Stories From The HHI Field

Working in Harmony

Harmony educators, when partnering with the phenomenal staff at facilities, can do great things for revenue insulation.  Oftentimes, HHI client express how much they love HHI in services. Recently, I did a Nursing Documentation in service for a nursing home. The facility praised Harmony for the great content and examples that I used. During the next site visit, I  reviewed the facilities’ notes and discovered that they had significantly improved, beyond my expectations.

-Harmony Vice President of Field Operations 

Harmonious Combination of Work and Fun       

I have provided ADL education to CNAs in a vacant patient room. I demonstrated to the CNAs how to transfer someone with limited assist of two bed to chair since this was consistent in their documentation. I used hand under hand technique and allowed CNAs to practice with her as the “patient”. I lay in the vacant bed and the CNAs around were attempting to transfer me with guided maneuvering alone. As this was occurring, the administrator, accompanied by a guest, walked into the room. She was surprised at the CNA’s response to the training, as everyone was laughing and engaged.  She was also pleased to know that, while they laughed, and had fun, they also learned how to how to transfer someone with limited assist of two bed to chair.                       

-Northeast Regional Harmony HealthCARE Specialist

Harmony Gets Hugs

A new Rehab Director ‘inherited’ a number of difficult therapists, productivity issues and rehab case management challenges. After 3 months of HHI mentoring, the facility made significant strides in productivity, clinically appropriate intensive therapy and improved documentation. That day the Rehab Director hugged me and said “I don’t know what I would have done without you.”

-Mid-Atlantic Regional Harmony HealthCARE Specialist

A Friendly Spy from HHI

I was auditing charts at a facility. Meanwhile, in the same room, the facility was holding a Medicare/PPS meeting.  I overheard the participants in the meeting combining COTs with a regular scheduled assessment when the RUG level decreased taking the lower reimbursement 7-days back when not necessary.  I explained the COT rules and that combining a regular assessment when the RUG level decreased was not necessary. The administrator thanked me for being there!    

-Harmony Vice President of Field Operations 

Impairment Scale – No Longer Impaired  

I went into a facility where Rehab has not been receptive. The OT manager of the facility asked me for help reviewing a Medicare B patient. Looking at the record I identified the need for help with G codes and impairment rating scales. I reviewed this topic with the manager, and gave her a few ideas to improve the OT documentation. In addition, I created an impairment scale specific to this case that the OT manager could use, and advised the manager that she could justify 3 visits per week instead of just 2. The manager was delighted to have the “custom made just for her impairment scale.”

-Northeast Regional Harmony HealthCARE Specialist 

Harmony Cares for Clients’ Pains & Wounds

I was performing medical reviews in a facility and discovered the client was struggling with wound care. I spent time with the MDS team to investigate etiology of wound, provided education to team regarding wounds, and proper coding applications on MDS. A few days later when the MDS was coding the treatments provided, she contacted Harmony for help. She expressed that she felt what the MDS captured did not reflect the skin care issue. HHI team was able to walk her through the process step by step on case review to capture cure provided by staff and maximized reimbursement.

-Southeast Regional Harmony HealthCARE Specialist

It’s Never Just “Goodbye". It’s Always Something Different ...

I was asked to assist a facility in determining their appropriate Nursing Staffing. Review revealed so many other pains such as: the client’s CaseMix CMI had fallen far below the facility acuity reported, the client had low Medicare Part B revenue, and the therapists at the facility were providing free care. I was able to target specific issues to set a plan to significantly increase CMI to better reflect resources used and therefore increase Medicaid revenues. I also provided great tips on how to increase Medicare Part B revenue, which increased the client’s CMI as well. In addition, I had a discussion with the facility which led the client to being open to assistance with therapies.By the end of that visit, the client’s notes at the exit were:

“Thank you! This is what we really needed.”

“Goals were set for next visits, but we feel we need more visits during Case Mix.”

“Harmony understands our facility.”

“Can we host a CHHRP and get all of our therapists certified for
long term care?”

-Harmony Senior Vice President of Education and Training

Harmonic Surprise

A client was seeking a compliance review to identify their potential risk as a skilled provider.  I was able to develop a product which catered to their specific needs.  Upon completing the product line in the client's facility the CEO was “blown away” with the info we discovered, using the product. He said, ‘The results have exceeded our expectations!’

-Northeast Regional Harmony HealthCARE Specialist

OMG, We Had a Successful OM(i)G Audit!

After a HHI mock Audit, a client commented: “We had an (OMIG) audit yesterday and they were only here 2 hours. Thanks for your help, everything was in order and they didn’t have any problems reviewing our charts. We would never have done so well without your suggestions. Thanks!”

-Harmony Vice President of Field Operations  

Death - Can Cheat It, But Should Not Miscode It

HHI Clients are often unaware that the “death in facility tracking” form is the correct form to choose if the patient has died while on LOA or while still a resident of the facility.  The death in facility form is a truncated tracking form which contains mostly demographic information and is much more efficient to complete. 

I enjoy sharing tips on how to correctly choose between the MDS 3.0 discharge assessment and the death in facility tracking form. I also enjoy teaching HHI clients how to save time and streamline their work process. 

The relief and delight on the MDSC’s face, when she realizes she has one less assessment to do, is priceless! This is one of the many reasons why I love this job!

-Harmony Vice President of MDS/Nursing Education and Training 

Harmonizing Revenues

I once worked with a facility with a Medicaid census that was 74.5% of their total census and a Medicaid rate of $135.00 per day completed their OBRA MDS assessments on a regular schedule, using an ARD that was based on the MDSC schedule.  It was an “AHA” moment when I explained to the client that MDS assessment should support the clinical picture of the patient and that the entire IDT team is charged with choosing an ARD that bests represents the clinical needs of the patient.  With my instruction, they began realizing that basing ARD selection on clinical issues with proactive management of ARD scheduling could improve the accuracy of their assessment and prevent lost revenue.  This led to a jump of $22.58 in their daily Medicaid rate that tallied at $157.58 about six months later.

-Mid-Atlantic Regional Harmony HealthCARE Specialist

Case Mix Increase     

I went in to the facility at the personal request of the owner to look at case mix before the end of the window.  The facility had no ADL documentation and was not notifying therapy of changes in status.  I assisted the facility in implementing an ADL tracker and provided education R/T ADL documentation and the important of notifying therapy services of a particular change in status.  These measures were implemented by the facility which significantly impacted their case mix, increasing it from a .76 to a .88.

-Mid-Atlantic Regional Harmony HealthCARE Specialist 

Just Breathe … We’re Capturing Your Respiratory Therapy Services

While visiting a facility, we recognized an opportunity to capture respiratory therapy services.  The facility nurse administrators were unaware of the ability to train their nursing staff and capture the services on the MDS.  A brief in service provided to nurse administrators and conversation on how to develop a competency resulted in a follow up visit where respiratory therapy services were captured due to accurate documentation.  This contributed to an overall increase in CMI score.  0.7 to 0.909!

-Northeast Regional Harmony HealthCARE Specialist 

Successful Mock Surveys

While I and a HHI consultant were providing a Mock survey to a customer, there was identification of areas of concerns. The facility worked collaboratively with me and the HHI Consultant with implementing recommendation based on the survey outcomes. The facility had a deficiency free Survey. This facility was so grateful to us and the positive outcomes, and said they could have not done it without us. We provided many HHI Clients with Mock Surveys that result in positive survey outcomes. These facilities utilize Harmony (HHI) each year for Mock Surveys for preparation and continue to have positive Surveys.

-Harmony Vice President of QAPI/QM