How do you decide on an ARD?

Talino · Mar 12, 2008

Changing the ARD (as long as you're still within the acceptable ARD timeframe) when necessary to capture a higher RUG is the work of a smart MDS coordinator, a good clinical accountant. That's what Adm should cherish and be wary about. Maybe extra work for staff, but what's a few additional mins. for each discipline compared to what the facility could have lost if they didn't.

Let's presume. If you stayed w/ your original ARD, you may have a RUG of CC1. After changing it, you'd likely get SE3.

This is just an estimated RUG rate (NY):

CC1 - 298.28 X 30 days = $8948.40

SE3 - 441.20 x 30 days = $13,230.00

Difference = $4281.60

Now present it to the disciplines. Still dissatisfied? Even after you give them each $20 for the extra effort, you're still ahead. You provided the service, you are rightfully entitled to be paid for it!

nratchet · Mar 12, 2008

I know when the resident has therapy, you base it on that, but what about when therapy isn't involved? We usually set for the first Monday in their assessment period, but sometimes it doesn't work out well.
What about changing the date after the assessments are complete, but not submitted? We had a resident this week that had her assessment completed last week, but over the weekend developed a really nasty cold. If I change her ARD to today, I can capture three doctor visits, about six new orders, IV meds, injections, abnormal labs. My MDS team is furious that they have to do their assessments over, but my DON would shoot me if I didn't capture everything.
I feel kind of guilty for causing more work, but it makes sense...and she didn't have changes that would allow me to do a significant change in status.

If your resident did not go out to the hospital, you have to base your ARD date on the day of admission no matter what. If you go over 14 days from day of admission you are out of compliance and will be tagged by state.

:nono:

flashpoint · Mar 12, 2008

If your resident did not go out to the hospital, you have to base your ARD date on the day of admission no matter what. If you go over 14 days from day of admission you are out of compliance and will be tagged by state.

Umm...this was a quarterly assessment not an admission...I guess I should have been more specific. I am aware that the admission has to be done in 14 days.

RN 4 Life · Mar 13, 2008

I know when the resident has therapy, you base it on that, but what about when therapy isn't involved? We usually set for the first Monday in their assessment period, but sometimes it doesn't work out well.
What about changing the date after the assessments are complete, but not submitted? We had a resident this week that had her assessment completed last week, but over the weekend developed a really nasty cold. If I change her ARD to today, I can capture three doctor visits, about six new orders, IV meds, injections, abnormal labs. My MDS team is furious that they have to do their assessments over, but my DON would shoot me if I didn't capture everything.
I feel kind of guilty for causing more work, but it makes sense...and she didn't have changes that would allow me to do a significant change in status.

Well, one thing I definetly would not do is have a prearranged idea of when every assessment would be "the first Monday in there assessment period". First look at the type of assessment you would be completing. I think you are on the right track by looking at the patient in terms of what you can capture. I look at the MDS as a picture. In the picture it is important to capture as many resources provided as possible. So you are doing the right thing by moving the ARD date.

Some things that might help you in the future:

1. Before setting the date- listen to report, read the 24 hour report for all the patients who will be due an assessment.

2. Determine if they are experiencing an increase in there needs: ADLs increased, increase in MD orders or visits, Med changes, or any instability.

3. Also look at indicators that will increase your RUG score: administration of IV meds, IV Fluids, Rehab, Wounds, UTI, skin tears, Suctioning, Trach Care, O2 administration, Blood Transfusions....

4. Then set the ARD.

Sometimes these events may not have occurred and you will have to guesstimate...but if the resident/patient is sick than you will very likely capture all or most of the resources by selecting an ARD close to the time these events began to occur. Many of the items have a 14 day look back period.

Begin by looking at everyone who is due an assessment in the next 30 days. If they have something going on set there date....remember it is okay to set Annual and Quarterly dates a little early.

I hope this helps.

nratchet · Mar 14, 2008

umm...this was a quarterly assessment not an admission...i guess i should have been more specific. i am aware that the admission has to be done in 14 days.

quarterly assessments can only have 89-92 days between them.

for example...if you do a quarterly 1 in december with an ard of 12/18 and an rb2 of 12/21 your quarterly 2 must have an ard of no later than 3/18 and an rb2 of no later than 3/21. if you go beyond these dates to capture medications and/or doctor visits you will be out of compliance. they can be done earlier but never later.

flashpoint · Mar 14, 2008

quarterly assessments can only have 89-92 days between them.
for example...if you do a quarterly 1 in december with an ard of 12/18 and an rb2 of 12/21 your quarterly 2 must have an ard of no later than 3/18 and an rb2 of no later than 3/21. if you go beyond these dates to capture medications and/or doctor visits you will be out of compliance. they can be done earlier but never later.
umm...i know that too. i was really asking more about how to handle changing dates after things come up.

nratchet · Apr 1, 2008

quarterly assessments can only have 89-92 days between them.
for example...if you do a quarterly 1 in december with an ard of 12/18 and an rb2 of 12/21 your quarterly 2 must have an ard of no later than 3/18 and an rb2 of no later than 3/21. if you go beyond these dates to capture medications and/or doctor visits you will be out of compliance. they can be done earlier but never later.
umm...i know that too. i was really asking more about how to handle changing dates after things come up.
if things come up or occur after the rb2, if you've set it for the last possible date available between assessments, then you will not be able to include them. if you go past the 92 days between assessments to capture it you will be late with your assessment.

rukiddingme · Apr 7, 2008

I'm new in my position, but I'm noticing that getting ARD dates from the PT/OT people is like pulling teeth. If the patient is medicare, and has items from their hospital stay that I can capture, then it's okay, but if their only on Therapy, it's terrible. They haven't been giving me anything until the last minute!! Sorry, just had to vent. Tara

RN 4 Life · Apr 7, 2008

This can be especially challenging when the therapist do not understand the role they play in reimbursement for the center/facility and completing the MDS.

I would try talking to them first telling them the importance of the information you need, second I would try to determine why it is difficulty for them to provide you an ARD. Could it be they do not plan therapy treatments, could it be insufficient staffing which leads to inconsistent treatment...these are just a few reasons both of which can be worked around. Next I would just set the date for them.

Begin by asking them what level of rehab they believe the resident/patient will need. Then look at the patients MDS calendar and pick a date that allows the therapist to achieve the 5 days and ____ minutes they need. It is good practice to meet with the therapy director daily or at least every other day to determine if the therapist are on schedule to meet the patients rehab minutes. Doing this will allow you to plan ahead and move the ARD if necessary before it is too late.

This may seem like a lot of work but it will save you time in the long run. I hope this helps..check back in and let me know.

nratchet · Apr 7, 2008

This can be especially challenging when the therapist do not understand the role they play in reimbursement for the center/facility and completing the MDS.
I would try talking to them first telling them the importance of the information you need, second I would try to determine why it is difficulty for them to provide you an ARD. Could it be they do not plan therapy treatments, could it be insufficient staffing which leads to inconsistent treatment...these are just a few reasons both of which can be worked around. Next I would just set the date for them.
Begin by asking them what level of rehab they believe the resident/patient will need. Then look at the patients MDS calendar and pick a date that allows the therapist to achieve the 5 days and ____ minutes they need. It is good practice to meet with the therapy director daily or at least every other day to determine if the therapist are on schedule to meet the patients rehab minutes. Doing this will allow you to plan ahead and move the ARD if necessary before it is too late.
This may seem like a lot of work but it will save you time in the long run. I hope this helps..check back in and let me know.

I agree. Our medicare coordinator gives the therapist the ARD date and then the therapist then gives her the minutes and lets her know if grace days are needed. By doing it this way, the assessments are done in a timely manner. :nurse:

edhcinc · Apr 7, 2008

Hi. You may also try involving your administrator in this issue...especially if he/she understands the many ramifications of this communication.

In most cases, rehab cannot make a decision because of internal departmental inefficiencies:banghead:--they may not complete evals/Plans of treatment timely or may not have a system in place to quickly look at and compute treatment minutes actually given. Sometimes just asking them to use a calendar to track minutes will work. If rehab uses an electronic system, the minutes are automatically calculated.

Good luck!:wink2: