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Thanks for the note. My question was as to whether or not the nurse
could be negligent in or deliberately "miscoding" the MDS because of the
decision not to record minutes and then not include the services on the
MDS
Corey
----- Original Message -----
Sent: Sunday, January 04, 2004 8:28
AM
Subject: Re: Facility chooses not to show
services?
I agree that all criteria must be met to count and code restorative
nursing, but in some states (specifically PA.) restorative nursing is counted
at 5 days a week in the PA. State Case Mix and I do not want people to feel
they must have 6 days in order to count. (The 6 days are
necessary to get credit and RUG out for Medicare PPS under Rehab
Low, but not necessarily in all case mix states) You will need to
know your state guidelines as well as Federal. In PA.for example, the
Restorative nursing is a split for the lower three categories(impaired
cognition, behavior problems and reduced physical function) and will
affect (increase) the PA. State Case mix if your assessment is
comprehensive. (AA8a = 1, 2, 3 or 4).
The RAI states to count the number of days, but does not
specify 6 days.
Also keep in mind that in order to remain skilled for
Medicare, you must have daily skilled services such as respiratory
therapy.
Jan Stewart
In a message dated 1/3/2004 7:16:26 PM Eastern Standard Time,
[EMAIL PROTECTED] writes:
I have noted among some of my clients and participants in
educational sessions around the country that many facilities are providing
services that they call restorative programs. In most cases, they are
even delivered by specially trained Restorative Nursing Assistants.
However, they do not qualify to be documented on the MDS, because the
programs do not meet all of the requirements spelled out in the RAI
manual. Generally, in my experience, the limiting factor is either the
programs are not available six days per week (as is the case here with the
original question) or their licensed nurses are not routinely monitoring
each resident's progress and documenting it in the
chart.
Rena
Rena R. Shephard, MHA, RN, FACDONA,
RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj: Re: Facility chooses not to show services?
Date: 1/3/04 4:04:03 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to:
[EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the
Internet
IT would seem to me that the facility should
take credit for the restorative minutes that it does give.
Facilities are required to keep the resident at his/her optimum level of
functioning. Restorative nursing is a very important part of that
process. It doesn't make any sense to not take credit for
restorative nursing that was done.
I know in PA, the UMR survey
team does give deficiencies if they find that the facility has done
restorative and not entered the minutes on the MDS.
----- Original Message -----
From: Corey
Ali
To: [EMAIL PROTECTED]
Sent: Friday,
January 02, 2004 5:27 PM
Subject: Facility chooses not to show
services?
This is a new one for me. I have a facility
that has decided to not show any Restorative Services (due to inadequate
number of staff to provide services 6 days a week, although restorative
is provided 3-4 days a week) and to not record any Respiratory Therapy
services provided from trained nurses (ile.; nebulizer therapy, postural
drainage, etc.) because it is too difficult to get the minutes
recorded. Assuming that the MDS nurse follows unwritten directions
to not include the restorative or respiratory therapy minutes, is the
nurse liable anywhere here?
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