VeryberryRN

Happy Thanksgiving! Sounds like you haven't enjoyed your day much. Stop worrying about work and have a glass of wine. To answer your question - first of all, you really should not be covering residents coming back from a mental health stay under med A. The feds do not see that as an "acute" hospital stay. I attended a Medicare seminar not too long ago, and they told us that 90% of the time those charts get denied in review. When you are covering for other things that are not therapy related, be sure you have the proper documentation to back up what you are covering for. Most of the time you can cover residents returning from the hospital for the presumption of coverage if they had an IV, as long as you have the proper documentation. If they can't continue to be covered, be sure to cut them by day 5, and issue a cut letter ond day 2. New residents coming in that are being covered for things other than therapy such as skin issues need excellent documentation by the nursing staff. Be sure you have measurements of wounds weekly, and daily notes. The cut letters are on the Medicare site one the internet. There are 5 different ones. They are generic. Be sure you put your facility letter head on each one. You must give a cut letter to residents when they are cut from part A medicare 3 days before they are cut. You also must give them one when they have a partial cut in benefits. For example - if they are recieving PT and OT, and they are only cut form OT, you must give a cut letter for the OT when it is cut. This is a new rule, and there is a special form for this. There is also special language that you have to put on the form that is available on the internet, also on the Medicare Site. You can keep track of the billing days for med A, but the billing dept. is responsible for actually doing the billing. There is a Exel Spread sheet for PPS Medicare days that you can download from from the AANAC site. If you are not a member I can e-mail it to you. You should not be giving out the letters to the residents. I am a firm believer that this is a Social Service function. I dont think that nursing should mix medicine with money. I also have a form that I have made up for the computer that I keep track of my medicare A residents stay on. It has their name, Medicare#, ARD dates, Billing Dates, Why they are in the facility, Date of admit, Hosp stay dates, and ICD-9 codes on it. I keep one of these filled on on each med A resident, and on the private insurance resident too, since most of them require medicare MDS's. I keep them in a note book, and when we have our weekly medicare meetings I have easy access to what we have. If you would like a copy of that I can e-mail you the shell to that as well. Good [email protected]

I don't envy you being the only RN over seeing the process. In NYS you have to be an RN to be an MDS coordinator. I would suggest you get your MDS nurses certified. That will help them understand the process so much better. You can take the AANAC courses on the computer if there is not one being offered near you. Medicare is getting more complicated every day, and the feds just want us to mess up so they can take money away. You have to know your stuff to survive in this finacial climate.

I appaude the way you handled the situation when you returned from vacation. Too many times these kiinds of things are allowed to slip by due to short staffing, and the staff get the misguided message that it is OK not to follow the rules. So pat yourself on the bacik, you are an excellent manager. Having said that, the answer to your question is yes, when I am away, nothing gets done. Luckily, I don't manage a unit. If you are the MDS Coordinator and a Unit Manager you need your head examined. Just one of those jobs is a killer. I am the MDS Coordinator for 120 beds, 40 of which are Rehab. Recently I had knee surgery, and was out for 5 days. It was near the end of the month, and I was in a panic, because I knew that my MDS's had to be finished for billing. Pretty bad when you can't even get sick. So - I am now working with a brace on my knee, and with a walker. I look and feel like one of the residents, but my job is getting done. The only other person in my building that knows how to do an MDS is the DON, and she not about to do them. I guess it's nice to have job security, but sometimes I really would like alittle more help.,:typing

Sorry if I didn't answer your question. I don't think you can get into any trouble technically. Your administrator is the one that will have to take the heat with Medicare. I am having a similar problem, but it concerns Medicaid. Recently we have switched from using the PRI for Medicaid reimbursement for the MDS. My Administrator,DON, and I went to a workshop a couple of weeks ago that told us that we can move the Quarterly and Annual MDS dates during the "picture dates" to improve the scores. Even do quartery MDS's as close as weeks apart. We have not heard this officially from the DOH as yet, but the picture date period has started, and My administrator of course wants me to begin to move the MDS's when residents are ill, or picked up for PT to improve their scores. I am very leary that we are creating a logistical nightmare that we will have a very hard time getting out of. Does anyone else from other states that have been being reimbursed by the MDS for awhile have this problem? Heeeeeeeeeeeeeeeeeeelp? Confused in NY!

Depending on where in the Syracuse area you want to land, there is alot to pick from. The big city Hospitals in Syracuse are University Hospital, ST.Jospephs, Communitiy General and Crouse. One of the other replys mentioned these. I live in Oswego,NY. We are 45 min. from Syracuse, and right on Lake Ontario. My Husband and I are both RN's. He works for Oswego Health, and I work for Sunrise RHC and Rehab Center. We love it here, and wouldn't live anywhere else. The RN salary range for an experenced RN starts somewhere around $20/hr and up, but that of course depends and experience and where you are working. There are also several other LTC facilities in this area that are always looking for RN's , as are we. Just as a side note, my son is married to a Canadian citizen from New Finland. Best of luck to you and your new hubby:yeah:Let me know if we can help you.

You are really in a no win situation. You are absouutely correct to be concerned. Your administrator is making decisions for your entire team that can get the entire team into trouble. My concern would be if he is as unscrupulus as you say that he is, when it comes time for a Medicare audit, he will blame anyone but himself for a bad audit. The key to the game is documentation! Protect yourself. Make sure you can back up what you put in that MDS.:typing Good Luck!

you are 100% correct, all of these things are needed. however, it is almost impossible to get staff to document all of the above unless you have perfect staff. having said that, this would be a very difficult area to do an omra on. remember, it is done 8 days after therapy is ended, so those 8 days after therapy's end the documenttion has to be perfect!

I am an MDS Coordinator in New York State. I have been doing my current job for three years, but have been doing MDS's since 1986. (Yea, I'm one of those old nurses) I have been an MDS coordinator in other facilities, and have managed a rehab unit before my current job. Here you have to be an RN to be a coordinator. My facility has 120 beds. Basically I really love what I do, and I really believe in the MDS. It works if it is used correctly, and if the staff allow it to work. It sounds like the place that you work has not learned to use it at all. From what you described, you were never given the tools to even do the MDS correctly, much less get the other departments to do their parts. Your didn't mention if you are certified. If you decide to stay in LTC, I suggest you get certified ASAP. This will help you more than you can imagine. Also, you need to sit down with administration, and work out a plan to become organized. You can NEVER be behind as much as you spoke of being behind. The other departments are setting you up for failure. Turning in your resignation out of anger may not be the best thing for you professionally. You may want to re-think that. Best of luck!!

Isn't it a good thing that we have become older and wiser over the years! As much as some nurses would like to think that restraints are for the good of the resident, that hardly ever is the case. Tying people down is just not the answer.