This issue goes way back to when they were first
designing PPS. The intent of section P was to require therapy on a certain
number of calendar days. For example Mon - Fri would be 5 days. However, when
they designed section P, it did not come out that way. If PT was Monday, Tuesday
and Wednesday, you put 3 days for PT. If OT was Tuesday, Wednesday and Thursday,
you put three days for OT. That gives you 6 days even though only 4 calendar
days were covered. Remember, the data in section P is all that is available for
calculating the RUG score. There is no magic. You don't indicate days of the
week or dates.
If you only have 2 days of therapy on the assessment with
ARD = day 11 then you don't qualify for RMC. You must have 5 days of therapy.
Nathan Lake, RN, BSN,
MSHA
Director of
Clinical Product Management
Computdatahealth
D.
Medium Intensity Criteria (either (1) or (2) below may qualify)(1) In the last 7 days: (section P1b [a,b,c] ) 150 minutes or more (total) of therapy per week
(2)
If this is a Medicare 5 day or a Medicare Readmission/Return Assessment, then the following apply: (section T1b, T1c, T1d): Ordered Therapies, T1b is checked AND In the first 15 days from admission:240 or more minutes are expected, T1d
RUG-III ADL Score RUG-III Class
15 - 18 RMC 8 - 14 RMB 4 - 7 RMA
-----Original
Message-----
From: Gola, Tammy [mailto:[EMAIL PROTECTED]]
Sent: Thursday,
November 06, 2003 2:40 PM
To: '[EMAIL PROTECTED]'
Subject: RE: Software and
RUG's
Hi Nathan, long time no talk/hear from you.
I actually
am getting more therapy time using day 14
I have the same "clinical" (lets
call them) elements on both (using day 11 or day 14) the difference is the
# of total days added together on day 11 I only have 2 days of therapy (because
2 of the days PT treated they didn't get at least 15 minutes). On day 14,
I have 3 days OT, 2 days PT.
No, my software does not pull right from
our documentation.
I can't seem to figure it out either, other than what I
thought the software did and actually is not doing, which is pulling the higher
paying RUG.
I am still confused about Rehab Medium though, I though it
had to be 5 days (meaning say PT say resident M-W-F and OT Tue and Thurs.)
What I have is 3 days of OT (say M,Tues and Wed) and 2 days of PT (M and
Tues).
Tammy Gola BSN, RN, CRNAC
Wilkes-Barre General
Hospital
Transitional Care Unit
575 North River Street
Wilkes-Barre,
PA. 187641-0001
570-552-5417
[EMAIL PROTECTED]
-----Original
Message-----
From: Nathan Lake [mailto:[EMAIL PROTECTED]]
Sent:
Thursday, November 06, 2003 2:21 PM
To: '[EMAIL PROTECTED]'
Subject: RE:
Software and RUG's
Tammy,
I assume this is a Medicare 14 day
assessment and therefore Section T is not impacting the score.
The
"consecutiveness" of your therapy should have no impact on the RUG score. The
total number of days and of minutes that fall within the 7 days prior to the ARD
determine the score. If you have a total of 5 days and 150 minutes listed in
section P, and all other requirements are met (ADL score =
15+), you should
RUG out in the RMC group.
It sounds to me as if a good part of the
therapy took place on days 1-7. Using day 11 for the ARD would capture therapy
on days 5 - 11 whereas using day 14 would capture therapy from days 8 - 14. Does
your MDS/PPS software pull information directly from a rehab documentation
system into section P? That is the only way I can see that changing the ARD
alone would give you different results.
Nathan Lake, RN, BSN,
MSHA
Director of Clinical Product Management
Compudata Health
Corporation
-----Original Message-----
From: Gola, Tammy [mailto:[EMAIL PROTECTED]]
Sent: Thursday,
November 06, 2003 11:18 AM
To: '[EMAIL PROTECTED]'
Subject: Software and
RUG's
Hi, I know that this was recently discussed, but I'm going to
ask it anyways. What is the correct way to bill the right RUG, by the
higher reimbursed RUG or higher CMI RUG. I have a patient that if I use
day 11, I RUG at RMC. If I use day 14 I get a SE3 RUG. Another
thought is that on the one using day 11, I don't have 5 consecutive days of
therapy between the 2 disciplines. but I do have 175 minutes. (there
were 3 days for OT and 2 days for PT but on the same days). Which is the
correct way to do this. At one point, I thought my software always pulled
the higher paying RUG, but I guess not.
Tammy Gola BSN, RN,
CRNAC
Wilkes-Barre General Hospital
Transitional Care Unit
575 North
River Street
Wilkes-Barre, PA.
187641-0001
570-552-5417
[EMAIL PROTECTED]
/----------------------------------------------------------
The
Case Mix Discussion Group is a free service of the
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"Committed to
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Be sure to visit the AANAC website. Accurate
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/----------------------------------------------------------
The
Case Mix Discussion Group is a free service of the
American Association
of Nurse Assessment Coordinators
"Committed to
the Assessment Professional"
Be sure to visit the AANAC website. Accurate
answers to your
questions
posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
/----------------------------------------------------------
The
Case Mix Discussion Group is a free service of the
American Association
of Nurse Assessment Coordinators
"Committed to
the Assessment Professional"
Be sure to visit the AANAC website. Accurate
answers to your
questions
posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
