5 day assessments r/t therapy minutes

catlady, BSN, RN · Apr 22, 2002

Why are *you* forecasting therapy minutes? That's the therapist's job!

You'd better not get in the habit of putting down a standard projection. Medicare has started to come down on estimated vs. actual, and if they don't match, you lose. Your therapist needs to come up with a realistic estimate, or it's fraud. Our corporate has told us that if the actual doesn't correspond to the estimate (such as if the resident is uncooperative or too ill to participate, which you might not know when you do the estimate), you have to resubmit the MDS with the actual minutes instead of the estimate.

tex · Apr 23, 2002

Dear Catlady, I do put the actual minutes in on the 5 and 14 day. In fact I recheck the minutes before I transmit them to the state, q time. But on the 5 day besides putting the actual minutes, You do have an area that you put down projected days of therapy and minutes. are You saying the the therapist is the one that should be projecting the days and minutes total? on that 5 day. Thank you for your response.........I learn alot from this site. Tex

tex · Apr 23, 2002

Also Catlady, if you have to resubmit to the state, lets say the patient does become sick, why would I have to do this? Wouldn't it be a correction to the state or do you just wait until the 14 day is completed, before you submit the 5 day, therefore go back and change the estimated days and minutes on the 5 day to match the actual on the 14 day? Thank you Tex

catlady, BSN, RN · Apr 23, 2002

How are *you*, as the nurse, supposed to estimate therapy minutes? That's absolutely the therapist's job.

If you haven't already submitted the 5 day, and you know you're going to need to correct it, of course it would make sense to do it before you transmit. Otherwise you can do a correction. I would, however, get a ruling from your Medicare intermediary before you start changing how you do things...l

Talino · Apr 23, 2002

Section T asks for estimated rx mins/days up to day 15. Depending on an individual resident's condition and motivation, a good clinician will be able project these times.

Projecting therapy minutes should be done by a discipline with the area of expertise... in which case, the Rehab. therapist. You as an RN Coordinator can enter these projected rx minutes in the MDS after conferring with the therapist.

These numbers are just an estimate. If you had transmitted the 5-day already you do not need to send a Correction if the resident gets sick on day 9 or refused rx on days 11 & 12, or if resident received an additional 2 hrs of rx . You will be paid the 5-day RUGs until day 14 regardless. Afterall, you did not know that these events would happen when you did the estimate.

The therapy absences or increased therapy mins. will be reflected on your 14 day PPS and will adjust your RUGs accordingly.

A habitual "fixed number" each time (10 days/660 mins) is an absolute RED FLAG! Get a realistic estimate as possible. When doing the 5-day, look at Section P1b: Therapies. If PT captures 2 days of rx / 110 mins. (and your facility provides 5 day/wk rx) it is safe to estimate that from day 1 to 15 the resident will receive 11 days/605 mins. of PT. (avg. of 55 mins/rx X 11 days).

Watch out though ... If Section P1b rxs is 0/0 up to the 5th day of your ARD, be very careful w/ the estimated numbers in Section T.

tex · Apr 23, 2002

Thanks for your responses...........I learn qd...Tex

Talino · Apr 24, 2002

Hey Tex...

Have you seen the NEW shortened MDS form to be used for PPS purposes only?

tex · Apr 24, 2002

Yes I have. Been so busy with trying to get my department togeather and learning the gray black and white areas of MDS that I don't understand if raps have to be done, when we choose to do the shorten form or do a reg pps mds........maybe you can enlighten me...........Thanks Tex

catlady, BSN, RN · Apr 25, 2002

Talino, what are you referring to? What new shortened form? Not that I've ever received any kind of training or updates or literature in my building so that I would know. But boy, do they expect everything to be perfect.

Not that I *care* any more, either, but I'm a little curious. Today was my last day. I start at an ICF on Monday. No Medicares, no PPS.

Fran-RN · Apr 25, 2002

Yes, the therapist should be doing the estimate for section T. Also, you shouldn't have to do a correction if the actual time doesn't match the estimate, after all it is an estimate. But if the projected time consistently produces a higher Rug category than the actual time then that is a red flag for Medicare, so you might rethink how you are arriving at your estimate. Raps, The only time you do them is when you are required to do an OBRA assessment. Not for PPS assessments unless it is combined with an OBRA assesssment. New short form???? sounds interesting, when will it be out. There has been talk about a special short form for short term stays such as hosp based facilities get, any one hear anything about those.

GeorgieGirl · May 1, 2002

I've heard about a new short form, but haven't seen it. That would be SUCH a relief. In Ohio, we do full assessments for EVERY quarterly, 14 day, 30 day, 60 day, 90 day. Regarding Section T; our therapists do that. They are signing for the accuracy of their section, I only sign as to the completion of it. I totally agree that a fixed number of projected days & minutes would be a red flag. I hope we will still hear from you, Catlady. Hope your new job works out. I definitely understand not wanting to deal w/ PPS any longer; the more I learn (slow process) the more I wish I hadn't left the floor!