MDS Alert

Hint: Try hard-to-ignore hot pink binders.

If your SNF uses Medicare Part A certs/ recert forms, you need a system to keep them from slipping through the cracks.

Case in point: Isabella Geriatric Center used to put certs/recert forms on the front of patients' charts so the doctors would see and sign the forms. But sometimes the forms were overlooked, reports Yaffa Ungar, director of clinical compliance at the facility in New York City.

So the facility staff came up with a vivid visual prompt: hot pink binders that contain the forms that need to be signed. The binders include dividers labeled day one through 31 for each day of the month. "When the MDS coordinator gets the first certification signed, she files it under the day of the month that the next one needs to be signed," says Ungar.

Next step: Everyday the neighborhood coordinator who is the unit clerk opens the binder to the day of the month and removes all the recerts to give to the nurse who, in turn, presents them to the doctors for their signatures, explains Ungar.

Key: "The physician doesn't fill in the information on the cert/recert -- we do that for them," Ungar says (for details on information that a cert and recert must contain, whether you use a form or not, see the article on page 153).

Before signing the form, however,the physician reviews the resident, the chart, and the information on the form. The signed form then goes under the day of the month when a recert needs to be signed.

Completed forms go in the resident's medical record.

"Getting the doctors to sign usually isn't a problem as the doctors come often, although we also have physicians on call who are familiar with the patients" and can thus sign the forms, says Ungar.

The facility "also has a Medicare roster that includes everyone on a Part A stay and the reason for their coverage," Ungar says. The staff updates the form daily, and each Friday, sends a copy to the nursing units. The neighborhood coordinator puts the roster in the pink cert binders. "The MDS coordinator can use this roster to make sure the recerts or certs are up to date in terms of the reason for coverage"-- for example, if the patient is now receiving physical therapy, says Ungar. The roster in the pink binder also alerts the nurses to what they need to document in their notes to support the Medicare skilled services for the patient, she adds.