As discussed last week, ADL’s are the major target for HHSC-OIG. ADL’s are the source for most errors resulting in RUG write downs. Not only did the facility lose money on incorrectly charted ADL’s they will also face large penalties after a RUG review.
Charting ADL’s
For most MDS nurses, ADLS are pieces of paper the CNA’s have scribbled some numbers on. Ideally this number reflects both the Plan of Care and what care was really given. Calculating an accurate ADL score for many residents is impossible to do using this system. A single MDS coding mistake will cause a review error and a RUG write down. Also, the practice of leaving charting until the end of the day or later can cost the facility a significant amount of money.
What really happens?
As an example; your facility has a resident who generally requires no assistance, but on the morning shift the CNA moves the resident’s legs over the edge of the bed while the resident sits up. The CNA charts 0 which reflects this resident’s independence. However, the correct charting should have been 3, limited assistance. This raises the ADL rate and the associated RUG. Your facility just lost money.
This same resident is pulling on their socks but drops one; the CNA picks it up and puts the sock on for them. The CNA charts 0 since the resident could have done it themselves. This should be charted as 4, extensive assistance, 1 person assist. Your facility just lost money again and over a 90 day period, it adds up to a lot of money. The real financial issues come into play during the MDS reporting period.
The MDS nurse reviews the ADL worksheets and notes the resident is charted as 0 on each shift. The MDS nurse does not know that the LPN noted the CNA assisted the resident by putting on socks. This will result in the allegation of a RUG error and reviewers will, by extrapolation, write down the entire resident RUG’s in that category. Not only did you not bill for the correct services rendered, you will be subject to a substantial recoupment
How to protect yourself and realize better profit
The only way to prevent this serious financial loss and to verify quality of charting is to use a good software program such as MDSMax®. Easy to use and inexpensive, it directs the CNA to correctly chart those easily forgotten ADL’s. It prevents the “prefilled” ADL worksheet (or worse), allows the manager to see real time charting and correct any issues immediately. It also correctly calculates the MDS entries for each resident and appropriately documents the ADL’s for the resident’s chart. Overall a package such as this will cut employment costs, boosts profits and correctly document ADL’s.
ADL’s are the financial “bread and butter” for the long term care facility. Don’t leave this important fiscal element to a few scribbled numbers on a piece of paper.
Next week – Charting by exception – the fast track to Review errors.
