For a Medicare 5 day or Readmission, Return
Assessment,
Rehab High - you only need 65 actual minutes
520 anticipated minutes for 1st 15 days
of
admission
Rehab Medium - no actual minutes needed
240 minutes or more expected
Rehab Low - no actual minutes
75 minutes or more expected plus
2 or more Nursing Restorative at least
15 minutes per day over 2 or
more days
--- "Wiedemann, Betty R" <[EMAIL PROTECTED]> wrote:
> If a resident is evaled and treated for 2 days. Is
> discharged to hospital
> RUg is a rehab RUG D/T projected minutes. Do they
> have to be seen for the
> obligatory 5 days to get the RUG?
>
> -----Original Message-----
> From: Nathan Lake [mailto:[EMAIL PROTECTED]
> Sent: Thursday, November 06, 2003 2:54 PM
> To: '[EMAIL PROTECTED]'
> Subject: RE: Software and RUG's
>
>
>
> 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]
> <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]
> <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]
> <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]
>
>
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> 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
> <http://www.aanac.org>
>
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The Case Mix Discussion Group is a free service of the
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