MDS Alert

If you use daily check-off sheets for Medicare documentation, make sure to do this.

Is your documentation good enough to hold onto your Medicare dollars? It will be if you continually make sure medical record documentation shows the facility provided medically necessary skilled services for Part A SNF patients.

"The key is that the person has to need and receive a daily skilled service," says Atlanta consultant Darlene Greenhill.

Tip: "If you are using check-off sheets for daily Medicare documentation, include a narrative note about what you are checking," advised Marilyn Mines, RN, RAC-CT, BC, in a presentation at the American Association of Nurse Assessment Coordinators meeting in October 2010. Mines noted that she's reviewed charts where it was impossible to tell what nursing expertise was needed to care for a resident.

Don't overlook: Daily skilled nursing documentation is also important for residents who are in rehab RUGs, stresses Elisa Bovee, MS, OTR/L, VP of operations at Harmony Healthcare International in Topsfield, Mass. "Nursing anchors all care," says Bovee, noting that's really why patients are in the SNF. "They are skilled for nursing and rehab is a component." So take a look at what's going on with the resident when he returns from therapy. "Is their O2 bumped up, blood sugar unstable -- are they weak due to therapy, at risk of falls, etc.?" Nursing should document all of those elements of care, especially teaching and training, she adds.

The facility also needs documentation "that supports that rehab picked up a person, in part at least, due to the person's decline in function," says Joel Van Eaton, BSN, RN, RAC-CT, reimbursement and RAI consultant/MDS 3.0 product development with Extended Care Products Inc.

"Documentation should also be clear that, as a practical matter, the care could only be provided in the SNF," Bovee adds. (See page 54 for Harmony Healthcare's "Core Components" nursing documentation approach to skilled nursing documentation for cerebral vascular accident. Nursing documentation core components are also provided for liver failure, lung cancer (chemotherapy), multiple sclerosis, MI, AIDS, and many more diagnoses, conditions, and services.)