Re: Software and RUG's

[RRS2000]

This issue around Rehab Medium and the number of days required to skill a resident still is being debated.  While it seems clear to some that the language requiring skilled rehab 5 days means that rehab has to be delivered on 5 different days in the week.  Others interpret it to mean 5 "treatment days," meaning that PT and OT delivered on the same day equals 2 "treatment days."  There is no basis for "treatment days" in the regulation, but because the grouper behaves the way it does, lots of folks are billing Part A when rehab is being delivered less than 5 different days in the week.  I have heard that CMS is working on clarifying this issue.

Rena

Subj: RE: Software and RUG's
Date: 11/6/03 2:02:17 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet



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 AND At least 5 days of any combination of the 3 disciplines

(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 AND rehabilitation services expected on 8 or more days, T1c.

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]

Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
"Setting the Standard for SNF MDS/PPS Education"
AANAC Office:  1-800-768-1880
Direct Line:  858-592-6799
[EMAIL PROTECTED]
www.aanac.org