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Q: Our daily PPS meetings have turned into more of a financial meeting than a nursing meeting. Shouldn't we be discussing the nursing and therapy needs of the residents rather than the amount of reimbursement we receive?

Julia's PPS Chat, February 1, 2006

A: Actually, you should be discussing both the level of care the resident requires and the amount of Medicare Part A reimbursement that you receive. Because the resident's care needs directly affect reimbursement, you can't discuss one without considering the other.

As I'm sure you are aware, receiving proper reimbursement is important for your nursing facility. This reimbursement depends upon the amount of care the resident requires, the documentation to support this care, and the proper completion of the MDS form.

When holding your PPS meetings, you might want to begin the meeting with the skilled care needs of each resident. Be sure to involve your therapy staff in this discussion.

After talking about this area, the meeting will probably flow naturally into a more financial discussion of the care needs plus the Resource Utilization Group (RUG) rate reimbursement that the facility received or is projected to receive in the future.

This part of the meeting is important to ensure that the facility obtains the appropriate RUG level by setting the assessment reference date properly and coding all reimbursement-affected items on the MDS correctly. Other participants in the meeting, such as the business office manager or the administrator, might discuss the billing procedures and whether the facility received payment.

PPS has made everyone, including nursing staff, more aware of the amount of reimbursement received. The nursing and therapy needs of the resident will affect this reimbursement greatly.

Be sure that you discuss all pertinent information about your Medicare residents. Remember that this meeting is a great opportunity for everyone to get together and talk about both medical needs and financial aspects of your Medicare residents.

Until we chat again about MDS coding-