Harmony Healthcare Blog

Rehab Case Management for Case Mix

Posted by The Harmony Team on Wed, Jul 25, 2012

Successful case management for Case Mix involves the coding of the accurate minutes of care provided by therapy on the MDS for those patients seen under Medicare Part B. There is significant opportunity to increase the case mix index with the intervention of rehabilitation during the appropriate assessment windows.  Increased communication between the Rehabilitation staff and the MDS Coordinator regarding patients receiving Medicare Part B services has the potential to increase the case mix index in two ways. 

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Topics: Rehab, Medicare Part B, Case Mix, OBRA, Assessment Schedules, Rehab Case Management, MDS Coordinator

Discharge Planning: Determining Prior Level of Function

Posted by The Harmony Team on Wed, Jun 06, 2012
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Topics: Rehab, ADL, Discharge Planning, Cognitive Patterns, Rehab Case Management

Rehabilitation Services Impact on Medicaid Case Mix

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Mon, Jun 21, 2010

Impact Rehabilitation Services Impact Medicaid Case Mix:  Rehabilitation Therapists are integral members of the interdisciplinary team as is their participation in the process of resident assessment.  The routine therapy screen assists in identifying areas of decline or the potential for improvement, before loss becomes permanent or opportunities for improvement are missed. 

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Topics: Case Mix, ARD, Rehab Case Management

Managing Medicare Length of Stay

Posted by The Harmony Team on Wed, May 26, 2010

Case management by the rehab staff is one of the primary factors effecting Medicare length of stay.  Generally, when a patient is admitted for short term rehab their underlying medical conditions stabilizes before they have reached their functional potential.  Therefore, although Harmony always teaches that nursing anchors all Medicare Part A skilled admissions, there are instances when the Rehab Department is the driving force behind the patients discharge plan. 
Medicare supports providing rehab services to help the patient achieve their prior level of function.  This should be thoroughly investigated and considered when discussing the patient's potential discharge and Medicare length of stay.  The following is a brief list of questions to consider before taking a patient off therapy:
Is the patient going home with an assistive device they did not previously use?  Does the patient have the potential to progress to a less restrictive device?
Are we asking caregivers to assist the patient with any of their ADL or IADL tasks that the patient was able to do before?  Does the patient have the potential to do these tasks on their own with further training?
If the patient is returning to an assisted living facility, did the patient utilize all of their services before or will they be using services that they previously did not?  Do they have the potential to resume their prior routine?
Even though the patient has assistance available (ALF, spouse, etc.) do they want to rely on their caregiver or are there activities the patient would like to be able to do on their own?
Does the patient enjoy making their bed every morning?
Would the patient prefer if other people did not wash their undergarments?
Does the patient like to make their own afternoon tea?
If yes is the answer to any of these questions it is clinically appropriate to investigate continuing the therapy program and further progress the patient to their highest functional ability.  It is important to update the therapy plan of care to include new goals specific to these higher functioning tasks and ensure that it documented that these goals directly relate to the patient's prior level of function and appropriate Medicare length of say. 

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Topics: Length of Stay, ADL Coding, Rehab Case Management

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