Harmony Healthcare Blog

Medicare Versus MMQ ADL Documentation

Posted by Kris Mastrangelo on Mon, Dec 01, 2014

ADL documentation is a critical component in capturing an accurate and appropriate rate of reimbursement for services rendered. Both Medicare (PPS RUG) and Medicaid (MMQ) use ADL assistance provided to generate a rate for reimbursement. Although both systems utilize ADL data, definitions and levels of assistance provided are different. Skilled Nursing Facilities often struggle to capture an accurate picture of the care provided for both Medicare and Medicaid.

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Topics: ADL, MDS, MMQ,

ADL Coding Clarification from CMS

Posted by Elisa Bovee on Wed, Apr 24, 2013

Providers sought clarification on the correct coding of MDS 3.0 item G0110: Activities of Daily Living (ADL) Assistance, Column 1: Self Performance. CMS has delivered.

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Topics: CMS, ADL, MDS 3.0

Beneficiary Review Meeting: Medicare Part A Skilling and MORE!

Posted by Peter Mastrangelo on Wed, Jul 11, 2012

Today we will be discussing the Medicare meeting, otherwise known as the beneficiary review meeting.  This meeting is set up so that the interdisciplinary team can discuss the clinical status of a patient and whether that patient continues to meet the criteria for skilling under their Medicare Part A benefit.  This meeting provides an opportune time to review the Medicare Part B beneficiaries or your managed care patients during this meeting.  The goal of the meeting is not to focus on when the patient is going to be discharged.   This is not a discharge planning meeting, the meeting is designed to review what the skilling criteria or the needs on a daily basis of the patient from nursing and from therapy. HHI recommends that the entire interdisciplinary team attend this meeting and that each member of the team be aware of what they are going to be reporting on during the meeting.  For example, the business office would be discussing how many days the patient has used in their benefit period or how many days the patient has left.  MDS may be discussing what the potential selected ARD date is.  As well, MDS may discuss ADL assistance provided to the patient to make sure that team members are in agreement with the level of assistance provided to assure levels are accurately reflected on the MDS.  Nursing should be talking about why the patient requires daily skilled care and therapy should talk about the patient’s status in relationship to their ability to continue to provide daily skilled care to the patient.  Again, this meeting is so that the team can assure that the facility is accurately utilizing the patient’s  Medicare Part A benefit.

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Topics: Medicare Part A, Medicare Part B, ARD, MDS, ADL

Discharge Planning: Determining Prior Level of Function

Posted by Peter Mastrangelo on Wed, Jun 06, 2012

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Topics: Rehab Case Management, Cognitive Patterns, ADL, Rehab, Discharge Planning

Medicare Meeting (Beneficiary Review Meeting)- Medicare Minute

Posted by Peter Mastrangelo on Wed, Mar 07, 2012

Medicare Meeting - Medicare Minute

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Topics: Medicare Part A, Skilled Nursing, Medicare, ADL

ADL Skills: Addressing Posture and Positioning in the SNF

Posted by Peter Mastrangelo on Fri, Oct 28, 2011

Poor sitting posture is a common problem in long-term care and has an effect on function and performance of ADL skills. Skilled Nursing Facilities strive for a restraint free environment, no recorded falls and eliminating the occurrence of skin breakdown at the facility level.  Committee meetings, QA teams and active walking rounds are a part of the daily operations in the SNF aimed at minimizing and eliminating the above listed clinical barriers to function.

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Topics: SNF, ADL, ADL Coding

Investigating ADL Coding

Posted by Kris Mastrangelo on Mon, Jul 25, 2011

Harmony continually discusses the significant clinical impact of accurate documentation. Accuracy is vital in developing the care plan, identifying changes in condition and attaining reimbursement that the SNF is entitled for services provided. The RAI Users Manual encourages the assessor to "engage direct care staff, from all shifts, which have cared for the resident over the past 7 days in discussions regarding the resident's ADL functional performance. Ask probing questions beginning with the general and proceeding to the more specific." It is with these discussions that inconsistencies can be identified, clarified and corrected. RUG's measure the resources utilized to provide care to the residents.

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Topics: ADL

SNF Discharge Planning for High Level Patients

Posted by Kris Mastrangelo on Wed, Jun 22, 2011

 

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Topics: ADL

Increase your Medicare Part A Revenue

Posted by Kris Mastrangelo on Tue, Jun 22, 2010

Increase your Medicare Part A Revenue  

There are numerous ways to increase your Medicare Part A Revenue Medicare Part A Rate. Here are a few suggestions for increasing your facility's Medicare Part A Revenue:

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Topics: Medicare Part A, Length of Stay, Medicare Reimbursement, ADL

Assessment Reference Date Management II

Posted by Kris Mastrangelo on Fri, Jun 18, 2010

Assessment Reference Date Management:  When consulting with our clients we usually see opportunities where a higher RUG category was potentially possible, if an alternative Assessment Reference Date was selected based upon the resident receiving IV fluids, which could be coded to obtain the additional ADL points.

Day 8 is habitually selected as the Assessment Reference Date for the 5-day assessment, based on the Rehab staff case managing minutes for day 8 to obtain a Rehab Very High or Rehab Ultra High category.  On the other hand, it is important to note that the RMX with the ADL score of 15 scores higher on the CMI index and pays higher than the RVL or RVB categories.

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Topics: ARD, ADL

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