Latest Comments by ibtootie - page 3

ibtootie 4,308 Views

Joined Dec 27, '10. Posts: 77 (6% Liked) Likes: 20

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    Resident admitted to SNF 7/2. 5dPPS ARD scheduled for day 8 (7/9). Resident had 5 days OT participation and 5 days PT participation for combined total of 496 minutes resulting in RHA. 14dPPS scheduled for day 15 (7/15). Again the resident had 5 days OT and 5 days PT for a total of 510 minutes resulting in RVA. There really is no CHANGE in therapy per se, but the additional 14 minutes over the course of the 5 days increased the RUG. I'm sure a COT will be required, but I'm not sure exactly where the COT actually started. Any suggestions?

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    I'm curious to know how many PPS MDS evals (all combined) everyone else submits per month. I'm trying to figure out if I am on track, or if I need to speed up. I am at a hospital based SNF -not swing bed, with 20 Medicare beds with an average length of stay of 13.7 days. I feel swamped, but don't have any other past facilities to compare with.

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    Can you set the ARD date for OBRA NC assessments before day 14? For some reason I thought the ARD date was set at day 14 unless the resident discharged prior to day 14.

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    Does Safe Harbor apply to SNF's?

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    That's my main complaint too. It would be great to be able to make changes without deleting everything and starting over. I thought that the changes could be made when the program first came out, but the upgrades along the way got rid of that feature. There may be a valid reason it was removed.

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    My facility currently uses jRAVEN. When I started they were using RAVEN, so I have never had any other software to compare it to. I'd like to hear from others who have used jRAVEN and how it compares to the other programs out there.

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    Resident admits from acute care on 11/5 and transferred back to acute care within 36 hrs. I completed NT and ND with A0310F=11-DC with return anticipated. She returned from acute care back to SNF on 11/19. I entered A1700-2=Reentry and submitted scheduled assessments as per routine. My understanding is that if a patient admits and discharges with intent to return to the SNF within 14 days all that is required is NT and ND. Our billing person says that the resident was out of the facility for more than 7 days, so in order to bill for the 36 hr stay an NC should be done. Is this correct?

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    Mr X admitted to SNF post MVC for rehab. He has Medicare, but Admission Coordinator admitted him to SNF with only 2 midnights in acute care, so he is now a no-bill. (Glad I'm not her) Should MDS eval be submitted as OBRA, or follow PPS 5-14-30 day schedule and answer A2400A "no"? Never had this happen before, so this scenario is new.

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    I have started doing inservices and have reoriented each CNA at least three times, but still find the same errors over and over from the older CNA's. I haven't found any material to cite specific examples, so I used real past patient scenarios (with identifying info removed) and made my own material. I have also been given a 2 hr orientation block to the new hires to try to train them from the start how to code appropriately and demonstrate to them the impact their documentation has on the facility. They seem more interested once they see that their input has meaning, and isn't just "busy-work" for them to complete. Overall, it's been an improvement.

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    Would that be in the Casper Reports? In Casper Reports there is a link MDS 3.0 QI/QM Reports-Under Construction. I saw that a few moments ago while printing my Validation Report, but it was blank.

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    Thanks Talino for the link. Still though, if you adhere to the script of the patient interview, it still seems to ask one sided questions. "Have you had ANY pain or hurting over the last 5 days?" yes or no. "Please rate your WORST pain over the last 5 days". There is no question to rate their pain after the pain intervention which could bring their pain relief score to a 1 or 2. Most of our patients are post-operative ortho and they do have frequent pain at a 7-10, but their response to the pain interventions arent captured when sticking to script.

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    It seems like it would have been simpler for everyone if CMS had just changed the rule to state that everyone receiving Medicare rehab services should have evaluations every seven days period.

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    Patient has been in SNF since 9/22/11 receiving IV Antibiotics only. 14 day ARD done on 10/6/11 resulting in RUG CA1. On 10/7 patient starts PT only for gait training with cane. ARD for SOT 10/13/11 resulting in RUG RMA. 30 day assessment scheduled for 10/21. Patient misses therapy 10/21, 10/22, and 10/23, so EOT-R OMRA combined with 30 day assessment which set the RUG back to CA1. Patient resumes therapy on 10/24 and 10/25 and is released from therapy on 10/25, having 106 minutes of Physical therapy for those 2 days. Remains in SNF until 11/1 to finish his antibiotics. Since I captured the resumption of therapy 10/24 on the EOT-R, do I need to do an EOT for 10/25, or should I still do an SOT to capture the therapy on 10/24 and 10/25?

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    My facility has the same issue. When we get post-op patients or patients with infected wounds, I would expect that a resident will say they are having severe pain or 8 out of 10. The problem is that the section J does not permit any inclusion of responses to their pain management. Our facility documents the pain number before the pain medication/intervention, and then documents the number afterward and there is a drastic reduction in the pain number response, but I don't feel like that is being captured in the rather black and white responses to choose from in the assessment.

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    tyvin likes this.

    I recently joined AANAC, and have found that, even though the same information can be found on the CMS website, AANAC's information is far more user friendly and has less "government speak". I am the first to admit that am NOT computer literate, and AANAC's site is easier to maneuver in and out of than CMS.


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