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:
Capture of Extensive Services: All instances of IV medications, IV fluids, ventilator support, suctioning and trach care need to be captured. This makes the information from the discharging facility as well as the pre-admission screen vitally important. It is important to know the last date of provision of these services to capture these services by using the 5 day assessment reference date and potentially for the 14 day assessment as well.
ADL Coding: As ADL coding provides the end split for all rehab categories as well as Extensive Services plus Rehab categories, it is necessary that the ADL coding on the MDS is as accurate as possible.
When it is apparent to the MDS Coordinator that the CNA's are under coding a particular patient, it is important to interview all staff and family that are involved in providing care to these patients to determine the correct levels of assist provided to the patient. Harmony recommends that the results of these interviews be documented by the MDS Coordinator in the patient's medical record.
At some facilities ADL flowsheets are often coded following the shift previous to the current shift being coded. The CNA staff should be encouraged to code what occurred during their shift only. However, when the coding of the CNA's appears to be highly over coded, the interview process should be initiated to code the MDS appropriately. If the CNA's are coding a two person assist, the MDS Coordinator may not be aware of this especially if it is occurring during the evening and night shifts.
Medicare Length of Stay: A lot of facilities do not currently track their Medicare length of stay. This is important as the optimal time period for capturing the higher RUG categories is the first two assessment periods with the capture of extensive services with rehabilitation. There are strategies to maintain the Medicare Part A rate after this time period with the provision of appropriate rehab services as well as capture of all nursing interventions.