the time, but sometimes a staff member is not available to write the note.

    also my state requires an 80% accuracy rate. if i repeatedly failed that audit it is very safe to say i will be unemployed rather quickly.
    Bella'sMyBaby likes this.
  11. 1
    Quote from Nascar nurse
    Our state auditors WILL NOT accept my note stating a discrepancy - I know this from unpleasant experiences. They will accept a note from the actual staff member that caused the original decrepency to occur & I get these most of the time, but sometimes a staff member is not available to write the note.

    Also my state requires an 80% accuracy rate. If I repeatedly failed that audit it is very safe to say I will be unemployed rather quickly.
    Nascar Nurse, you are exactly right. The State Auditors told us that if the MDS Dept. changes the ADL coding (late loss ADL's) this would be a good way to lose our nursing licenses.
    Nascar nurse likes this.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top