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| |  Pushing The Limit For $
So frustrated !!  One of the places I work has a administrator who is really pushing the lmits of Medicare.. this goes beyone Ruging for Dollars, way into me thinking... "if this chart gets pulled for review Medicare will take back every last cent"...  Nurses notes are lacking or the same old , v/s stable no signs of infection, etc... this administrator is having me cover individuals who RUG out at PA1... ( he/she was in a psych hosp with a 3 day stay ), PD2 (he/she went out for mental status changes, pulled out the IV, had po abt and RUG out at PD20, therapy ended 2 weeks ago and we are mointoring them to be sure they don't decline... on and on and on...I feel as if this is fraud, not even pushing the limits, myself and other nurses, therapists are feeling the same way, we rool and eyes and whisper under our breath, oh my god, how are we going to justify this ?  Everytime we review this with the administrator, he indicates this is all coverable and appropriate under Medicare Part A for skilled observation, and I am reeling, what are we skilling for ?!?!? I'm so glad that all I do is complete the MDs and not be held liable for the decision to keep the person on, I'm okay , right ? I am not making the medicare decision, of course this is documented no where, should I worry if Medicare comes looking ? I am doing the MDS correctly, if nothing happend in the hospital stay or look back period, than nothing happened... but , this is all making me very very ill...thoughts please , no , I cannot quit, and no, I can't go above the adminstrator, been there done that all I had was negative outcomes for me... 
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Oct 06, 2008, 02:15 PM
 Re: Pushing The Limit For $ Originally Posted by disney158  So frustrated !! One of the places I work has a administrator who is really pushing the lmits of Medicare.. this goes beyone Ruging for Dollars, way into me thinking... "if this chart gets pulled for review Medicare will take back every last cent"... Nurses notes are lacking or the same old , v/s stable no signs of infection, etc... this administrator is having me cover individuals who RUG out at PA1... ( he/she was in a psych hosp with a 3 day stay ), PD2 (he/she went out for mental status changes, pulled out the IV, had po abt and RUG out at PD20, therapy ended 2 weeks ago and we are mointoring them to be sure they don't decline... on and on and on...I feel as if this is fraud, not even pushing the limits, myself and other nurses, therapists are feeling the same way, we rool and eyes and whisper under our breath, oh my god, how are we going to justify this ? Everytime we review this with the administrator, he indicates this is all coverable and appropriate under Medicare Part A for skilled observation, and I am reeling, what are we skilling for ?!?!? I'm so glad that all I do is complete the MDs and not be held liable for the decision to keep the person on, I'm okay , right ? I am not making the medicare decision, of course this is documented no where, should I worry if Medicare comes looking ? I am doing the MDS correctly, if nothing happend in the hospital stay or look back period, than nothing happened... but , this is all making me very very ill...thoughts please , no , I cannot quit, and no, I can't go above the adminstrator, been there done that all I had was negative outcomes for me...
You are really in a no win situation. You are absouutely correct to be concerned. Your administrator is making decisions for your entire team that can get the entire team into trouble. My concern would be if he is as unscrupulus as you say that he is, when it comes time for a Medicare audit, he will blame anyone but himself for a bad audit. The key to the game is documentation! Protect yourself.  Make sure you can back up what you put in that MDS.  Good Luck!
| | No. 2 |
Oct 07, 2008, 09:10 AM
| | No. 4 |
Oct 15, 2008, 09:27 AM
Re: Pushing The Limit For $
I too am in NY and we too have all been to the same workshop, as if it isn't bad enough to do the calendar right, now we will be playing the "move the ard" game for NYS reimbursement also, I have some clincians who still can't get the right dates no matter how often I go over it, I am told I am talking "MDS", did you know that "MDS" is no a recognized language of it's own, ... and these are smart people..
| | No. 6 |
Oct 21, 2008, 09:30 AM
Re: Pushing The Limit For $
Nope, no-one... corporation is now purchased by a new owner, so we will see what happens, as we know, new owners sometimes "clean house" so i won't have to worry, maybe the administrator won't be there too long.. I can always hope....
| | No. 7 |
Oct 21, 2008, 05:36 PM
Re: Pushing The Limit For $
I work in Texas we just recently went the RUG 34 to replace our TILE payment system for Medicaid. But before I start on that let me comment to the ADMIN problem... I have been working in LTC for 31yrs, 15 of which I have been doing MDS's, TILEs ie. It has been my experience that if you make someone responsible for their actions they will usually come around. Have the ADMIN sign the MDS. Say that it is for accuracy. Any how.... all disciplines that have input in the assessment are to sign. Sounds like he has quite a bit of INPUT. Back to the above - I have taken a position with a company as a Case Mix Resource Nurse. We look at MDS and find the "best" RUG rate. At this moment there is no rule in how often, or close together you can complete an MDS - but I believe that will change.... Because the almighty state  will not abide with so much money going - not to LTC facilities...
| | No. 8 |
Oct 22, 2008, 10:29 AM
Re: Pushing The Limit For $
This is a very interesting thread. Although there are no statements in the RAI Manual re: how close together OBRA assessments can be scheduled, it is clear that the schedule cycle SHOULD last approximately one year. The care plan is developed or reviewed following each assessment. Compressing the OBRA schedule for reimbursement purposes is not explicitly disallowed.
You say that a workshop presenter informed you that you could "flex" the ARD within the "picture" dates--I presume that follows SOME sort of guidelines, like the PPS schedule, where the ARD could be (+) 4 or 5 or (-) 8 to 10 days of the "target" date. (as long as completed within 92 days of last quarterly or 366 days of last comprehensive). This would be reasonable, as it would also allow staff to schedule assessment dates to allow for staff vacations. Clarifying ARD's with your state RAI coordinator or Medicaid agency, as previously mentioned, would "ease" your mind. Facility policies/procedures should specify the parameters for this flexible scheduling.
At one point we were cautioned NOT to submit quarterlies "early" to change the QI/QM. Am sure that the same "caution" would apply here.
Good luck!  | | No. 9 |
Dec 17, 2008, 10:49 PM
Re: Pushing The Limit For $
I am in Illinois, who is going under what is called Medicaid Audits. If your facility gets paid thru medicaid, be leary over too many "early assessments" as this will send a red flag to them and guaranteed they will make a visit to your home. My facility went thru a "mock" audit, and that was bad enough. As for the administration ordeal, it is not going to matter if you make him sign the assessment or not, your signature is on it as well. As a matter of fact, I believe that all department heads sign the assessment stating that all information is true and correct. You are signing it as being the person completing the information. It is your responsibility in the end, no matter who comes in and "audits" you. Unfortunately, since you went to the chain of command and it did not work for you, you may have to make other arrangements of whom to talk to. In the end, it is your license on the line.  |
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Re: Pushing The Limit For $
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