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  1. ibtootie

    Section G

    We have a resident who is total care with assist times 2 for all of his ADL's except eating which requires set up and supervision. All of the nursing aides except one scored him as Self Performance 4/ Support Provided 3 during the seven day lookback. The one aide scored him on one shift as 3/3. I know I can't score his self performance as a 4, but since she also scored his support provided as 3 can I capture that, or must it be all defaulted to 1 also?
  2. ibtootie

    Overworked or slow, I want to know

    I work in a 20 bed Hospital affiliated Medicare SNF that averages 44 admissions and discharges per month with an ALOS of 13.7 days. I am responsible for the entire MDS assessment, including all of the patient interview sections, as well as calculating the therapy minutes. I absolutely am drowning in MDS assessments! Not one of my superiors have any background in Skilled Nursing. Their areas of expertise are acute care and they seem to have the opinion that a RUG is as easily obtained as a DRG. I can't seem to make any of them understand how complex the MDS process is. They can't seem to understand why I am asking for extra help and why I am not able to just "do the RUG's as they come in." (Their words, not mine) I am about to throw in the towel and leave, but I first want to know if this load is really a heavy load, or am I just slow? I really want to know others opinions.
  3. ibtootie

    Assessment out of sequence

    Resident admitted on 8/24/15 and then sent back to acute care on 8/29/15. She didn't qualify for a short stay assessment. I completed a 5 day assessment combined with a discharge-return anticipated. She readmitted back to our facility on 9/2/15. Using jRAVEN, I entered an admission tracking assessment, but I keep getting a warning saying that the assessment is out of sequence. The jRAVEN user manual only states that you can ignore it, but I would like to know why it is showing a warning. What am I doing wrong?
  4. ibtootie

    Omitted POA PU on last Quarterly

    Resident admitted to our facility with 2 POA stage 4 pressure ulcers. On his last assessment one of the ulcers healed to stage 2, and the one on his coccyx was still stage 4, but decreased in size dramatically. It is time for his quarterly assessment and I have discovered to my horror that on that last assessment, I failed to include the stage 4 ulcer on the assessment. Now the former stage 2 has healed completely, and the stage 4 is still stage 4, but decreased from 10X10 cm to 2X1 cm. Can this omission be corrected?
  5. ibtootie

    OBRA discharge correction

    Resident sent to hospital 8/7 for worsening wound infection for which he was admitted. The wound was documented in chart, but nurse failed to also document in the chart a fall with no reported injury that occured the day prior (8/6/14). I just found out about the fall, but his discharge assessment has been long sent. Would a modification suffice?
  6. ibtootie

    Albumin infusion

    Does an IV Albumin infusion count as a blood product or simply an IV med?
  7. ibtootie

    SOT or not?

    Resident admitted for IV antibiotics and therapy. After 2 days of therapy, the doctor put him on strict bedrest, so 5 day PPS captured a Medical RUG, not rehab. On day 9 he resumed therapy, but again his minutes failed to capture a rehab RUG, so my question is can I (or should I) do an SOT?
  8. ibtootie

    I think I already know the answer

    MCR resident admitted to SNF from acute care at 5:00 pm and was transferred back to acute care at 9:15 pm the same day. No midnight stay. She didn't return to the SNF, but went home instead. Since she didn't even have a midnight, I know we can't bill, but do I even need to do an NC assessment for a four hour stay? I'm tinking I don't have to submit a comprehensive assessment, just a discharge tracking assessment.
  9. ibtootie

    ARD dates with MCR Advantage Plans

    Does anyone know of any of the Medicare Advantage plans that adhere strictly to the PPS schedule?
  10. ibtootie

    ARD dates with MCR Advantage Plans

    Whenever I have a Resident with a Medicare Advantage Plan, I usually adhere to the PPS timing of ARD dates since I have encountered a few that prefer the timing to be the same, even though the subsequent NP assessments aren't submitted to CMS. It has always seemed simpler to do it that way, especially if those residents required a longer stay than 14 days, but what if the Resident stays less than 14 days? Do I have the option of setting the ARD date at day 11 if we are certain from the start that the resident will not stay beyond 14 days?
  11. ibtootie


    First I just need to blow my stack that no matter how much I instruct and educate the Unit Assistants on ADL documentation, they still either don't get it or don't care to get it. No matter how much I complain to the Nursing Director about it, either she too doesn't get the importance of it, or she doesn't want to! That being said, Mrs. X was admitted to our facility for rehab after a total knee arthroplasty. She was in our facility 7 days and had 8 different UA's assigned to her. Of that 8, only 2 actually documented ADLs. "Bob" is one of the night UAs and had her 2 nights. His documentation is pretty accurate, and coincides with the Nurses and Therapists documentation. "Sherry" is one of the day UAs who had her for 3 days, and her documentation is rarely ever accurate. She often combines self performance and support in ways that are not even logical, such as independent and 2 person physical assist, so most of the time I cant use any of her documentation. I have instructed her and reinstructed her until I am blue in the face, and it doesn't seem to sink in with her. My problem is that there were only five entries for ADLs, and only 2 of those 5 entries could be used. Technically there were more than 3 episodes ADL documentation, but I don't feel comfortable submitting what there is since I know it isn't accurate. Has anyone else ever experienced this, and if so, how did you handle it?
  12. ibtootie

    Fatal Error Message-Not sure why

    Thank you Talino!
  13. ibtootie

    Fatal Error Message-Not sure why

    Resident admitted to SNF post Rt Knee Arthroplasty that developed stitch abcess for continued rehab and antibiotics. On day 7 Ortho Doctor placed her on bedrest and suspended therapy due to concern for DVT and did not resume therapy. ARD was for day 8. I combined the 5 day assessment with A0310C=3, which gave a Z0100A RUG of RMA15. After submission to QIES got a Fatal Error message -3804 In consistent HIPPS code: If A0310C equals 1 or 3, then the first character of Z0100A calculated by the QIES ASAP must equal R. The QIES recalculated score was AAA00. Should I have not combined the 5 day with A0310C=3 and submitted them separately as a 5 day Comprehensive and then another on day 10 as an EOT? What did I do wrong?
  14. ibtootie

    Is a Correction Record needed?

    We discharged a resident to home on 1/16. She returned to the hospital 1/25, and was readmitted back to our facility on 1/30. I submitted her NT A1700 as Reentry rather than Admission in error and got a WARNING -1018 Inconsistent Record Sequence on the Validation Report. Should I create a Correction record for this or correct it when submitting the NC assessment?
  15. ibtootie


    This morning I went to a new residents room for her Comprehensive assessment. Upon entering the room and introducing myself and why I was there, she said, "Oh you are here for the MDS assessment. Just don't use the words sock, blue or bed on me, because I've been in so many facilities over the past few years and I have the words memorized and am sick of them." Trying to humor her, I substituted shirt, shoe, and couch, and to my surprise she missed all three for C0400-Recall. My delema is deciding whether to go back and reassess her with the specific sock, blue, bed, or just documenting that she requested not to use those exact words and score her as she was. Any thoughts?