Harmony Healthcare Blog

Isolation and Quality Care Top 10 Criterion You Need to Know: Coronavirus (COVID-19) Pandemic Repost

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Tue, May 26, 2020
Kris Mastrangelo, OTR/L, LNHA, MBA
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C.A.R.E.S.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency Survey

 


Kris Presenting Montana-1

As the Coronavirus pandemic evolves, we are actively observing our world change at an exponential pace.  Despite this rapid change, the commitment level of the team at Harmony Healthcare International (HHI) has not deviated from our uppermost dedication to you, your staff and most importantly, to our role in helping you provide the highest quality care to your residents.

First, and most importantly, the safety of you, your staff and your residents remain the number one priority.  Most of you have readily adapted and maintained our Harmony Healthcare International (HHI) services using remote access.  We are grateful for your flexibility and appreciate your awareness of the potential risks of missing your monthly medical record reviews.  Many scenarios cannot be recouped and a heightened focus on care and reimbursement is essential to successfully navigate the upcoming months.

This leads me into a very important subject matter that fits the current world situation:

Isolation of patient’s with infectious diseases.

The past 3 weeks of Harmony Healthcare International (HHI) audits on our national client base depict opportunity with the coding of isolation and properly implementing isolation criterion on residents. 

Isolation protects you, the staff, the residents and requires an effective procedure for all employees to be educated on.

The Top 10 Isolation Criterion

  1. The resident resides in a room alone because of active infection and the resident cannot have a roommate.
  2. The resident must remain in his/her room and all services are brought to the resident (e.g., Rehabilitation, Activities, Dining, etc.).
  3. The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
  4. The Precautions are over and above standard precautions. Precautions are transmission-based precautions (contact, droplet, and/or airborne).
  5. There is an MD Order for Isolation.
  6. There is Physician Documentation (Progress Notes) that supports the rationale for isolation.
  7. Track isolation on a TAR/MAR to identify the exact days in which isolation occurs.
  8. Be sure the Care Plan addresses interventions to reduce the negative impact of isolation.
  9. Review the patient status for Significant Change MDS
  10. The Facility Policy for Isolation updated.

Download Isolation

Resident Checklist Here

 

Single Room Isolation

Per the MDS 3.0 RAI User’s Manual, Isolation is coded only when the resident requires transmission-based precautions and single room isolation (alone in a separate room) because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.

Single Room Isolation can be coded only when all the following conditions are met:

  • The resident has active infection with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission.
  • Precautions are over and above standard precautions. That is, transmission-based precautions (contact, droplet, and/or airborne) must be in effect.
  • The resident is in a room alone because of active infection and cannot have a roommate. This means that the resident must be in the room alone and not cohorted with a roommate regardless of whether the roommate has a similar active infection that requires isolation.
  • The resident must remain in his/her room. This requires that all services be brought to the resident (e.g. Rehabilitation, Activities, Dining, etc.).
  • At least one day in the look-back is required to code.

When is Isolation No longer Required and Healthcare Professional Return to Work?

There might be many of you reading this article that have tested positive for COVID-19. Depending on where you live, you may or may not have been formally tested.  Below are the current guidelines (as of March 16, 2020), for the removal of home isolation and the return to work.

  1. No Test: Time Based Strategy

    Persons with COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:

  • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications;

    and
  • improvement in respiratory symptoms (e.g., cough, shortness of breath);

    and
  • At least 7 days have passed since symptoms first appeared.

  2. Test: Test Based strategy

A test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing. For jurisdictions that choose to use a test-based strategy, the recommended protocol has been simplified so that only one swab is needed at every sampling.

Persons who have COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation under the following conditions:

  • Resolution of fever without the use of fever-reducing medications

    and
  • Improvement in respiratory symptoms (e.g., cough, shortness of breath)

    and
  • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart. (Total of two negative specimens).
  3.Individuals with laboratory-confirmed COVID-19 who have not had any symptoms may discontinue home isolation when at least 7 days have passed since the date of their first positive COVID-19 diagnostic test and have had no subsequent illness.

 

Transporting an Isolated Resident

If a facility transports an isolated resident (i.e., meets the criteria for single room isolation) to another healthcare setting to receive medically needed services (e.g. dialysis, chemotherapy, blood transfusions, etc.) which the facility does not or cannot provide, the CDC Guidelines for the transport of patients with a communicable disease must be followed.  The facility may still code O0100M for single room isolation since it is maintained while the resident is in the facility.

Significant Change of Status Assessment (SCSA)

Finally, when coding for Isolation, the facility should review the resident’s status and determine if the criteria for a Significant Change of Status Assessment (SCSA) is met based on the effect the infection has on the resident’s function and plan of care.

The definition and criteria of “significant change of status” are found in the MDS 3.0 RAI User’s Manual Chapter 2. Regardless of whether the resident meets the criteria for an SCSA, a modification of the resident’s Plan of Care will likely need to be completed.

Documentation of Isolation

The MDS 3.0 RAI User’s Manual provides clear instruction on the Documentation to support Isolation. Documentation must support the medical necessity of Isolation.

There must be:

  • An MD Order.
  • Documentation to support the need for a private room.
  • Documentation to support the need for the resident to remain in their room.

If the isolation precautions continue for extended periods with no documentation to support medical necessity (or for conditions that are excluded, such as wound infections), the Reimbursement Level will be classified into a lower Category under audit.

Documentation that supports the coding of Isolation should state that all treatments, therapy, and activities are provided in the patient’s room due to isolation precautions. Further information can be found in Chapter 3, Section O of the RAI User's Manual.

$ Impact of Isolation

The above blog describes the clear importance that isolation plays on the quality of care.  For those that know me, I am the daughter of a mathematician, so I love the numbers.

There is a significant financial upside to properly coding isolation.

It can be upwards of $200-$500 per patient per day!

Example:

​$1,005.54 versus 845.47 Middlesex County, MA

$160.07 ppd x 35 days = $5.602.45 Revenue Increase 

 

PDPM.Calc

https://pdpm-calc.com/

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Call

1.800.530.4413 Harmony Healthcare International (HHI)

Or

617.595.6032 Kris Mastrangelo OTR/L, LNA, MBA

Today!

for monthly audits to ensure accurate and appropriate care and reimbursement!!

  

What are Conditions that isolation Not Required?

Isolation is not coded under the following conditions:

  • If the resident only has a history of infectious disease such as “s/p MRSA” or “s/p C-Diff” with no active symptoms.
  • If the precautions are standard precautions because these types of precautions apply to everyone. Standard precautions include hand hygiene compliance, glove use, masks, eye protection, and gowns.
  • Urinary Tract Infections, Encapsulated Pneumonia, and Wound Infections.
  • There are psychosocial risks associated with isolation and it is recommended that psychosocial needs are balanced with infection control.

 

Download Isolation

Resident Checklist Here

 

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


 harmony20 October 29-30 2020 Encore Boston Harbor

Topics: Isolation, coronavirus, COVID-19

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