Harmony Healthcare Blog

Assessment Reference Date Management II

Posted by Kris Mastrangelo on Fri, Jun 18, 2010


Edited by Kris Mastrangelo

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.

Despite meeting minutes for the RVL or RVB category, the RMX will yield because the nursing time included pays more per unit of CMI than therapy time, as the category with the highest case mix index yields.  In many instances, one ADL point may result in attaining the next highest category and rate. 

Therapy Minutes Delivered

Qualifies for RUG

Extensive Services

ADL

Score

RUG Category

Daily

Rate

Urban

CMI

150

RM

Yes

14

RML

$359.83

44

150

RM

Yes

15

RMX

$390.60

47

550

RV

Yes

14

RVL

$388.37

46

550

RV

No

15

RVB

$358.83

43

550

RV

Yes

16

RVX

$414.20

49

 

The ADL score upon admission will assist in attaining the RMX.  The ambulance transfer and bed mobility for the patient that receives extensive assist of two will allow for optimal ARD management of day 7 and earlier to capture day one of the admission, while routine use of day 8 may result in attaining more "L" or "B" categories.

$ Impact IV Fluids:  RMX vs. RVB = $390.60 - $358.83 = $31.77 x 14 days = $444.78 (potential)

$ Impact IV Fluids:  RMX vs. RVL = $390.60 - $366.37 = $ 24.23 x 14 days = $339.22 (potential)

In order to select the best Assessment Reference Date:

  • Determine when the last Extensive Services may be coded on the MDS.
  • Determine Therapy qualifications for Rehab RUG.
  • Determine what the ADL Score is on day 8 and earlier.
  • Determine if the higher ADL score is captured with an earlier day.
  • Determine if there are IV fluids in the look back.
  • Identify all categories that the assessment qualifies for.
  • Identify the case mix weight for each category qualified for.

For example:

  • Day 8 is selected for the goal of Rehab Very High.
  • Patient's IV fluids was discharged the day patient was leaving the hospital.
  • ADL's are coded as a 2 assist for bed mobility and transfers only on day one only.
  • Patient will not meet the 16 ADL score required to obtain an RVX.
  • The team must then re-look at the selected ARD:
  • Day 6 or 7 will capture the additional "2" extra ADL point for the IV fluids.

The care is not altered based upon the goal RUG for the 5-day.  Minutes of therapy should be delivered as clinically appropriate.  That is to say the goal of an RMX should not limit delivery of more intensive minutes as the additional minutes and focus is valuable for the 14-day and may result in attaining the RVC/RUC.  

 

For more information of Managin your Assessment Reference Date click here

 

Tags: ADL, ARD

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