Re: Below the line Rugs

[Holly Sox, RN, RAC-C]

Title: Below the line Rugs

Angie, I have a resident currently on Med A who is at the PD1 level. She is on our dementia unit, and had a pretty bad GI bleed, resulting in hospitalization and 6 units of blood. She was inappropriate for therapy due to her really, really poor cognitive function.  Her meds have changed several times, but there haven't been 4 order changes in 14 days during the assessment window.  I am not comfortable dropping her at this time, as we continue to hemoccult all stools, monitor for GI bleeding, etc.  She is unable to express her needs well, so we cannot depend on her to complain of discomfort, so we are having to monitor even more closely.  The documentation for this resident is good.  I expect we will be dropping her from Med A once the doctors are through with changing the meds and getting labs, etc, and I feel comfortable with her status.   I have also carried people with behavior and or impaired cognition, again, when I really felt they required skilled assessment and management by nursing.  I am really specific on the medicare documentation that I need from the nurses, and they do a pretty good job with it. The key is getting the documentation of the skilled service you are providing. Flow sheets can be helpful with this, if your nurses are having trouble with keeping narrative notes.   It is also imperative that you have your late-loss ADLs documented.  (Eating, transfer, toilet use, bed mobility) I have a cheat sheet that defines and describes each of these ADLs, to help improve the accuracy of the documentation. I have been bemused to learn how few nurses understand what bed mobility means, and no longer take it for granted that they will know.   I hope this helps a little bit. Holly F. Sox, RN, RAC-C  Clinical Editor, Careplans.com www.careplans.com [EMAIL PROTECTED] ----- Original Message ----- From: Angie Palac To: [EMAIL PROTECTED] Sent: Thursday, December 04, 2003 7:44 PM Subject: Below the line Rugs I am just wondering if any facility is pursuing the lower rug categories for payment such as Impaired Cognition, Behavior Only, and Physical Function Reduced?  A facility in Illinois who is thinking of doing this called their Fiscal Intermediary and the FI said they could do it, but they would eventually be audited so they needed to have all their documentation in place.  If anyone is doing this, what needs to be addressed with these RUG categories?  Is it only the Restorative after a 3 day qualifying stay?  Any advice would be greatly appreciated. Thanks again for the help I have received on this list serve. Angie