Re: RE: RE: Re:productivity and ethical/legal limit s

[Guest guest]

Regarding the questions that keep popping up about the 5 day assessment:

You do not have to see patients each of the first 5 days from admission to

qualify for ultra or very high as has been previously posted. I clarified

this earlier and Anne Coffman did as well. This question came up a few

months ago so HCFA was contacted. ce from HCFA sent e-mail

back confirming our interpretation, which is essentially what I posted

earlier. He also addressed it again in the MDS Q & A at the HCFA site for

all to see, which I referred to.

Clarification:

Section P - Clinician records the number of days and minutes of therapy

received by the patient during the past 7 days of the observation period.

So if you are in the first MDS observation period (5 day assessment)and you

choose day 5 as your end date, then only days 1-5 can be used to determine

rehab classification. If you choose day 6, then days 1-6 can be used. If

day 7, then 1-7 can be used. If you choose day 8 as the assessment

reference date, then you use days 2-8.

There is no requirement that the 5 rehab days (for categories) be

consecutive, decreasing the need for large amounts of weekend therapy (may

still need some).

Section T - Only used for initial assessments (or readmission initial

assessments). Allows us to report the number of days and minutes expected

through day 15 and should include those already received. Section T can

qualify pt.'s for low, medium and high categories. Also note that therapy

minutes provided outside the facility can be captured here (see SOM

transmittal # 272 pp. R64).

Hope this helps!

Dean Myers, MS, PT

Re: RE: Re:productivity and ethical/legal limits

Someone please correct me if I am misinterpreting the previous posts or if I

just simply have the wrong information.

I think we are taking about two separate things here. As I understand it, to

be able to get in the ULTRA HIGH and HIGH categories, you have to provide

720

minutes of therapy in the first five days (of admission - we are not talking

of the assessment reference dates) with one of the of the discplines

providing

therapy 5 days. Therefore if your window is, say, day 2-6 you can only count

the therapy treatment minutes given in day 2, 3, 4, 5 (assuming therapy

treatment started on day 2) - and since you did not provide 5 days of

therapy, you cannot be clasified in the ultra high and high categories.

Now comes Section T. Section T allows us to project the number of therapy

minutes in the first 15(?) days of stay in the facility. Use of Section T

allows the patient to be placed in a higher RUGS grouping (highest you can

get

on Section T is a Low) which would not have been possible if you defaulted

into the lowest classification by not treating the patient on day one.

So there is absolutely nothing wrong with seeing the patient for therapy on

day 2, 3, so on... but by doing so the patient defaults to a lower RUGs

classification (assuming that the patient could have been potentially be

classified as ultra high or high). As I understood during from the data from

the demonstration states, only 20-25% (?) of the patients were classified as

ultra high and high anyway; most of the patients typically seen in therapy

fell under the classifications below ultra high/ high. That's why there is

talk about audits for facilities with a high percentage of patients falling

in

the highest two RUGs classifications.

You need to figure out the difference in the reimbursement between the

highest

two categories and the default rate and you will see why therapy companies

want therapists to see that patient on day 1.

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