I Am Completely Baffled....

Published

Specializes in Medicare Reimbursement; MDS/RAI.

I couldn't really explain adequately in the title what my post is actually about but I would like some advice.

I am an LPN with more than 25 years LTC/SNF experience, and have been an MDS Coordinator for more than 10 years. As part of my position, I oversee, participate in, and educate staff regularly on Medicare claim denials. Both RAC (part B) and MAC (part A) audits are given to me solely to handle. It is my responsibility to gather all information, interview all staff, discuss pertinent issues with all disciplines involved before I send in our appeal and cover letter stating why we deserve payment for our services rendered. It is an arduous job but in 10 years I have been able to get payment on 100 percent of our claim denials.

We have gone through some major changes in our facility and our administration no longer feels LPNs should be allowed to perform this job and has given me the ultimatum to go back to school in xxx amount of time or I may be relegated back to floor nursing (which I am asked to do anyway when we are short staffed- at least a couple of times a month).

I am now enrolled in school on my dime because when I do get that degree, I'd like to look around and see what else is out there I may be interested in, keeping along the lines of what I do now.

With that being said, I was asked by a local hospital recruiter to give an online confidential recommendation on a nurse I supervised when I was at another facility. At the end of the recommendation, a window popped up asking if I'd like to look at current open positions they had. When I took a look, they had an opening quoted as "Clinical Reimbursement Specialist- RN/LPN. Upon "clicking" on the title link, the job description was described as being a reviewer of Medicare denials and RAC audits and appropriately appealing them, as well as educating staff, staying up to date on Medicare guidelines, etc, etc. The nurse filling the position was required to have at least 3 years experience in Medicare billing/appeals/HCPCS, be familiar with the new ICD-10 codes, and be LICENSED AS AN LPN OR RN. All the other recommendations were just that, recommendations, not requirements (specific computer programs, etc). The hours and benefits were more attractive and plentiful than what I have now, and it appeared to look like a nice job and "right up my alley", so I applied and uploaded my current CV/resume.

Today, I got an email stating that they had decided to "pursue other applicants". Now, this part did not upset me. But the CHANGE in the job description following it did.

Now, the job was listed as "Clinical Reimbursement Specialist- RN. The job ticket number was still the same, but the title had changed from "RN/LPN" at the end, to just "RN".

So, I went back to the website and looked up the ticket number. Lo and behold, not only had to job title been changed, but the requirement had been changed to read "licensed as an RN". No LPN anywhere in the description OR the title.

Now, before you think I just overlooked that, and saw what I wanted to see instead of what was actually there, I had a friend over the night I filled out the application and she looked at the job title and description as well. And I called another friend on the phone and asked her to look at it. I thought since they were employees there, they may be able to tell me where at the hospital I might be working. Also, I have the original confirmation email thanking me for the application and if they are interested they will contact me at a later date. That email also had the "LPN/RN" tag on the end of the description and ticket number.

I am hard-pressed to find any valid reason for this change. I would love some feedback as to what possible motives could have caused them to completely change the job description to exclude LPNs when LPNs were included in the original posting, which had been up over a week, until I submitted my application.

I guess what I am asking is - am I being too sensitive thinking they changed the job description after I applied?

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With any change in administration, there is also a change in what they perceive to be what an LPN can and can not do. I suppose if you think about it, if you are counseling RN's on how not to make the same mistakes again, it could be considered "clinically directing" an RN. It is a stretch, but that seems to be the 1 major definite no in most all LPN state scopes.

After a long and successful career at bedside, and floating to every area of acute care imaginable, the LPN's in my facility were told that they no longer could work as nurses unless they get a BSN. Period, end of story. Could care less about how much was invested, how good your scores were, what your performance evaluations said.....oh well, too bad, so sad....comply or look elsewhere. It was a shock to my system, as I am sure it was to yours as well.

The job description that you saw more than likely was not updated in quite some time. With that being said, there is any number of nurses who are fresh BSN's who would like better hours and no bedside.

And the sprinkles on top would be that if you chose not to get your RN, you would be training the new RN in a job you enjoy, you are successful at, and have not a clue why you can't continue other than political bru-ha-ha.

A lot of what an LPN can and can not do is facility based. There are states that have more pointed scope of practices. In my state literally the only thing an LPN can not do legally is clinically direct an RN. Otherwise, a facility can choose to use or not use LPNs however they see fit.

Sorry that this happened to you.

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Specializes in Medicare Reimbursement; MDS/RAI.

I guess I just felt as if the post had been changed because they actually had an LPN apply. This particular hospital has "phased out" their LPNs, forcing them to either get a higher degree or work as a tech, or in some non-bedside manner. Now, they are "phasing out" their ADNs, forcing them to all return to school for a BSN, retire, or go work somewhere else. It's crazy!! Who's going to do the bedside nursing? Unless things have changed since I last worked acute care, there aren't many nurses sporting BSNs who spent all that time and money to advance their education to work odd shifts, crazy hours, weekends and holidays, and deal with less critical situations that actually could be delegated. Don't get me wrong, I'm in SNF care now so maybe I'm a little oblivious to the staffing needs of a hospital, and I support all nurses getting whatever degree they need to accomplish whatever they need. I'm going back myself and though I was forced to in order to keep my job, I do find it rather fulfilling to be back in school all these years later. I just wonder, I guess, why less acute patients couldn't be assigned lesser-degreed nurses who cost a little less and therefore may save the hospital and the patient some expense. The more I ponder the more my head hurts!!

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Specializes in Allergy/ENT, Occ Health, LTC/Skilled.

I totally get what your saying. I have mentioned many times how helpful it would for RNs in hospitals to have float LPNs they could delegate tasks to and lighten their load. It's cheaper than hiring more RN's and better care would be given at the same time. Our title, plain and simple, means nothing to most hospital systems. Even though I am fairly certain I did not tack on the "nurse" to "licensed practical nurse" myself, I have often been made to feel that way. Like I am posing as a nurse when I am truly not one. Our state just passed a law that LPNs can do certain skills with PICC lines. In the LTC setting there is now no difference in our scope of practice but yet we are still paid far less. I am back in a bridge program myself because of the lack of respect AND pay. I am a good nurse and take care of 10 skilled and 15 LTC patients combined every shift. It's a **** show every time I go in but I handle it and give good nursing care. But that doesnt mean much when you do not have the almighty RN BSN after your name. The fact that you have to get a BSN is laughable. During my bridge program for ADN, I have had extra time and am doing all of my BSN pre reqs. I also have the class list for the BSN program. The only science class on that damn list is nutrition. The rest are things like world religon, etc etc. Sure, important, but not sure why that = better RN. No more pay is offered and hospitals around here have been trying to skirt around paying for BSN even if you work full time for them. The health care enviroment makes as much sense as it always has, which is zero. Its because people in suits who have never worked the floor or taken care of a patient a day in their rich life are making these recommendations.

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Things have changed, OP. Near every hospital in my area are requiring a BSN for any entry level nursing position on units, as case managers, as MDS nurses.

OP, perhaps there WAS an LPN in that position where you applied and declined to get a BSN, therefore, was let go or re-located. And they just reposted a stock ad. That they more than likely have not had to post in quite some time, and their new "policies" did not catch up with HR. OOPSIE!!

The business goal is customer oriented, have the very highest degreed person to say "Is there anything else I can do for you? I have the time" and other various uber cool catchphrases in order to make money. Regardless of the fact that the MDS nurse makes them money. But 25 years in and one makes a nice salary. A newly minted nurse would require half your salary.

BSN's seem to be all on the road away from bedside, onto NP or CRNA school. So the question becomes what then? Perhaps medical assistants, medication assistants, and patient relations people and others that the can pay even less. But then that flips to another plan of all customer service all the time and to not be disturbed by that pesky nursing stuff.

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Specializes in Psych, Addictions, SOL (Student of Life).

The 2011 Institute of Medicine's Future of Nursing report which declared the goal of 80% of nurses nationwide to be bachelor's prepared by 2020 (Nickitas, 2013). This goal is directly linked to multiple studies which have shown a decrease in hospital mortality rates correlates to higher education levels. According to Nickitas (2013), for every 10% increase in bachelor's prepared nurses, there is a 7% decrease in mortality. Personally, these numbers speak volumes to me, as I want to ensure that I am caring for my patients to the best of my ability. It is also a goal buried deep in the text of the ACA that all acute care nurses bedside or otherwise be BSN prepared by 2030. It's a lofty goal but the theory is that better educated nurse make safer nurses. Hospitals who have Magnet status or 5 Star satisfaction rating get higher levels of reimbursement than hospital's that don't. So I am shelling out $30,000.00 + dollars for a BSN just so I can keep a job.

To the OP - I don't envy you and I am sorry your position is being phased out - I just did MDS for month in the facility where I work because the regular person who holds that position went on vacation. It is an incredibly complex and difficult job to do right and I would gladly care for 20 patients that do it again.

hppy

Nickitas, D. (2014). Investing in nursing: Good for patients, good for business, and good for the bottom line, Nursing Economics, 32(2) 54-69.

Spetz, J. & Bates, T. (2013). Is a baccalaureate in nursing worth it? The return to education, 2000-2008. Health Services Research, 48(6), 1859-1878. doi:10.1111/1475-6773.12104

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I am so sorry you are experiencing this, OP.

I saw the writing on the wall several years ago when I was an LVN. In our credential-obsessed society, degrees are valued more than the person's skill set. This is one of the reasons I earned my RN licensure.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

It is the change of the times, my dear friend has decades more experience than me as ADON/MDS Coord....but when the last SNF she worked at...,was purchased by a new "owner".... She was shown the door.... As the new company thought her position could only be held by a RN.

.. I am saying as a former DON... "I always was grateful when she was in my building, when there was a state audit....„She could carry a facility....but in the end..she was LVN...

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Specializes in Medicare Reimbursement; MDS/RAI.

To hppy, re: the articles you posted: I've saved them to read them in detail when I have time; but I'd like to pose a question to you, since you've read the entire texts, if you don't mind me picking your brain. :)

I understand, in theory and in practice, that more education = better care. But, could the mortality rate, at least in part, have dropped, because as BSN nurses are hired, they are allowed to have more stringent demands as to how they are assigned? I don't have a clue as to what kind of bargaining power a BSN nurse might hold in a major metropolis area, as I live in a somewhat smaller town with two hospitals with level three trauma centers and one of those also has a level three NICU. The nurses here with BSNs RULE. They are given choice assignments, hours, benefits, etc. I'm not complaining, mind you. Just making an observation to point out that, maybe, if BSN nurses can demand more nurse-friendly working environments -a lighter nurse to patient ratio, not having to work overtime, actually getting to take a week long (or longer) paid vacation, getting offered facility-paid educational opportunities, etc.- the stress factor of the nurses go down and the health factor of the patients go up? Could the quantifying factor at least in part be shorter hours, less patients, etc. ? Which would, in theory, result in less mortality as nurses have time to notice smaller differences in baseline health, rather than having to react to ones that have been overlooked and are now larger ones?

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I couldn't really explain adequately in the title what my post is actually about but I would like some advice.

I am an LPN with more than 25 years LTC/SNF experience, and have been an MDS Coordinator for more than 10 years. As part of my position, I oversee, participate in, and educate staff regularly on Medicare claim denials. Both RAC (part B) and MAC (part A) audits are given to me solely to handle. It is my responsibility to gather all information, interview all staff, discuss pertinent issues with all disciplines involved before I send in our appeal and cover letter stating why we deserve payment for our services rendered. It is an arduous job but in 10 years I have been able to get payment on 100 percent of our claim denials.

We have gone through some major changes in our facility and our administration no longer feels LPNs should be allowed to perform this job and has given me the ultimatum to go back to school in xxx amount of time or I may be relegated back to floor nursing (which I am asked to do anyway when we are short staffed- at least a couple of times a month).

I am now enrolled in school on my dime because when I do get that degree, I'd like to look around and see what else is out there I may be interested in, keeping along the lines of what I do now.

With that being said, I was asked by a local hospital recruiter to give an online confidential recommendation on a nurse I supervised when I was at another facility. At the end of the recommendation, a window popped up asking if I'd like to look at current open positions they had. When I took a look, they had an opening quoted as "Clinical Reimbursement Specialist- RN/LPN. Upon "clicking" on the title link, the job description was described as being a reviewer of Medicare denials and RAC audits and appropriately appealing them, as well as educating staff, staying up to date on Medicare guidelines, etc, etc. The nurse filling the position was required to have at least 3 years experience in Medicare billing/appeals/HCPCS, be familiar with the new ICD-10 codes, and be LICENSED AS AN LPN OR RN. All the other recommendations were just that, recommendations, not requirements (specific computer programs, etc). The hours and benefits were more attractive and plentiful than what I have now, and it appeared to look like a nice job and "right up my alley", so I applied and uploaded my current CV/resume.

Today, I got an email stating that they had decided to "pursue other applicants". Now, this part did not upset me. But the CHANGE in the job description following it did.

Now, the job was listed as "Clinical Reimbursement Specialist- RN. The job ticket number was still the same, but the title had changed from "RN/LPN" at the end, to just "RN".

So, I went back to the website and looked up the ticket number. Lo and behold, not only had to job title been changed, but the requirement had been changed to read "licensed as an RN". No LPN anywhere in the description OR the title.

Now, before you think I just overlooked that, and saw what I wanted to see instead of what was actually there, I had a friend over the night I filled out the application and she looked at the job title and description as well. And I called another friend on the phone and asked her to look at it. I thought since they were employees there, they may be able to tell me where at the hospital I might be working. Also, I have the original confirmation email thanking me for the application and if they are interested they will contact me at a later date. That email also had the "LPN/RN" tag on the end of the description and ticket number.

I am hard-pressed to find any valid reason for this change. I would love some feedback as to what possible motives could have caused them to completely change the job description to exclude LPNs when LPNs were included in the original posting, which had been up over a week, until I submitted my application.

I guess what I am asking is - am I being too sensitive thinking they changed the job description after I applied?

I had something sort of similar happen. There was an opening at my employer for a position that was listed as an LPN OR RN. I double checked with HR to make sure this posting was correct because to apply for any position you must inform your manager first. The reassured me that indeed I should apply as my current job and education experiences matched the job description EXACTLY.

So I informed my manager (who acted like a child when I told her and refused to speak to me for weeks) and applied. I contact HR to ask the status after a few weeks went by. Their response was they had an RN apply so they were going to pursue her first even though she was a new grad. That's fine, whatever. The job posting remained up on our website for 4 months post this event and the position still remains open. Guess that person didn't pan out. I was asked if I was still interested.. Uhh no thanks. Shove that job elsewhere because I'm back in school and getting the h&ll out of this dump.

They've contacted me several times about taking it now. Nope still not interested. You had your chance and refused to even offer me an interview, now you're begging me. Guess my LPN license isn't as sh%tty as they thought. You're better off OP. My suggestion is to head back to school. I'm enjoying it overall (I mean there are some things that do REALLY suck), but I can admit I am actually learning a lot by pursing my RN and am happy to have finally stopped making excuses and get it done.

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Specializes in Medicare Reimbursement; MDS/RAI.

Not that I'm glad it happened to you, Emmy, but I am glad I'm not being overly sensitive and seeing an issue where there wasn't one. I am in school, and I was when I applied. I was forced to do so when my facility decided an LPN with ten years of MDS experience wasn't enough. Still, like you, I am enjoying the learning for the most part. I just wish I had done it sooner. It seems harder for me to absorb the material than it used to. :)

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Specializes in Psych, Addictions, SOL (Student of Life).
To hppy, re: the articles you posted: I've saved them to read them in detail when I have time; but I'd like to pose a question to you, since you've read the entire texts, if you don't mind me picking your brain. :)

I understand, in theory and in practice, that more education = better care. But, could the mortality rate, at least in part, have dropped, because as BSN nurses are hired, they are allowed to have more stringent demands as to how they are assigned? I don't have a clue as to what kind of bargaining power a BSN nurse might hold in a major metropolis area, as I live in a somewhat smaller town with two hospitals with level three trauma centers and one of those also has a level three NICU. The nurses here with BSNs RULE. They are given choice assignments, hours, benefits, etc. I'm not complaining, mind you. Just making an observation to point out that, maybe, if BSN nurses can demand more nurse-friendly working environments -a lighter nurse to patient ratio, not having to work overtime, actually getting to take a week long (or longer) paid vacation, getting offered facility-paid educational opportunities, etc.- the stress factor of the nurses go down and the health factor of the patients go up? Could the quantifying factor at least in part be shorter hours, less patients, etc. ? Which would, in theory, result in less mortality as nurses have time to notice smaller differences in baseline health, rather than having to react to ones that have been overlooked and are now larger ones?

I think it's a multi-level issue. 1st the hospital's pushing for Magnet status which means all RN have BSN which in turn guarantee's higher capitated rates of reimbursement from insurance companies.

Secondly - and please don't take offense as I have know many LVN and Associate level RN who are fantastic nurses, but the recent push by for profit schools to turn out huge numbers of nurses has in some parts of the country led to a work force of nurses who have inferior skills and know it but got into nursing for nothing more than job security in a depressed job market.

Third - As the federal government continues to push the minimum wage up many nurses without higher degrees will be working for minimum wage or just slightly above. As anyone knows when minimum wage goes up so do expenses like rent, food etc.......so in essence people really aren't making more.

In theory better educated nurses have better trained clinical instincts which in turn lead to better assessments, care a patient outcomes.

I recently went back to school to get my BSN and although it's been tough scraping the $37,000.00 dollars together to do it. I do find that I am learning a lot of new things and looking at my patients with a different clinical eye than I did in the past. I actually don't expect to make a whole lot more Money unless I pursue a NP - but since I plan to work on an Indian Reservation when I leave the bedside it probably won't be a huge amount of money.

Peace

Hppy

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