I
agree whole heartedly with this response. I think that if you start setting up
inflexible patterns that pre-select your RUG levels for you based on your use or
lack of use of grace days you could potentially find trouble on either end of
the spectrum. Grace days are part of the system and meant to be used to allow
flexibility in the assessment process so that an accurate picture of resident
resources may be presented. Grace days can be used if a patient were ill or if
the MDS coordinator was to busy or for any number of reasons. The 1999 Final
Rule for SNF PPS spells this out very well and I think should be referred to in
these instances. Facilities should not be losing money because they fear use of
grace days, on the other hand they should not use grace days indiscriminately
either. If each patient and assessment is handled on a case by case basis you
will find that you do not overuse grace days or that you have reasons why you do
(i.e. a majority of rehab patients in ultra high or very high on the 5-day
assessment) - either is okay as long as you are not back dating
assessments. I would also add that each state and facility have differing FI's
and state systems that may take different interpretations or stances on issues
such as these. It is important to know your specific variables but also to know
the regulations so you can speak towards those regulations when issues
arise.
-----Original Message-----
From: Ann Schoeny [mailto:[EMAIL PROTECTED]
Sent: Wednesday, February 25, 2004 1:17 PM
To: [EMAIL PROTECTED]
Subject: RE: projection of therapy minutesI attended a DAVE inservice and one of the top things they are looking at is projected minutes vs actual minutes delivered on 14 day mds. They are also looking at patterns of rugging residents. ie everyone is rehab high,,,,,I would be careful of falling into any pattern, but again look at every resident individually and what that resident needs.....HOPE THIS HELPS.-----Original Message-----
From: Laurie L Swanke [mailto:[EMAIL PROTECTED]
Sent: Wednesday, February 25, 2004 11:59 AM
To: [EMAIL PROTECTED]
Subject: RE: projection of therapy minutesWe use lots of projections and few grace days. What is important is that the documentation supports the projection and really supports the reasons if the projection is not achieved. Usually our projections have been pretty accurate. You also need to look at each individual resident and not just have a blanket policy that everyone is projected into high, or everyone uses grace days.-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Tanya Jordan
Sent: Wednesday, February 25, 2004 10:20 AM
To: [EMAIL PROTECTED]
Subject: projection of therapy minutesI need some help with this one. We have a new director of our Rehab area and he wants to use projections, putting everyone in a high category with the first MDS assessment if they are on therapy. He doesnt want me using grace days to set the inital ARD. He said as long as they get a couple days of therapy they can use those minutes and do the projection.This is not the way we have been doing it here at all. Whenever possible we have been using the grace days on the 1st assessment to capture 5 days of therapy, and we do use the projection too. Now if it is impossible to capture 5 days of therapy for whatever reason in the 1st 8 days, we base that RUG on the projection.I dont want to do anything that is wrong. I sure dont want to be charged with Medicare Fraud, and I just dont see how you can do what he is wanting to do and put everyone into a high RUG. Most of our residents are in a high or a very high to start with, but we have had some that are in a Medium.ThanksTanya
Tanya Jordan, RNAC
Homewood Retirement Centers
Williamsport, MD
Fax 301-582-1819
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