We always code exactly what was given and
do not “drop time” anticipating a change in service in the
future. How do you know that is the case, residents’
condition/needs constantly change as does the plan of care? I cannot count the
number of times I have been told of an anticipated change in rehab only to have
them change their minds for one reason or another. I have observed that in the
long run it all works out about right. Think of all the therapy given on
day of discharge that you cannot bill for, the number of times therapy picks
someone up that the rehab RUGS cannot be captured until the next PPS assessment,
the number of midnights spent in the ER by a Medicare resident. Etc. PPS is
prospective payment.
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of Libby
Cawthorn
Sent: Monday, January
26, 2004 1:54 PM
To: [EMAIL PROTECTED]
Subject: RE: therapy minutes--try
again
Please type in larger
font, these old eyes cannot read this small print!!
----Original
Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]On Behalf Of Joyce
Nicholson
Sent: Monday, January 26, 2004
12:27 PM
To: [EMAIL PROTECTED]
Subject: therapy minutes--try
again
I questioned our lead therapist last week about several
resident's who had missed a therapy RUG group by 10-15 minutes, wanting to know
why she hadn't brought it to my attention so that the assessment period could
be adjusted to capture the minutes. She told me that she was purposely lowering
the minutes during the assessment period because one of the two disciplines was
planning on discharging the resident the following week or so, and the lower
RUG group would better reflect what services would be given. My response was
that per MDS rules, we should code the services given now, not what we think
might occur within the next month. The therapist brought in her regional boss
and they are insisting that if we don't "taper" the minutes to
reflect what is expected to occur during the payment period, then we are
opening ourselves up for Medicare auditing and could be seen as being
fraudulent. What are your thoughts?
Scope
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