Grace Days

[nratchet]

A patient comes in on Friday with therapy orders for 5 x weekly. No therapy is done on the day of admission (Friday), the patient is evaluated and treated Saturday, no therapy on Sunday, treated Monday and Tuesday. (A total of 3 days of treatment only 2 days missed)

The Therapist is requesting 3 grace days but has only missed 2 days of therapy. Are we allowed to give the 3 grace days making treatment days add to 6 rather than the 5 days ordered by Doctor?

[Talino]

Therapy may start anyday of the week. The total 6 therapy days in the past 7 days incedently captures 1 day (Sat) from the previous week. It does not mean that the therapy would be provided Mon-Sat (=6 days), but rather Mon-Fri only, or whatever days to total 5. So go ahead and use the grace days to maximize your RUGs. There is nothing illicit about it.

[nratchet]

Ok. But what about the Doctor's order that says to treat 5 days only? Change the day to Monday, eval and treat Tuesday, Wednesday and Thursday, miss Friday. A total of three days treated in the same week with only two days missed, and the therapist wants 3 grace days which will make 6 days equaling Monday through Saturday and one day more than the doctor ordered.

[Talino]

Ok. But what about the Doctor's order that says to treat 5 days only? Change the day to Monday, eval and treat Tuesday, Wednesday and Thursday, miss Friday. A total of three days treated in the same week with only two days missed, and the therapist wants 3 grace days which will make 6 days equaling Monday through Saturday and one day more than the doctor ordered.

Do you mean up to 5 days only then DC (as opposed to 5 days per week)? If so, the total rx provided by the 8th day ARD (using 3 GDs) must not exceed 5 days. The extra rx day (6) defied MD's order and should not be captured in the MDS.

Even if therapy is provided 5 days in a week, there will be instances wherein 6 days can be captured during the ARD. Example:

Week 1

Mon - rx

Tue - rx

Wed - rx

Thu - rx

Fri - out all day for clinic appt.

Sat - rx (to makeup for Fri)

Sun - closed

Week 2

Mon - rx

Tue - rx

Wed - rx

Thu - rx

Fri - rx (ARD) - total rx days captured = 6

Sat - no rx

Sun - closed

[nratchet]

Doctor order usually reads PT 5 x wk for 30 days. I guess what I'm trying to ask is this. If the patient misses 2 out of the 5 days for whatever reason, (i.e. dr visit, dialysis, illness, etc), how many grace days are we allowed to use legally. We, my coworker and I, believe we are only allowed to use them to replace to amount of days missed. Our therapy department believes we can use the maximum amount of 3 grace days no matter how many days are missed to make the RUG score higher.

P.S.

Sorry if it seems I'm asking the same question over and over but our PPS coordinator is dictating the question and she keeps rephrasing it.

[Talino]

Doctor order usually reads PT 5 x wk for 30 days. I guess what I'm trying to ask is this. If the patient misses 2 out of the 5 days for whatever reason, (i.e. dr visit, dialysis, illness, etc), how many grace days are we allowed to use legally. We, my coworker and I, believe we are only allowed to use them to replace to amount of days missed. Our therapy department believes we can use the maximum amount of 3 grace days no matter how many days are missed to make the RUG score higher.

P.S.

Sorry if it seems I'm asking the same question over and over but our PPS coordinator is dictating the question and she keeps rephrasing it.

It is wise to use grace days in order to capture the highest RUGs possible. See the definition of Grace Days in Appendix A, A-5.

I believe your initial concern is that the therapy may have been provided more than 5 days in a given week when the grace days are used.

Just put it this way...

If your week begins on Monday and ends on Sunday, how many times did resident receive therapy? The total should not exceed 5 days. So if therapy is normally provided Monday - Friday but resident misses Wed & Thu, a therapist who provides the therapies on Sat and Sun to make up the for the absences equalling 5 days for the week, deserves a pat in the back.

When choosing the ARD, do not confuse the grace days used as trying to provide more therapies than the 5 days prescribed. The grace days simply allows you to capture the most number of therapies provided in the last 7 days.

You are not being repetitive. The MDS is quite complex. One false interpretation can result in huge revenue losses. Never hesitate to seek clarification.

[Nascar nurse, ASN, RN]

It is wise to use grace days in order to capture the highest RUGs possible.

You seem to be most concerned about reflecting more than 5 days of therapy. In my building often PT and OT work together, both with orders for treatment 5 days/wk - BUT NO ONE SAID IT HAD TO BE THE SAME 5 DAYS!

PT = Sun, Mon, Wed, Fri, Sat

OT = Sun, Tues, Thurs, Fr, Sat

Now the MDS will reflect 7 days of therapy treatment and you would definately want to use grace days to capture this (this can make a huge financial difference), but the resident still received the exact ordered amount of treatment.

[noc4senuf]

Nascar Nurse said it, you can use grace days to total the whole 7 days of the ARD. The whole idea is to capture as many days possible to drive up your RUGS rate.