Medicare Charting

Specialties Geriatric

Published

I have a question.... In your LTC facility how often do you document on your Medicare residents? What guidelines do you use? Do you do vitals on them every shift?

At the facility I am currently working at we have to do vitals on each medicare resident, document on them in their chart every shift, even though it's pretty much the same on each night shift. We now have new guidelines that we have to chart on one each resident and it takes almost an hour to do 5 residents!!!!!!! That is just nuts when we have so many other things to do!!!!!! The facility frowns on having any overtime, so we end up donating :angryfire time to the facility or get a stern talking to from management. But then there is one nurse who always is there for at least 2 hours after her shift and c/o not getting her break and that she can never get her stuff done, but never gets "yelled" at...

Am just curious about what other facilities do for medicare... or even managed care...

Thanks

Specializes in Gerontology, Med surg, Home Health.

This is an unrelated aside....why do y'all feel the need to put (male) next to your name? Do we read your posts differently because you are a man? Nurses are nurses male or female and do we really need to differentiate on the basis of gender? When I was a little kid, there were 'women doctors.' Thank goodness now they are just doctors. When are we going to get over the 'male nurse' name tag?

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Specializes in Geriatrics, WCC.

When denials for Medicare are given out and the QIO is called by the family, the QIO calls the facility at anytime, day/night, ALL the info needs to be faxed ASAP to the QIO. It doesn't matter what day of the week it is.

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Specializes in ER CCU MICU SICU LTC/SNF.
When denials for Medicare are given out and the QIO is called by the family, the QIO calls the facility at anytime, day/night, ALL the info needs to be faxed ASAP to the QIO. It doesn't matter what day of the week it is.

This is absolutely correct. You have however at least 2 days to notify the beneficiary that a skilled service is to be terminated. But before that even transpires, the therapy department must have notified the facility of the plan. Thus, a responsible provider will be collecting all the necessary documents, photocopied or faxed, whether they be required or not, before finally issuing the beneficiary notice.

This is an unrelated aside....why do y'all feel the need to put (male) next to your name? Do we read your posts differently because you are a man? Nurses are nurses male or female and do we really need to differentiate on the basis of gender? When I was a little kid, there were 'women doctors.' Thank goodness now they are just doctors. When are we going to get over the 'male nurse' name tag?

LOL. I guess you'll receive more replies if you posted it in the general discussion forum or blame Brian for having this as an option. I prefer not to indulge in a hokum.

Let me share one thing, 'tho. Did you know a cadaver brain of a man will sell more to a medical school lab than a woman's? Yep, ... because it's "hardly used"!

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Specializes in Vascular Access Nurse.
this is an unrelated aside....why do y'all feel the need to put (male) next to your name? do we read your posts differently because you are a man? nurses are nurses male or female and do we really need to differentiate on the basis of gender? when i was a little kid, there were 'women doctors.' thank goodness now they are just doctors. when are we going to get over the 'male nurse' name tag?

call me weird (as i'll admit i am...) but i like to know who's a guy and who's a gal...though i'm not sure why! where i work, we still tend to say "you know, rich...the male nurse" when identifying him. but then, we may say "you know, judy....the long-haired blonde gal" in the same way. it's nice to have a guy or two around... a lot of our confused older ladies think they're doctors and will listen to the "male nurses"....we've exploited that on a few occasions (not telling the resident that he's a doctor, of course, but if goes into the room and asks mrs. smith nicely to take her medicine, she might do so for him when she just told me to go fly a kite......)

:nuke:

oh...and it says "female" next to my name.....so it's just an identifier....

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Specializes in Gerontology, Med surg, Home Health.

Don't forget, you can discharge the resident from therapy and keep 'em skilled on nursing.

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Specializes in Vascular Access Nurse.
Don't forget, you can discharge the resident from therapy and keep 'em skilled on nursing.

That's very true...but sometimes it's hard to explain to families that even though grandma has a foley catheter and can't feed herself, she doesn't qualify for "skilled nursing" as defined by Medicare....but she isn't well enough to go home without 24 hour care, either. Heck, the regs took me a while to figure out, so I can understand why our families are confused...and the $218/day bill is pretty tough to swallow, too. Of course, we encourage families to apply for MA and our population is about 70% medical assistance on any given day. I just don't think our government resources are going to be able to continue to handle the growing older population and their needs...but I've no clue as to what the answer is. Does anyone know how other countries are dealing with this?:deadhorse

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Specializes in Geriatrics, WCC.

$218/day??? Ours is more like $300-350/day. We stay around 40% on the medicaid, the rest is private pay and medicare.

Just because a denial is given does not mean we are going to start gathering and copying all the documents together "in case" we get a request for a demand bill. If and when it is needed, it will be done. Otherwise, it is a waste of valuable time, as we only get them once or twice a month.

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Specializes in Gerontology, Med surg, Home Health.

I believe Eskimo elders find an iceberg.

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at my facility all my pts are medicare (20-23 pts per night) and we have alot of admissions as well..so sometimes we are there 3 hours after we should have clocked out.. we have to document v/s q shift.. and then chart according to dx. however our unit manager gave us a sheet to help keep our thoughts to what we should chart.. maybe you should see if someone has a medicare guidelines sheet for you.. ours breaks it down to each skilled dx, chf, hip fx, etc.. and lists all the things we should chart on.. it takes alot of time.. but it actually is really great in the long run.. that way the pt is adequately being cared for and any problems can be addressed quickly and efficiently..

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Krislyn,

This sounds awesome. I have been trying to get some charting guidelines just like you are talking about. Where I I get some??? :confused:

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We are required to do assessment on day shift for all our MCR pts and vitals every shift. Night shift just does a few short notes. We also have regulations for charting on pts receiving abx, recent falls or injuries (even if they bump their arm and get small skin tear, which happens a lot), new admits, etc. I am still trying to get everything done, and though I learned how to assess in school, I always worked at a hospital where the RN's were required to do all assessments. Anybody with advice would be greatly appreciated.

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Specializes in Peds, CCU, ICU, Cardiac, ER, MS, SNF's,.

Hello CapeCodMerMAID:

document.png Re: Medicare Charting

This is an unrelated aside....why do y'all feel the need to put (male) next to your name? Do we read your posts differently because you are a man? Nurses are nurses male or female and do we really need to differentiate on the basis of gender? ... When are we going to get over the 'male nurse' name tag..."

I simply can not resist; but you have set yourself up for this reply; which I am sending with a big smile and laughing heart, not to be cruel at all.

My question is, regarding your post:

Does not your cyber-pseudonym used here indicate Your gender is female? Unless you actually are a male with a gender-switching cyber-pseudonym.... ????

Okay by me, but "MAID" usually indicates female to the masses. So, you have done what upsets you when another has done such, oh how very human you are!

If you go to your profile, options, there is a box to check whether or not you are female, male, or leave unchecked.

If you pick one, then the little blue Male emblem or pink Female emblem is displayed by your cyber-name here on the forum.

Hope you can see the humor in this. Gypsy.

Who chose to reveal herself as a female here simply because "I felt like it" at the time I was checking boxes, not to indicate any female superiority or inferiority complexes!!!

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