Raising CMI

Nascar nurse, ASN, RN · Apr 16, 2009

I know how to go about raising the CMI in my state, but don't know if the states have different qualifications for their CMI's.

Always capture an IV med, IV fluids, trach care. Have therapy do a screen prior to Ann/Q so that you can pick up minutes if the resident will be attending therapy. Add more residents to restorative care.

nursekara78 · Apr 16, 2009

What systems do you have in place....tracking ADL's.... ADL's are usually the most undercoded. Does therapy screen res. upon return from hosp. They can usually justify therapy for a few wks. Often order chgs and md visits are missed. Can they see the dentist a week early??? I often see what RUG they grouped in and how i can improve....eg: if they are i clin. comp. can i work w/ SS and see if they missed coding something in E1 & E4. or can restorative nsg be added to their plans of care before next case mix if they score in Behavior, Impaired Cog and physical function. You can do some books earlier to capture something that will give you a higher rate. ie: pneum. wounds etc. although you may raise your QI reports. we have some good systems, if you have more specific situations, I can share what we do. We are presently trying to figure out a system to capture section E better. We know the res. do things on the w/e and 3-11 etc. that we are missing. Good Luck!

luvwine · Apr 16, 2009

WE do use an ADL tracking form. Therapy does screen upon return from hosp.We do a lot of short term rehab. My promblem is we have several long term residents with a very low CMI . I am having Therapy reeval when they are due for their annual. I am inservicing CNA on documentation. What do you mean by doing books early? I am new to this position. I have only been doing this for 6mo. I appreciate any suggestions. Thanks for your response

Talino · Apr 17, 2009

what do you mean by doing books early?

that would probably be slang for doing an assessment earlier than actually scheduled.

example:

last quarterly r2b was 2/1/09, rug = pa.

next quarterly r2b would be due on or before 5/3/09, probably w/ an ard set on 4/20 or later.

resident was seen by a dentist on april 1st with an order to keep denture off for 2 days.

on april 3, the opthalmologist saw resident for his glaucoma follow-up and change his eye meds.

these would equal to 2 md visits and 2 md orders.

since your ard begins on 4/20, you would have missed these events based on the 14 day lookback for p7 & p8.

however, if you move the assm't earlier and set the ard on or before 4/14, you will capture the visits/orders and raise the quarterly rug score to ca.

have a cheat sheet similar to this and memorize what conditions yield a higher rug.

be present during the daily 24 hr. report and check if a resident has an acute change in clinical condition or may have required more staff assistance in adls during the week. when is his next assm't due?

most important, choose ards wisely. be flexible. schedule it later or earlier depending on what conditions or better adl sum you can capture that will produce a higher rug. just remember you have to complete the assessment (r2b) within 14 days of the ard, and, that r2b is within 92 days of the last assm't's r2b.

luvwine · Apr 23, 2009

Thanks I appreciate your advice.

KelliSipe · Sep 25, 2009

Since the rate doesn't change until the first of the month following the ARD, one thing we do is this: If you have a resident that has an assessment due on say 10/5/09, most people would set the date a little earlier rather than later so as to avoid potential compliance issues. However, if you set the ARD for 10/1/09 rather than 9/30/09, you have kept this resident in a Higher Rug for an additional 30days at the new lower rate will now change as of 11/1/09 rather than 10/1/09. Creative scheduling and you have to really watch to make sure these are closed on time since you are completing so close to when your R2b has to be. With that said, just by doing this and tracking for 2 years the results just at my building, we have created an additional $300,000+ dollars in two years alone. I developed this along with a few other creative scheduling things and have created so much additional money that our corporation has implemented this corporate wide for states with Case Mix. Hope that helps... Any questions, feel free to e-mail me at [email protected]

luvwine · Sep 25, 2009

Thank you :yeah:

disney158 · Oct 16, 2009

:down: I'm glad I stumbled into this thread, in Jan. 2009 NY went to case mix for reimbursement based on MDS and I can't tell you how angry I am and annoyed, at one organization I work at. What a miracle that 75% of the Medicaid patients in this facility needed some sort of restorative therapy during the capture period, and I'm talking about everthing above a RHB even up to RUB, and that remaining 25% miraculosly fell into a skilled or special care category. How lucky for that organization!!!!!:imbar:eek::angryfire Tell you what, I am mortified that I am involved in this as the MDS person, and I can not believe the OT's PT's went alng with this and did these "therapy " sessions and the Dr.'s signed the orders. Of course, the bull ****...

it's good for the patient" was thrown about, give me a break, lets do RPT 5 x45 minutes for 3 weeks so it will be easier for the CNA's to transfer this mechanical lift, non-verbal severly Demented... really now, this person had no need for this therapy is no different than she was before the therapy and is no different no. EXCEPT the organization was able to get more $ by increasing the CMI... this is total and utter "rape the system" for the money, but in the end is is our $ that will be affected, all of these budget cuts are happening as I am sure many for profits are playing this game , and it is total crap.

amylpn24 · Oct 23, 2009

ADL's are by far the most miscoded item. Behaviors as well. You must do education continuously with your nurses and CNA's. I don't know what kind of program you have, but the one I use calculates the ADL score when it calculates the RUG. I think most of them do. Pay attention to your ADL score. If it is 7, or 15 - search for just one piece of information that will bring that ADL score up one more point. Search documentation, ask direct care staff and document yourself if you need to. Bringing the ADL score up one more point will increase your RUG score, therfore, increasing CMI and revenue.

amylpn24 · Oct 23, 2009

I want to just clarify the reply i made yesterday. When I say write your own note if you have to, what i mean is after talking with direct care staff, document what they say. Just make sure you do it before the ARD so you can count it.

CapeCodMermaid, RN · Oct 24, 2009

Just be glad you don't live in a state with MMQs. You can teach and train till the pigs fly, and the surveyor will find one t not crossed and take away payment for 6 months.