Ask the payment expert: Why do we have so many A's in our ADL coding?

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Patricia Boyer
Patricia Boyer

Why does it seem that we have so many A's in our ADL coding resulting in lower reimbursement?

The new RUGs-IV scoring methodology has a strong tendency to score your ADLs lower. 

It takes repetitive education of your CNAs to ensure you are capturing the correct level of assistance being provided to your residents. 

Unless you have the need for two-person physical assistance in at least some of your “late loss” ADLs, you probably won't be above an “A”.  Physical assistance is more heavily weighted.

Also, in the RUGs III system, if the ADL did not occur, the scoring equated to a 3 or 4, which had higher scores. Now an 8 (did not occur) or a 7 (occurred only once or twice) equates to a 0 or 1, which are the lowest scores.  It is not surprising that facilities are seeing more “A's” in their scores, which means lower reimbursement.

The key is: How can you get the highest possible scores? First, you want to provide training to your nursing staff on hire, and on a routinely scheduled basis. Secondly, you want to make sure that a “look back” tool is utilized at least once a shift for at least seven days prior to the Assessment Reference Day (ARD). 

Finally, calculate your ADL sum score prior to submitting your MDSs and double-check those that are on the cusp of the next level. That one check could mean up to $90 per day increase in your RUGs rate.  


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