RE: PPS schedule question

[Jane Holmer]

Title: PPS schedule question

 It's all about maximization......staff provide the needed services, it's our jobs to figure out how to legitimately capture the $$. We use a variety of days for the ARDs.  The ARD for the 5 day is pretty consistent but after that, we highlight the available days on our scheduler and watch them day by day to capture the opportunity to maximize.

Had the "exception review" a few years back and last year CMS requested records.  Out of both audits, we had one chart that had one assessment "re-rugged" by CMS. 

From the nightmares I hear from others who endure the CMS audits, we are doing OK.

 Jane  
     

 -----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Vogt, Kathy
Sent: Wednesday, November 12, 2003 12:05 PM
To: [EMAIL PROTECTED]
Subject: RE: PPS schedule question
     

 I too have been doing my assessments on a rigid schedule of 5, 14, etc.  I had also been told that using grace days would raise red flags.  My FI ,Mutual of Omaha, stated that this was not so.  The grace days were there to take advantage of the best RUG possible.  Also have learned that by using day one or two of the stay as the ARD for the 5 day, you can capture hospital services that may put the resident into a higher paying category.  This has worked out well for me as I am very involved in the admission process.  Also another trick I have heard of is to look at the end splits r/t ADL performance.  On the first days of stay, residents generally require more assistance than they do on day 5 or later.  This can give you a higher paying RUG level for the first 15 days just based on the ADL score.

 

Kathy

-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Tuesday, November 11, 2003 2:35 PM
To: [EMAIL PROTECTED]
Subject: PPS schedule question

I have always been setting my 5 day assessment, 14 day assessment, 30 day assessment, 60 day assessment and 90 day assessment on the 5th, 14th, 30th, 60th and 90th day of a patients stay unless they are capable of being graced to other days.  I have been setting my schedule up using day 30, 60 and 90 since the initiation of PPS because that is the way I was trained to do it.  I recently had it brought to my attention that day 30-34, day 60-64 and day 90-94 are considered grace days.  How are other facilities setting up their schedules?  Do you use day 29, 59, and 89 for your PPS assessments?  I know that if you consistently use grace days it can send a red flag up and may cause a review and I don't want to do that unless the patient would benefit from using the grace days. 

Thanks in advance
Diane R. Wierenga RN BSN RAC-C

 

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