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Doesn't the RAI Manual say that if the
resident is on therapy/Medicare that a significant change may not be necessary
till they plateau? Because that is the goal which needs to be reflected on
the care plan. Unless, of course, there have been major
changes.
----- Original Message -----
Sent: Tuesday, March 30, 2004 7:55
AM
Subject: RE: Significant Changes in
Regard to Rehab
You have two weeks to see if the event can resole it self. You
don't have to wait the two weeks. If you see sig change and know it is not
going to be resolved in two weeks you can go ahead and do the sig change. And
since this would change the rug category I would not wait the 2 weeks if the
res has change in 2 areas for the MDS
Those areas have to change first for over 2 weeks
before the criteria for significant change is meet. Facilities just
have to deal with that for however
long.
Davina
DeMerritt, RN
If the wt bearing status is increased wouldn't that mean that
possibly toileting,transferring and ambulation would improve? Wouldn't
that be a sig change?
A resident who has a new weight-bearing status would most likely
need extensive assistance with ambulation. Changing from "Activity
did not occur" to "Extensive Assistance" is NOT a criteria for
Significant change. There might be other reasons that would allow
a SCSA in some cases, but this is not an automatic reason for a
Significant Change assessment. You also must realize that you are
receiving a rehab RUG payment for 8-10 days after all therapies
discontinue when residents continue to receive skilled services after
all therapies end. So, most of the time, the payment evens
out. Many times, when there is delayed therapy for weight
bearing purposes, the Medicare coverage is delayed until weight bearing
is allowed. In these cases, the onset of therapy would be day 1
for Medicare, then the first PPS asssessment would be a rehab RUG.
So, there should not be a lot of instances where there is a delayed
therapy RUG. Sounds like your MDS coordinator is
correct. -----Original Message----- From: Julie
Schwarzenegger <[EMAIL PROTECTED]> Sent: Mar 29, 2004 7:48 AM
To: Message Board MDS <[EMAIL PROTECTED]> Subject: Significant
Changes in Regard to Rehab
I am the operations manager for a
contract therapy company in NC so this questions may seem trivial to you
-- I apologize for that.
Here's the scenario: A patient is
discharged from therapy but remains skilled by nursing. Several
weeks later, when the patient is between assessments, he/she becomes
appropriate for rehab services as a result of a weight bearing status
change, for example. Is there any way to achieve a rehab RUG by
completing a significant change?
We encounter this problem frequently in our
nursing homes and end up treating the patient for up to two weeks under
a nursing RUG. It seems like Medicare should allow the facility to
capture a rehab RUG but our MDS coordinators often say that a patient's
weight bearing status change or increased ability to participate in
therapy is insufficient in warranting a significant change.
Any information you can offer is greatly
appreciated.
Julie Schwarzenegger, OTR/L
Operations
Manager
Ballard Therapy Services
[EMAIL PROTECTED]
(704)
293-9859
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