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The problem with nurses’ notes - page 8 / 12





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Page 8

PPS Alert for Long-Term Care

November 2009

IV medications

< continued from p. 7

Marilyn Mines, RN, BC, RAC-CT, manager of clinical services at FR&R Healthcare Consulting, Inc., in Deer- field, IL. “SNFs really need to get the medication admin- istration record, known as the MAR, which shows the last date the resident received the medication.”

The supporting documentation for IV medications provided during the acute care stay must also be gener- ated by the discharging hospital.

“In the past, we had on-site evaluators go into the

hospital and document the information on the SNF’s preadmission screen form,” McCarthy says. “But this be-

came an issue because the documentation was technically generated by the SNF, not the discharging hospital.”

Get the family involved

“When it comes to getting information or documenta- tion from hospitals, the resident’s family may have more success than the SNF,” Marshall says.

When asking a resident’s family for help obtaining the supporting documentation for IV medications, a SNF should explain the situation to the family members and make sure they understand why this information is need- ed. Although the documentation may result in a higher reimbursement rate for the facility, financial gain is not the only reason the SNF needs this information. The supporting documentation also affects the care planning process and services provided to the resident.


When it comes to getting the supporting documenta- tion needed to code for IV medications provided prior to SNF admission, communication between the SNF and the acute care provider is crucial.

“The SNF’s ability to provide services to a resident is de- pendent upon knowing what that resident’s needs were during the acute care stay,” Mines says. “SNFs should let the resident’s family know that the care planning process may be negatively affected because the SNF does not have all the necessary information.”

“Before a resident is sent from a hospital to a SNF, there is usually a phone call between the hospital and the SNF’s discharge planner, a member of social services, or even a nurse. At this point, the SNF representative should ask for the current MAR,” Mines says.

SNFs should also make sure the resident’s family mem- bers understand that, if the hospital provides them with this documentation, it is the family members’ responsibil- ity to deliver these records to the SNF.

However, just because a SNF requests the information does not mean the hospital will provide it, even if it

agreed to do so. Sometimes, persistence is necessary.

Feeling the financial effect Many SNFs have felt the pinch of the economic down- turn and, as the long-term care industry continues to

“If a SNF is having problems trying to get supporting documentation, it can be helpful to meet with someone from the hospital,” says Lilla Carter, RN, BSN, case management specialist at Athena Health Care Solutions in Southington, CT. “Some hospitals have been hesitant

change, some providers are unsure of how they will fare

with even tighter budgets than they have now. Losing the ability to count IV medications provided in the acute care stay toward a resident’s RUG score will have a significant effect on a SNF’s bottom line.

to provide this documentation because they don’t un- derstand why we need it. But after we explain our situa- tion, they are usually cooperative and willing to help.”

If, after communicating and working with the hospital, a SNF is still unable to obtain the supporting documenta- tion for IV medications, the facility should consider turn- ing to the resident’s family for help.

“I think this will affect SNFs more than any of the changes they will face under the MDS 3.0 and RUG-IV,” McCarthy says. “This change could have the most signifi- cant negative financial impact on SNFs in the upcoming years, which is why it is so important for SNFs to capture

IV medications from the acute care stay on the MDS while they still can.”

© 2009 HCPro, Inc.

For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.

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