ADL Documentation Part 1 of 2

Harmony Healthcare International provides the long term care industry the tools to obtain accurate reimbursement and ultimately provide better care to its residents. Through seminars and consulting services, Harmony educates, trains and advises with a client centered approach. We also provide monthly onsite audits to ensure MDS accuracy, Medicare compliance and Case Management review.


ADL DOCUMENTATION Part 1

ADL Documentation and Coding: Harmony clarifies that CNA documentation is but one of many areas to support ADL coding of the MDS. The entire medical record may be used in identifying a true ADL status. Harmony recommends review of the therapy documentation to investigate support for higher ADL coding. The translation from therapy terminology to MDS coding is as follows:

MDS Score
MDS Terminology
Therapy Terminology
Therapy Definition
0
Independent
Independent
No physical or cognitive assistance required.
1
Supervision
Supervision/
Stand By Assistance
Therapist is needed for supervision for safety and performance specifics.
2
Limited Assistance
Contact Guard
Therapist is in contact with patient via gait belt, just in case physical assistance is needed.
3
Extensive Assistance
Minimal Assistance
Therapist provides 25% of physical output needed for task; patient does 75% of work.
3
Extensive Assistance
Moderate Assistance
Therapist provides 50% of physical output needed for task, patient does 50% of work.
3
Extensive Assistance
Maximum Assistance
Therapist provides 75% of physical output needed for task, patient does 25% of work.
4
Total Dependence
Dependent / Total Assistance
Therapist provides 100% of physical output needed for task, patient does 0%.

ADL's comprise approximately 30% of the rate of reimbursement associated with the RUG score/rate. On admission or return from outside appointments it is important to ask nursing to detail the mode of transfer from stretcher to bed and positioning. Often, the patient may receive more assist on return which may be included on the admission or return re-admission nursing assessment form.
Example:
Ø "This 78 year old male is admitted from MCH via ambulance stretcher. Patient transferred from stretcher to bed and positioned in bed with assist of (3)."

This documentation may be the difference between two RUGS levels.

ADL Coding $ Impact: (Essex County, MA RUG Rate) RUX ($626.00) vs RUL ($549.75)=$76.25/day x 14 days =$1,067.50

This example is for one assessment.

Part 1 of 2. To be Continued


For more information on ADL Documentation, Skilled Nursing, Part A and Case Mix revenue enhancement go to: http://www.harmony-healthcare.com or email jrouthier@harmony-healthcare.com