Re: SNF evaluation on day of admission

[Guest guest]

I think many would disagree with your consultant. For all the reasons you

mentioned, but then even more specific to " cheating " the facility out of

reimbursement by locking the patient in to a rehab. RUGS category based on

minutes projected on the 5-day MDS, when a patient with more comorbidities who

might need to further medically stabilize would actually be (appropriately) paid

at a higher rate if the patient was in one of the SE (non-rehab) categories.

SE3 is actually $50+/day more than RHB where I am so it's not small $$ being

lost.

My understanding is if therapy is in on day 1 you are " locked in " to a therapy

RUG. Identify patients for whom day #1 is " pushing it " can be better for the

patient and the facility.

Bill Bogdanovich

Chatham , MA

SNF evaluation on day of admission

I have a question that about the benfits of ALWAYS evaluating and

treating a new admission at our SNF/Short-term rehab facility. I

have a administrative consultant who is saying to me that WE MUST

under any circumstances evaluate and treat all Part A Medicare

patients on the day they are admited! NO EXCUSES based on time of

day, or the patient fatigue, etc. She stated that is we do not

maximize the number of minutes on each day including the first day

it will bring down the reimbursement based upon the minutes recorded

on the UB-92.. and lower the total amount they can bill? My

understanding is that PPS reimburses you based upon the RUGS score..

plain and simple! In other words if a resident scores as a RHB I say

that the minutes can be 325m per 7 days or 400m per 7 days and this

is paid at the exact same rate. Am I correct? The first 5 days are

also based upon the PROJECTED minutes for the first 15 days anyway

UNLESS the are a VH or a UH... then they must actually have 500 or

720 minutes during the first 5 days and be treated by at least 1

disciple for all 5 days.. again am I correct or incorrect? This

person is talking on and on about the minutes on the UB-92..... that

we need more minutes to maximize reimbursement... but if the minutes

do not raise the RUGS category does it really mean anything?

She told me that the rule at other facilities is that all

admissions MUST be evaluated and TREATED the first day ... and that

the is an " iron-clad " rule, because if not the facility is " cheated "

out of the highest reimbursement??? I also believed that Medicare

allowed 5 days to accomodate the fact that many people coming from

acute care to rehab are very ill and very fatigued on the first day

of so and may benefit from waiting a day or so. I rarely postpone an

evaluation to the 2nd day as I often feel the resident and the

nursing staff benefit from having the information on transfers, ROM,

assist needed , etc as soon as possible after admission.. but in

the " real world " a full evaluation and 30 to 90 minutes of treatment

time are just not appropriate or beneficial for everyone. I have

also

had residents refuse to be treated on the first day due to pain,

etc. I would love to hear your opinions on this and also any

supporting info I can present from Medicare billing rules...

Thank you for your input!

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a professional

workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join and

participate now!

[Guest guest]

Hello,

It sounds like your consultant is mis-informed regarding time frame of

evaluations.........there is NO rule stating admission and treatment must be

performed on day of admission.

good luck,

Phyllis

[Guest guest]

I'm wondering if you are working for a contract rehab company? Frequently

the payment schedule for the contract company is set up on a " per minute "

basis, and sometimes it is " per minute provided " vs. " per minute threshold

for a RUGs level " . That may be why the push.

It is my experience that folks who are pushing rehab in on day one are

from the old school when PPS first hit the streets and there was so much

confusion, but it seemed like rehab would the " answer " . Turns out, in

many of my urban markets, that an " SE3 " or the high, complicated nursing

RUG actually pays more per day than the highest rehab RUG. We will

frequently capture an SE3 just based on the events in the 7 day look back

period in the hospital -- with all the IVs, suctioning, etc. And that

allows us to ramp up therapies when the patient is more medically stable

and more able to tolerate and participate. (Assuming they are " straight

Medicare " -- our managed Medicare are a whole different story.)

Ultimately, if we do the right thing based on patient needs, the money

will work itself out. If we force it, it will be a mess very quickly.

Also, your supervisor may not be thinking in terms of what it costs to

deliver the highest rehab RUGs categories. That's another whole kettle of

fish.

Good luck. Feel free to call me directly if you want to discuss " live

voice " .

Betsi Slider Young, M.S., CCC-SLP

Regional Director of Operations - Rehab

Rocky Mountain Region

Mariner Health Care

Office:

Mobile:

" Noreen "

08/19/2004 04:29 PM

Please respond to

PTManager

To

PTManager

cc

Subject

SNF evaluation on day of admission

I have a question that about the benfits of ALWAYS evaluating and

treating a new admission at our SNF/Short-term rehab facility. I

have a administrative consultant who is saying to me that WE MUST

under any circumstances evaluate and treat all Part A Medicare

patients on the day they are admited! NO EXCUSES based on time of

day, or the patient fatigue, etc. She stated that is we do not

maximize the number of minutes on each day including the first day

it will bring down the reimbursement based upon the minutes recorded

on the UB-92.. and lower the total amount they can bill? My

understanding is that PPS reimburses you based upon the RUGS score..

plain and simple! In other words if a resident scores as a RHB I say

that the minutes can be 325m per 7 days or 400m per 7 days and this

is paid at the exact same rate. Am I correct? The first 5 days are

also based upon the PROJECTED minutes for the first 15 days anyway

UNLESS the are a VH or a UH... then they must actually have 500 or

720 minutes during the first 5 days and be treated by at least 1

disciple for all 5 days.. again am I correct or incorrect? This

person is talking on and on about the minutes on the UB-92..... that

we need more minutes to maximize reimbursement... but if the minutes

do not raise the RUGS category does it really mean anything?

She told me that the rule at other facilities is that all

admissions MUST be evaluated and TREATED the first day ... and that

the is an " iron-clad " rule, because if not the facility is " cheated "

out of the highest reimbursement??? I also believed that Medicare

allowed 5 days to accomodate the fact that many people coming from

acute care to rehab are very ill and very fatigued on the first day

of so and may benefit from waiting a day or so. I rarely postpone an

evaluation to the 2nd day as I often feel the resident and the

nursing staff benefit from having the information on transfers, ROM,

assist needed , etc as soon as possible after admission.. but in

the " real world " a full evaluation and 30 to 90 minutes of treatment

time are just not appropriate or beneficial for everyone. I have

also

had residents refuse to be treated on the first day due to pain,

etc. I would love to hear your opinions on this and also any

supporting info I can present from Medicare billing rules...

Thank you for your input!

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

I'm wondering if you are working for a contract rehab company? Frequently

the payment schedule for the contract company is set up on a " per minute "

basis, and sometimes it is " per minute provided " vs. " per minute threshold

for a RUGs level " . That may be why the push.

It is my experience that folks who are pushing rehab in on day one are

from the old school when PPS first hit the streets and there was so much

confusion, but it seemed like rehab would the " answer " . Turns out, in

many of my urban markets, that an " SE3 " or the high, complicated nursing

RUG actually pays more per day than the highest rehab RUG. We will

frequently capture an SE3 just based on the events in the 7 day look back

period in the hospital -- with all the IVs, suctioning, etc. And that

allows us to ramp up therapies when the patient is more medically stable

and more able to tolerate and participate. (Assuming they are " straight

Medicare " -- our managed Medicare are a whole different story.)

Ultimately, if we do the right thing based on patient needs, the money

will work itself out. If we force it, it will be a mess very quickly.

Also, your supervisor may not be thinking in terms of what it costs to

deliver the highest rehab RUGs categories. That's another whole kettle of

fish.

Good luck. Feel free to call me directly if you want to discuss " live

voice " .

Betsi Slider Young, M.S., CCC-SLP

Regional Director of Operations - Rehab

Rocky Mountain Region

Mariner Health Care

Office:

Mobile:

" Noreen "

08/19/2004 04:29 PM

Please respond to

PTManager

To

PTManager

cc

Subject

SNF evaluation on day of admission

I have a question that about the benfits of ALWAYS evaluating and

treating a new admission at our SNF/Short-term rehab facility. I

have a administrative consultant who is saying to me that WE MUST

under any circumstances evaluate and treat all Part A Medicare

patients on the day they are admited! NO EXCUSES based on time of

day, or the patient fatigue, etc. She stated that is we do not

maximize the number of minutes on each day including the first day

it will bring down the reimbursement based upon the minutes recorded

on the UB-92.. and lower the total amount they can bill? My

understanding is that PPS reimburses you based upon the RUGS score..

plain and simple! In other words if a resident scores as a RHB I say

that the minutes can be 325m per 7 days or 400m per 7 days and this

is paid at the exact same rate. Am I correct? The first 5 days are

also based upon the PROJECTED minutes for the first 15 days anyway

UNLESS the are a VH or a UH... then they must actually have 500 or

720 minutes during the first 5 days and be treated by at least 1

disciple for all 5 days.. again am I correct or incorrect? This

person is talking on and on about the minutes on the UB-92..... that

we need more minutes to maximize reimbursement... but if the minutes

do not raise the RUGS category does it really mean anything?

She told me that the rule at other facilities is that all

admissions MUST be evaluated and TREATED the first day ... and that

the is an " iron-clad " rule, because if not the facility is " cheated "

out of the highest reimbursement??? I also believed that Medicare

allowed 5 days to accomodate the fact that many people coming from

acute care to rehab are very ill and very fatigued on the first day

of so and may benefit from waiting a day or so. I rarely postpone an

evaluation to the 2nd day as I often feel the resident and the

nursing staff benefit from having the information on transfers, ROM,

assist needed , etc as soon as possible after admission.. but in

the " real world " a full evaluation and 30 to 90 minutes of treatment

time are just not appropriate or beneficial for everyone. I have

also

had residents refuse to be treated on the first day due to pain,

etc. I would love to hear your opinions on this and also any

supporting info I can present from Medicare billing rules...

Thank you for your input!

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association. Join

and participate now!

[Guest guest]

Not only you can eval and treat the patient on the second or third day, also

the utilization of grace days(up to three days) can assist you to capture the

minutes for patients in very high or ultra high categories on the 5 day MDS

book.

Chia-Yang Chung OTR/L

Long Island, NY

In a message dated 8/19/2004 10:04:54 PM Eastern Standard Time,

BillBogdanovich@... writes:

I think many would disagree with your consultant. For all the reasons you

mentioned, but then even more specific to " cheating " the facility out of

reimbursement by locking the patient in to a rehab. RUGS category based on

minutes

projected on the 5-day MDS, when a patient with more comorbidities who might

need to further medically stabilize would actually be (appropriately) paid at a

higher rate if the patient was in one of the SE (non-rehab) categories. SE3 is

actually $50+/day more than RHB where I am so it's not small $$ being lost.

My understanding is if therapy is in on day 1 you are " locked in " to a

therapy RUG. Identify patients for whom day #1 is " pushing it " can be better

for

the patient and the facility.

Bill Bogdanovich

Chatham , MA

SNF evaluation on day of admission

I have a question that about the benfits of ALWAYS evaluating and

treating a new admission at our SNF/Short-term rehab facility. I

have a administrative consultant who is saying to me that WE MUST

under any circumstances evaluate and treat all Part A Medicare

patients on the day they are admited! NO EXCUSES based on time of

day, or the patient fatigue, etc. She stated that is we do not

maximize the number of minutes on each day including the first day

it will bring down the reimbursement based upon the minutes recorded

on the UB-92.. and lower the total amount they can bill? My

understanding is that PPS reimburses you based upon the RUGS score..

plain and simple! In other words if a resident scores as a RHB I say

that the minutes can be 325m per 7 days or 400m per 7 days and this

is paid at the exact same rate. Am I correct? The first 5 days are

also based upon the PROJECTED minutes for the first 15 days anyway

UNLESS the are a VH or a UH... then they must actually have 500 or

720 minutes during the first 5 days and be treated by at least 1

disciple for all 5 days.. again am I correct or incorrect? This

person is talking on and on about the minutes on the UB-92..... that

we need more minutes to maximize reimbursement... but if the minutes

do not raise the RUGS category does it really mean anything?

She told me that the rule at other facilities is that all

admissions MUST be evaluated and TREATED the first day ... and that

the is an " iron-clad " rule, because if not the facility is " cheated "

out of the highest reimbursement??? I also believed that Medicare

allowed 5 days to accomodate the fact that many people coming from

acute care to rehab are very ill and very fatigued on the first day

of so and may benefit from waiting a day or so. I rarely postpone an

evaluation to the 2nd day as I often feel the resident and the

nursing staff benefit from having the information on transfers, ROM,

assist needed , etc as soon as possible after admission.. but in

the " real world " a full evaluation and 30 to 90 minutes of treatment

time are just not appropriate or beneficial for everyone. I have

also

had residents refuse to be treated on the first day due to pain,

etc. I would love to hear your opinions on this and also any

supporting info I can present from Medicare billing rules...

Thank you for your input!

Looking to start your own Practice?

Visit www.InHomeRehab.com.

Bring PTManager to your organization or State Association with a

professional workshop or course - call us at 313 884-8920 to arrange

PTManager encourages participation in your professional association.

Join and participate now!