Managed care

Well, all the facilites in Southern Arizona expect the MDS coordinator to case manage the Med A's which is a snooze, but the case management for managed care is a nightmare. Every payor source has a "special" weekly case management form which has to be filled in for week to week authorization, and you can't usually just say "see attached" and attach your own facility forms which already contains the information they want you to rewrite. They lose the first fax usually, then their fax lines are busy for hours.
BUT! I have learned some tricks for fighting back.
1) As soon as the patient is admitted, I fax everything I can think of, usually at least 40 pages. (These case managers usually work from home, and have to drive into offices to pick up more paper, so this gives them pause before they ask you to fax in stuff they really don't need..let's them know you are serious.)
2) I ask them to "carve out" anything I can think of: expensive meds, special beds, transportation, escorts, anything not specifically defined in the contract.
3) I ask for a "higher level of care" on anyone who remotely qualifies for more therapy than the plan allows, and fax quite a few pages of documentation about why the patient needs it.
If you ever get another job requiring case management another thing you can do is insist on faxing your paperwork in on the same day to all payor sources. This insures that you will have at least two days a week to do just MDS's. I personally can't do MDS's and case management in the same day. Two and a half days a week I do case management, and two and a half days I do MDS's. The problem is case management is so insidious that sometimes you absolutely HAVE to do something right now, no matter when it is. The way I deal with that is let the administrator know how many hours a certain company is demanding of my time, and what it is costing him in terms of my salary. He makes money when I am doing Medicare MDS's. He is breaking even or losing money on my time if I am doing anything else. I get lots of support.
ST

oh your stories of managed care certainly do not look like fun, our company has its own medicare biller but she is not a nurse, tries to tell me how to count PT minutes lol and will ask me are you sure they did not have iv fluids??? I can not imagine doing all that mess on top of the mds's careplans and revisions, I am all for making the best rug score we can but not going to say someone has had 200 minutes when they only had 135!! The problem is that we use out of facility PT and they will not give us but 3 days a week when most of our residents need 5 days a week. Of course it is crap to make these people go out in the cold, take a driver and a nurse aide to transport them off the floor. This is the perils of small facilities

Seriously...the armchair quarterbacks need to chill, no? I've been reading medical records for 37 years, and I know an IV med when I see one. Everyone's an extensive services expert....I had to explain to a lovely admissions nymph that a diagnosis of IV DRUG USE in the community is not an extensive service. I don't think she ever believed me. The consultant insists that everyone in the hospital has an IV. I just asked her to show me any that I had missed. She disappeared. If I make a mistake, I will OWN it, and send a correction, for heaven's sake. I've been in the hospital, and I didn't have IV meds during the look back. Nor was I on a ventilator, nor did I have trach care. (Thank all deities involved). I just smile and hand them whatever measly records I did get from the hospital and ask them to show me. It's a hobby now.

yes they do need to chill-- and you can not squeeze blood from a turnip!! But they swear you can. They the non nurses are asking me to fax the mds over now lol not just the rug scores so she can try to figure out what I am missing. and of course it does not help that the hospital tries to use all the swing bed days they can