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Q: My administrator has instructed me to always use day eight as the assessment reference date (ARD) for the five-day MDS to get as high a Resource Utilization Group (RUG) rate as possible. Is this the correct way to determine the ARD?

Julia's PPS Chat, November 10, 2004

Welcome once again to our PPS chat!

What should you do when your supervisor requests you follow a procedure, and you're not sure it's correct? This can be a very difficult situation. Should you confront your supervisor with your objections or just follow what he or she asks you to do?

Read on to find out the answer to this question-

Q: My administrator has instructed me to always use day eight as the assessment reference date (ARD) for the five-day MDS to get as high a Resource Utilization Group (RUG) rate as possible. Is this the correct way to determine the ARD?

A: No, routinely using three grace days for every five-day MDS is not appropriate. Routine use of all available grace days could, in fact, trigger a federal audit. Let's review some examples to illustrate how you should use grace days.

If you admit a resident on a Friday and you consider the resident skilled due to the need for rehabilitation-but he or she is too weak to receive therapy the day of admission-you might not begin therapy until the following Monday. In a situation like this, you should definitely use grace days in order to receive the appropriate higher RUG payment, which reflects the level of therapy you began on Monday.

In another example, if you admit a resident on a Monday and begin rehab that very day, by the fifth day of the resident's stay you probably would have delivered five days of therapy. Therefore, setting the ARD on day five without using grace days would likely give you an accurate RUG rate for that resident.

Just remember, you should certainly use grace days if they more accurately reflect the level of skilled services you provide. But a blanket policy of always using grace days is definitely not the purpose for which CMS intended them.

Explain to your administrator that using three grace days will not always guarantee a higher RUG-and in some cases, it might even result in a lower reimbursement rate. Use your own best professional and clinical judgment when setting the ARD.

So, the best way to deal with this situation is to check you reference materials, and explain your reasoning to your supervisor. Maybe you will both learn something new during this process.

Until we chat again about care plan meetings-