OMRA

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    Back again! Apparently, my brain is having a hard time getting back into MDS gear after 3 years in Labor and Delivery! So heres the situation. I had a resident that was working with PT and OT, they d/ced, resident had a nursing skilled need so we did an OMRA. After a few weeks ST decides to pick her up for a while. IDT team talked it over, and since resident wasn't in a assessment period we did another OMRA to pick up the new RUG. Today our regional MDS guru came in and she had me inactivate the assessment. So now half the IDT is saying OK, whatever, the other half is saying we should have kept the OMRA in place. In the manual it only mentions doing an OMRA when therapy is d/ced, but it is an Other Medicare Required Assessment, so whats the deal? What do you guys do?
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  3. 6 Comments so far...

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    OMRA's are only appropriate when all therapies have been D/C'd - that is the whole purpose of them. They are to remove a resident from a REHAB RUG catagory. If you want to be a $$ grabber, you can always pick up an early quarterly, although more and more state agencies are looking negatively on facilities that are doing this kind of thing with the intent of increasing their reimbursement.
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    I wasn't actually thinking let me grab us some $$. Thanks for the answer, but being called a money grabber just rubbed me the wrong way. Its not like I put it in my pocket.......I wish I got a percentage, lol. What the whole team was thinking is we are going to be losing about $50 on the resident per day if ST sees her and we don't get a higher RUG. Not something anyone can afford these days.
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    Quote from crissrn27
    So now half the IDT is saying OK, whatever, the other half is saying we should have kept the OMRA in place. In the manual it only mentions doing an OMRA when therapy is d/ced, but it is an Other Medicare Required Assessment, so whats the deal? What do you guys do?
    Inactivating the 2nd OMRA was the correct action. Since you're performing an MDS outside an assessment window, the only way to get the Rehab RUG is to code the MDS as Sig. Change (AA8a =3) and OMRA (AA8b = 8). However, the criteria for Sig. Change must also be met. If not, you will have to wait for the next assm't window to capture therapy. Hopefully, this scenario does not occur too often, so look at the brighter side - when you do an OMRA, CMS still pays you up to 10 days of the Rehab RUG even tho' therapy was not provided anymore.

    Quote from crissrn27
    I wasn't actually thinking let me grab us some $$. Thanks for the answer, but being called a money grabber just rubbed me the wrong way. Its not like I put it in my pocket.......I wish I got a percentage, lol.
    The MDS coordinator should get a percentage! A bonus, that is. In case mix states, a coordinator's mindset of maximizing reimbursement is sought after by facility operators. As long as the guidelines are adhered to, I cannot fault the industry for taking advantage of that opportunity. Only the state is to blame for creating loopholes.
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    and we all have something to "look forward to" in 2010!! with mds 3.0, we get to do an omra when therapy starts (as well as when it ends)!! lucky us!!

    if a patient is medically unstable, i really look forward to doing twice to 4 times the currently required number of assessments!! or, better yet, working with rehab to figure out the best date to start therapy so the "start date" is within the window for a regularly scheduled assessment!!

    so much fun!! :angryfire
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    Quote from talino
    inactivating the 2nd omra was the correct action. since you're performing an mds outside an assessment window, the only way to get the rehab rug is to code the mds as sig. change (aa8a =3) and omra (aa8b = 8). however, the criteria for sig. change must also be met. if not, you will have to wait for the next assm't window to capture therapy. hopefully, this scenario does not occur too often, so look at the brighter side - when you do an omra, cms still pays you up to 10 days of the rehab rug even tho' therapy was not provided anymore.

    in my state, we can also pick this up with an early quarterly for our case mix. does not have to be a significant change



    the mds coordinator should get a percentage! a bonus, that is. in case mix states, a coordinator's mindset of maximizing reimbursement is sought after by facility operators. as long as the guidelines are adhered to, i cannot fault the industry for taking advantage of that opportunity. only the state is to blame for creating loopholes.
    i agree with this 100%. i have said forever that their should be a bonus system in place for the mds coordinator based on the medicare rate and case mix scores. bet we would both be rich, retired, sitting on a beach somewhere!

    to chrissrn - sorry, did not mean to offend you. i was actually the queen of being a money grabber in my facility and was quiet proud of it. some others around here though have almost scolded me for being a $$ grabber with the thinking that this is cheating the system. i have just learned to tone it down and not show my true side most of the time. the facilities have always loved me and paid me well tho!
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    Thanks everyone.....no problem Nascar, you know all us MDS nurses have thick skin. So when 3.0 comes out we will have to do an OMRA in this same situation?


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