RE: Medicaid charting

[Connie L. Frank]

Title: Message

I’ve had the best luck with the philosophy “he who does it….documents it” this has prevented variations due to interpretation changes etc. It takes time to inservice, fine tune, monitor and reteach when necessary, but in the end promotes more accurate documentation be it CNAs or licensed staff…etc   -----Original Message----- From: m silberg [mailto:[EMAIL PROTECTED] Sent: Wednesday, February 04, 2004 4:59 AM To: [EMAIL PROTECTED] Subject: Re: Medicaid charting   At the facility I worked at recently, we placed a 7 day lookback tracking sheet out on each nursing floor for all Medicare A residents, and only the licensed staff was allowed to chart on this . The CNA'S had their own forms to complete, and they also gave any pertinent information to the nurses for their forms. In addition to this the RNAC did an interview with the staff at the time of MDS completion to verify any information or answer any questions. This was a lot of work but it worked out well. HOWEVER.... the big problem came into play when the regular nursing notes did not reflect the same information as the lookback sheets; or worse yet, the notes stated something totally different. As the RNAC it was my responsibility to EDUCATE THE STAFF on this matter, and on all 3 shifts. I put in many long hours[ that I might add I was NOT paid for, as I was on salary ] and worked on many different time scales to reach the staff. No sooner did I have the regular staff convinced that their lives were in serious jeopardy if they did not comply with the proper charting,[just kidding] then along comes the agency nurses that did not chart at all and the new staff that had not a clue what our charting system was all about. The job was never done,and I had to do all the other work of the RNAC ,too . However, the saga gets worse!!!!! The poor home health nurses are faced with an extensive 22 page admission OASIS form for all admissions, in addition to any regular charting for the agency. It takes an average of2-3 hours to do an admission set. In our area the Medicare nurses for home health are PAID PER VISIT, and no longer paid by the hourly rate they once received. For the average admission this nurse gets averaged out at about $ 10 to $ 11 an hour for this job. The CNA's in this area are now receiving $ 12 an hour !!!!!  Go figure.......... the home health agencies can't keep any nurses on staff longer than 2-3 weeks to do the Medicare patients.  I wonder why//// Anyway, I didn't mean to run off like this, hope the first part helps you. Maureen Stettner wrote: For ADL's get Resource Systems' Caretracker- expensive but great.  We had only one ding on ADL's this week on Medicaid audit.  We taylor make our 24hr summary during week of observation for Medicaid- i.e. List 3 items and tell which ones res could recall after 5 minutes.  Caretracker is great for all this tracking but someone still needs to narratively write the specific example.   Decision making is the hardest one to track.  Does anyone have a good example?  Auditors would not accept refusal of meds or food.  They said that is a choice not a decision.  Whatever!!!! ----- Original Message ----- From: Annette M. Corn To: [EMAIL PROTECTED] Sent: Wednesday, February 04, 2004 6:18 PM Subject: Medicaid charting   After completing a the RUG III, Supporting Documentation and Case Mix Reimbursement class that deals with the system for Medicaid and RUG reimbursement, our facility has hit a brick wall in regards to the documentation. Specifically 7 day 14 day and 30 day(look back period) documentation that would support the MDS. We are trying without success to get the documentation we need. How has every one been dealing with this change? Are you using the same documentation as before? Has anyone come up with assessments just for Medicaid documentation and the specific look back periods? Are your staff complying? If not then what? One thing that stands out from the class was that best way to get accurate documentation from the staff for the 7 day look back for ADL's is to have only licensed staff document for those 7 days. What is everyone doing? If you have any documentation or a  helpful solution I would love to hear it or see it. I realize this may be a time consuming question but please know your response is appreciated.  I look for this information on the website daily and don't see anything which makes me think someone's got this figured out. Thanks for your undying support. [EMAIL PROTECTED] -- ----------------------------------------------------- Click here for Free Video!! http://www.gohip.com/free_video/