Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency
MDS Nurses do not need to be expert coders, but it is essential that they connect the dots between the diagnoses and rationale for skilled care.
PDPM flips the script and highlights nursing care. For the last 2 decades, therapy dominated the RUGs classification at 92%. This means that skilled claims leaned on therapy as the skilled qualifier. Although Harmony Healthcare International (HHI) consistently preaches that “nursing rules the world” and that “nursing always anchors the patient for skilled coverage”, many providers may have relied solely on therapy for coverage.