keeping skilled open

noc4senuf · Sep 24, 2008

If when you say a skilled unit such as Medicare, they are indeed the bread and butter of a facility. It does require making sure the coding on the MDS captures everything possible.

CapeCodMermaid, RN · Sep 25, 2008

wow....skilled units are the money makers for most facilities. If you know how to admit the right case mix, pick the correct ARD for your PPS MDSs....you can make money

texasnurse46 · Sep 25, 2008

9/25/08

Okay...So, what if you work @ an in hospital Transitional unit, The Dr's & case mgrs feel that anyone should come to the unit. We get IV ABX, wound care, ortho pt's, CVA's, etc...the ortho pt's usually come up on Sat.'s. I need help with figuring out the correct ARD and how to educate Dr's & Case mgrs on who should come & who shouldn't. We have had one pt come here because he's wife recovered from ortho sx here and he had never been here before. They did receive PT/OT, but could have been dc'd from the hosp with outpt therapy. In my region, a lot of in hospital skilled units have closed as they are not money makers. It does keep the med surg, ortho units from keeping the pt's longer & loosing more money. Outside or Independent SNF's in our area, do not do IV ABX, & are usually filled as they keep pt's in their mcr section up to the 100th day. I appreciate all the input you all are giving. Thank-you!

noc4senuf · Sep 25, 2008

All of those items listed would generate more money under medicare. Do they have the 3 day qualifying hospital stay before they come to you? You need to look at when they are receiving these services and according to the MDS guidelines of when you can capture them (such as going back 7 days on some items and 14 days on others). Then adjust your ARD to capture the most.

Where I used to work in WI, they also tried to use up the most number of medicare days possible and as close to 100 days as they could. I now work in the Metro area on MN and our turnover on medicare stays now averages 7-10 days. It is a big push by managed care to get them in & out quickly. Also, the government wants it that way too.

texasnurse46 · Sep 25, 2008

9/25/08

Yes, our patients all meet the required 3 day hosp stay. We are an in hosp Transitional Unit, I look back at charts to capture transfussions, IV therapy, PT/OT,ST, etc. We are trying to keep stays down to less than 14 days to keep payment high, costs low.

UdonNomi · Oct 3, 2008

9/25/08
Yes, our patients all meet the required 3 day hosp stay. We are an in hosp Transitional Unit, I look back at charts to capture transfussions, IV therapy, PT/OT,ST, etc. We are trying to keep stays down to less than 14 days to keep payment high, costs low.

Are your PT/OT folks getting in there the day of admit? Are they treating on weekends and holidays to make the most of the 14 days you follow? Are you maximizing your ADL scores (while still staying legal)..:) Ya'll oughtta be making some money. Try setting the ARD for your 5 day (play with early/grace days) to get the maximum amount of rehab time you can, same with the 14 day. Good luck.

gonenutz · Oct 7, 2008

I work in a small facility and have found that if I set my 5 day at the 7th day and the fourteen day on the 11th day i can maximize therapy minutes and still capture the IVs ect from the hospital and put the residents into the rehab plus extensive rug. I also stay on top of my staff making sure they are coding the ADLs correctly and this has increased my facility's medicare reimbursment tremendously.

texasnurse46 · Oct 17, 2008

10/17/08

I did use the 6th, 7th as much as possible. The 8th day was used, but not as often.

This is an inhosp. TCC where the Docs & Admin would bring pt's up & "park them" for a couple of weeks. Of course, Ortho, brought the best reimbursement in, but, when Docs, families & Admin push to bring the pt's up who bring in the least amt of reimbursement in, it's very difficult to keep RUGS up.

Thanks all for your assistance & help. :yeah: