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Increasing Reimbursement in Long Term Care

While quality of care is the top priority, working to get the top level of payment that is justifiably regarding services rendered is of the utmost importance. Increased funds produce more resources for care. 

Know the Federal and State Regulations. MDS data and documentation out of compliance, due to errors or lateness, risks having assessments being paid at the default rate; the lowest rate of payment. 

Be familiar with the documentation requirements of skilled care. Knowing the requirements of skilled care provides opportunities to spot residents falling into higher reimbursement levels upon admission or when the level of needed care changes. Making sure the required documentation is in place assures that the facility will be paid for those services. 

Know the criteria for RUG IV categories. Many elements of the MDS affect the RUG IV categories, and being familiar with them will help spot aspects of care that might otherwise be overlooked. 

Use Grace Days to capture a higher RUG IV score. One of the reasons the Grace Days exist is to enable the facility to capture services for higher reimbursement. Work with the Therapy departments to set the ARD to capture higher Rehabilitation categories. 

Monitor residents for changes that could alter the level of care. Scheduling Significant Change assessments when they are needed not only keeps the Care Plan appropriate for the resident’s needs, but it can also captures higher payment rates do to the increased need for care. Read the 24 Hour reports, attend Stand-up meetings, and examine the Physician’s telephone orders daily to catch changes.  

Schedule assessments to capture higher RUG IV categories. Although Quarterly assessments can be no later than 92 days of the completion date of the last assessment, it is perfectly legitimate to schedule them earlier than the 92 days. 

Guest Article by Debra Collins RN, RAC-CT, and Pedagogy author of multiple Inservices and Compliance online education courses for certified nursing assistants, CNA’s, and home health care aides.  As CEO and President of LTCS Books, Inc., Debra maintains a knowledge base and writes weekly articles on long term care and home health care federal regulatory changes.
Posted: 7/12/2013 4:56:00 PM
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