imkaren2

I would consider keeping the patient on skilled also to prevent/manage skin issues, pain, physical and/or emotional, to name a few.

yes, thats exactly what the RAI says, I didn't have my hands on it at the time but knew that...so my question was how are other facilities handling that? I know I am not working around the clock!

As a rule only our admin and admission director can accept admissions, they accept them VERY quickly before someone else gets them!! I review online the preadmission screening, then when they are admitted, I look at the d/c summary sent from the hosp which gives the prim dx and a few others. I review the d/c summ and am usually able to put tog the whole pic for the dxs codes. But the pre-admission screen will have given me the reason for admit to the hosp. The d/c summ will give you a good pic of why they went to the hosp and now why they are with you. If you aren't getting the d/c summ. keep after your admission director to call the hospital each time immediately after the pt is admitted and they don't come with it, right away. The hosptial has it, they can easily fax it.

I do all the medicare MDSs in the building and today my medicare census is 21. The facility has 154 beds so I also do about 30 long term care MDSs. I attend daily PPS, care plan meetings 2x weekly and several other weekly meetings and other jobs as well regarding management of medicare boards that the regional team views daily. I complete on average 50-70 medicare MDSs a month, that isn't including the long term care which would only add about 12-15 more MDSs. All of the Medicare are new admits soI follow them until they go home so I do their CAAs, and their care plans as well then their discharge assessments.

Medicare will cover her for rehab 3x/wk and 2 restoratives, I'd look into pain and if we are how often do we need to change her meds to manage her pain, how about the bleeding and what is being done with that and how often in a weeks time? All are skilled under medicare if we are doing them. If not, she may become custodial once rehab pulls out.

I thought so too but after reading the RAI in ch 2, it appears that the ARD needs to be set prior to d/c. Our company has stated that and I'm reading it that way also. Only then you are able to modify the ARD to the d/c date. The RAI is saying that once the pt no longer is a med A pt hence is d/c you are no longer able to set the ARD. I'd love it if someone else would read it and give me another interpretation. Thanks for anyones help!

I'm wondering what other MDS and CCMs are doing in the case where your medicare patients are admitted late friday after you go home and are discharged to the hospital or expire before you return on monday and you aren't able to set and ARD. Are you taking the default days, are the floor nurses setting the ARDs for you, are the unit managers, DONs setting the ARDs? We are being asked now to plan for this after being taken off salary, we don't work weekends so I'mm looking for a plan. thanks!

I'm just reading this now, We need to be closed by the 3rd of the month, mincluding those that came in at the end of the month. It doesn't make sense to us to hold up billing and bill the next month when the patient didn't come in that month. I am an MDS person and it would be sloppy billing for us to hold up claims and bill later. It makes sense when you are running a large corporation and are paying out bills monthly, it would seem that you really need to get paid timely. thanks!

I was managing 20-28 medicare and 6-10 managed care pts. and that was way to overwhelming and attending multiple meetings nearly daily. Our SNF is 154 pts and the rest are LTC, I have 1 other MDS person who did the rest of it. About 2 months ago the company finally realized that we were only getting farther and farther behind with her working the floor every week and on weekends. We were a month behind with every pts MDS in the building before they would look at us and make changes. Not a single pts care plan was current. Not a discharge assessment was done in 2 months. We have been banned from all meetings since then, she took over managed care and I added LTC only on the unit I have my office on and she supports my by helping me completing as many MDSs as she can while keeping up with her work. So far this new plan has worked out very well. I would advise you not to take on such a huge committment, theres too much to learn and do right now, too big of a job for one person especially when you don't know the job already. Your MDS position will come along, this isn't it. Good luck!

My feeling is the eval counts as a day, and the next 2 days make 3 days without therapy. The person who said this rule doesn't apply to the 5 day, not so, if there is no therapy for 3 days, including weekends regardless if you are a facility with/out rehab on weekends an EOT needs to be done unless the previous RUG was a nursing RUG. However, in this case, you may look at doing a SOT if able before resorting to the EOT. I'm not sure if an EOT-r would be useful at this point. My understanding of that type of assessment is to resume rehab where you left off within the past 5 days at the same RUG. If the pt. never got rehab, I can't see how that would apply. Just my thoughts..

We'd be admitting him too. I'd use the d/c date as the 5-day and combine them. 11/8/11. You'll want the RUG to cover for a day is what I'm told even though we don't charge for day of discharge.

It's standard precat in our facility too, and some of our folks have ESBL, VRE or MRSA with it and its still standard. Basically if it's strict isolation, they go back to the hospital for reverse iso. is what we are told. Otherwise we do everything else standard.

Our building is 154 pts. myself, RNAC, and a MDS person, we attend al of the careplan meetings, there are 3 at risk meetings, I attend 1 of them, she attends 2, I attend PPS daily, and keep up the management board daily, Monthly PI, and of course, we complete the MDS, CAAs, and all of the careplans for the facility. I'm salary and do ALOT of work at home. She is not and has to leave on time.

I love that goats smile! LOL:)

Hi Sheryl If I understand you correctly, your pt. went out to the hospital and returned, the day he returns is day 1 of his medicare stay. So now that 5day is set for the day the pt. went to hospital and is also the discharge assessment. Both of those assessments can be combined. It doesn't sound like it meets the requirements for a short stay. Ok so when you bring back the pt. and are doing another discharge, yes, the start of medicare would be the "reentry" date and the "end date" would be the discharge date. As far as therapy goes, no end dates there because they never ended. Ask yourself this question.."If the patient didn't go to the hospital would therapy have ended?" At some point in time, that date will come to play should you decided to do a short stay. Does all this help? Karen