Raising CMI

disney158 · Oct 26, 2009

I used to work in Pittsfield MA, so I also suffered thru thse audits, not a very fun job we have, so many people to please....so many people to teach to do the right thing....uggh...I just came to work depresseed already ! :sniff:

nyteshade, BSN · Nov 4, 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!

Do you use behavior sheets for all your psychotropic medications?

amylpn24 · Nov 21, 2009

just keep in mind that you may not move the ard date once an assesment window has closed, or if you have already picked an ard date and that date has passed.

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.

Talino · Nov 21, 2009

just keep in mind that you may not move the ARD date once an assesment window has closed, or if you have already picked an ARD date and that date has passed.

The instruction you are referring to only applies to Medicare PPS assessments.