Guest guest Posted May 12, 2010 Report Share Posted May 12, 2010 I guess the question to ask now is, " Is more better? " If most of your patients are being seen at the highest RUG level, are they showing better outcomes than if they were seen at a lower level? That's the " reasonable and necessary " pierce- rather subjective, but in some cases the answer may be very obvious. Providing LOTS of therapy can result in inflammation and swelling or over-fatigued patients- a negative outcome for doing " more. " Or patients may be no better off than if they got less therapy. And of course in some cases the patients will get better faster with more therapy. This is why the therapist's professional judgment must be the basis for determining RUGs levels. Now from the business side- you need to look at the cost of the therapists to provide the highest RUG level attainable, the reimbursement amount available for that level (in typical Medicare rationale, Rehab Medium + extensive services pays more than Rehab High + extensive services which offers more therapy time...) Knowing the optimal timing of services can help reimbursement as well. A large reimbursement benefit could result from deciding to provide a weekend therapy session on Saturday instead of Sunday, for example. A few missed minutes one day could reduce the daily Medicare payments for a two week period or more... Everyone needs to have at least a basic understanding of how this system works and tracking tools need to be as close to real-time as possible. October will bring us some adjustments to the Medicare system. ine o's RUGS to Riches course (Encompass Consulting and Instruction) will help therapists to understand the implications of those changes. Her Medicare Made Easy course is also a great resource for learning about Medicare A & B systems. My read is that " More is better " is destined to be replaced by buzz words " efficiency " and " outcomes. " Melinda Nygren Pierce, PT, MS Director of Rehabilitation Presbyterian Homes 3200 Grant Street ton, IL 60201 phone: fax: " Working to encourage older adults to experience fullness of life in community with dignity, joy and the maximum level of independence their health will allow. " ail Disclosure Statement This email and any attachments are intended solely for the addressee(s) named. It may contain confidential and privileged information that should remain confidential. If you are not the intended recipient of this message, or if it has been addressed to you in error, please immediately alert the sender by reply email and then delete this message and any attachments from your system. If you are not the intended recipient, do not deliver, distribute or copy this message and/or any attachments; and, do not disclose or take any action upon or rely on any information in the communication. ---------- BEGIN:VCARD VERSION:2.1 X-GWTYPE:USER FN:Pierce, Melinda TEL;WORK:492-4838 EMAIL;WORK;PREF;NGW:mpierce@... N:Pierce;Melinda END:VCARD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 12, 2010 Report Share Posted May 12, 2010 Let me clarify. The rehab RUG is determined by the therapy dept. Whether they are ultra high, very high, high, medium or low. We project how many minutes are needed throughout the week to attempt to meet that initially set rehab RUG level. The final RUG level is determined by what information the MDS coordinator gets from nursing. She formulates in the extensive services by nursing and if the patient had IV feeding in the past 7 days or if they were on IV meds, suctioning, trach care or ventilator/respirator in the past 14 days to come up with a final RUG score. The facility is paid based on the final RUG score.  However, this RUG level, and facility reimbursement, can change throughout a patients stay. An MDS is done on day 5, 14, 30, 60 and 90. As the patient improves  the extensive services number from nursing generally gets smaller, that means nursing is not doing so much to help the patient with transfers, bed mobility, toileting, bathing, dressing and feeding.  Egbert DOR Draper, UT   From: jonmarkpleasant <jsppleasant@ verizon.net <mailto:jsppleasant %40verizon. net> > Subject: Re: Learning about SNF To: PTManager@yahoogrou ps.com <mailto:PTManager% 40yahoogroups. com> Date: Tuesday, May 11, 2010, 11:54 AM , I work in an outpatient clinic so I'm unfamiliar with a SNU's inner workings. My questions are simply out of curiosity. 1. When is a patient's RUG level determined? Is it determined after the first PT encounter? 2. Who determines a patient's RUG level(Treating PT, PT director, case management, other)? Thank you in advance. Jon Mark Pleasant, PT Methodist Medical Center > > > From: mapt2012 <mapt2012@.. .> > Subject: Learning about SNF > To: PTManager@yahoogrou ps.com > Date: Tuesday, May 11, 2010, 12:08 AM > > > Â > > > > I am interested in learning as much about providing PT in a SNF facility as an independent contractor but I have only had experience with Medicare B in an outpatient setting. Does anyone have resources (books, seminars, etc) to learn about this area of practice. I need it to cover the very basics. Thanks > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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