Pending Denials Increasing?

Published

Specializes in LTC.

I have been a MDSC for a little over a year now, and historically I would have the occasional PND denial on my MCD's. It seems that since Jan 1 the powers-that-be are much more hesitant to pay on the MCD's than they were just a few weeks ago. Just last week I had 4 PND at the same time. I also had one flat denied for the first time ever. I haven't changed the way that I argue for MN, so I believe that maybe the state has tightened it's purse strings, so to speak. Has anyone else noticed this trend or is it just me? I live in Texas, BTW.

Up Vote Up Vote ×
I have been a MDSC for a little over a year now, and historically I would have the occasional PND denial on my MCD's. It seems that since Jan 1 the powers-that-be are much more hesitant to pay on the MCD's than they were just a few weeks ago. Just last week I had 4 PND at the same time. I also had one flat denied for the first time ever. I haven't changed the way that I argue for MN, so I believe that maybe the state has tightened it's purse strings, so to speak. Has anyone else noticed this trend or is it just me? I live in Texas, BTW.

I live in Texas too and I have noticed the increase in pending denials. I had one recently that after picking the chart apart, correcting the LTCMI, calling the TMHP nurse three times it was sent back to the doctor and denied. They told me my next step would be to send a letter from the doctor saying why he needed LTC. It finally was approved. If they need a note from the doctor why do we spend our time assessing and doing the MDS. This patient seemed like a slam dunk for MN. He was under 60 years old and they are getting really bad about wanting to deny them. Our LTC has quite a few people from their 30's to 60's. I spend a lot of time on the MDS to begin with then they want us to sweat blood! It makes me look harder about accepting residents that might not qualify. It does not help our census and doe not help these people that need our services.

Up Vote Up Vote ×

I recommend you contact your state RAI Coordinator, Cheryl Shiffer, at 210.619.8010 to discuss MN requirements.

Up Vote Up Vote ×
Specializes in LTC.
I recommend you contact your state RAI Coordinator, Cheryl Shiffer, at 210.619.8010 to discuss MN requirements.

Thank you and I have been to seminars with Mrs. Shiffer and she is very helpful. My RRS is very useful as well. However, the problem that I see in my facility is that we have many LTC residents who truly don't need to be there. My DON is the primary person who decides if inquiries meet MN. I have no say in who is admitted and who is not. So, when it comes time to activate LTCMI's, I'm the one who's supposed to work miracles and get these people approved.

Up Vote Up Vote ×
+ Join the Discussion