Ask the payment expert: How will our new e-charting system influence our reimbursement?

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Patricia Boyer, MSN, NHA, RN
Patricia Boyer, MSN, NHA, RN


We are getting a new electronic charting system. Is there anything we should be aware of with the change?

Absolutely. It is always challenging whenever you are changing your system. I'm assuming that the electronic health record (EHR) also includes your MDS software and hopefully integrates with your financial and therapy systems. That will be a big plus if it does and more of a challenge if it does not. 

Make sure your vendor gives you complete training on its system and you understand how its integration from one element of data to another works. We recently had a client who implemented a new EHR system and didn't understand all the system needed to know.

One issue the provider faced was automatic coding of isolation on the MDS if someone documented isolation during the “look back” period. Of course, RAI rules only allow limited coding of isolation with specific stipulations that need to be met. If the facility fails to review that on the MDS, it could be paid at an inaccurate rate and therefore owe significant dollars back to Medicare. 

Another issue was that when the system started, it coded all assessments as first assessments and, therefore, missed multiple areas of the MDS coding. This could result in survey compliance issues.  

So what should you do? Make sure that you ask to review all automatic feeds to your MDS. Make sure you talk thoroughly about any coding on the new MDS system that might impact the output on your present MDS.  In other words, know what questions to ask. Carefully review your MDSs for the first assessment completed for each resident to ensure coding is correct. 

Contact your software vendor with any issues. Sometimes, they inadvertantly create a coding nightmare.