In this volatile economy, facilities must be aggressive in assuring they are receiving all revenue due for services provided.  The Long Term Care industry is not sheltered from the strain our economy is having on business in America.  Expenses are going up, and it will be taking longer to get paid for Medicare and Medicaid services rendered in the coming fiscal year.  This industry will be seeing less private pay admissions and decreased census in the hospitals as elective surgical intervention will decline.  All is not lost, as the new Medicare Part A rates went into effect October 1, 2008, reflecting a 3% increase in most counties.  Now is the time to maximize reimbursement to increase the bottom line!
 
Last week our newsletter discussed prevention of denials for claims in the lower 18 RUG categories.  This week as promised we will provide documentation examples to support Lower 18 claims and protect facilities from monetary take-backs, which no one needs at this time. 
 
Harmony recommends instruction of the nursing staff to focus the skilled documentation on:
 
Ø      Beneficial and adverse reactions to the recent medication adjustments and changes,
 
Ø      Behaviors that endanger the safety of the resident and other residents and staff,
 
Ø      Indications of hostile behaviors. 
 
Ø      Sleep pattern signs insomnia and lethargy.
 
Ø      Nutritional and fluid intake, signs of inadequate hydration or unplanned weight loss.
 
Ø      Review the potential medical conditions that may have exacerbated, causing psychiatric instability or other maladaptive behaviors.
 
Ø      An underlying medical issue may have caused the decline in mood and behaviors. 
 
Ø      Infections, unstable blood sugars, adverse effects of medication and poor nutrition and hydration may warrant further daily skilled observation and assessment as their effects may be significant on a medically compromised elderly patient. 
 
Ø      Comment on review of laboratory studies for abnormal values (review is skilled, even for negative results).
 
Ø      Assessment for therapeutic response to medication or discontinuance of medication.
For additional insight into documenting on this challenging population please contact Harmony Healthcare.
 
Remember:
“Patients who, in addition to their physical problems, exhibit acute psychological symptoms such as depression, anxiety, or agitation, may also require skilled observation and assessment by technical or professional personnel to ensure their safety or the safety of others, that is, to observe for indications of suicidal or hostile behavior.  The need for services of this type must be documented by physicians’ orders or nursing or therapy notes.” (Final Rule 7/31/99)
 
At Harmony we partner with our clients and assist them in assuring accuracy in MDS coding, Medicare billing and creating a clean audit trail to prevent loss of earned revenue.