charting medical necessity???

[mamac0805]

I work in an inpatient rehab unit at a hospital. we are currently undergoing a chart review by medicare. Our biggest problem with the rejected charts has been the lack of showing medical necessity. why do they need 24hour nursing care and an inpatient stay rather than outpt therapy or a snf? so does anyone have ideas or things that their facility does to really highlight why their pt's need 24 hour nursing in a rehabilitation setting? we currently focus on charting what we as nurses do for their comorbid conditions in an end of shift summary but something is lacking, I just can't figure it out. Thanks for any help.

[IHeartPeds87]

I work as a caregiver at a LTC facility for adults with disabilities. whenever 1:1 with a patient we are required to fill out documentation detailing why the patient needed to be one on one.

So, for example, if I was scheduled to be 1:1 with a patient for four hours, I would detail what I did in those four hours.

example:

"Staff spent four hours with client. Staff transfered client from the wheelchair via pivot transfer and from the wheelchair to the toilet again via pivot transfer; this process occurred twice. Staff provided cues about surrounding to client, including time, location, and client's current status in the program"

That's just an example. My point is that the purpose of the documentation is to get across the point that "yes this client did need 1:1 care. and this is the care they got during the time I was with them."

Hope that helps.