Be thorough on evaluating ADLs, expert advises

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The functional status and behavior sections of the MDS 3.0 often lead to risk and liability dangers for providers, a long-term care coding expert said Sunday.

The MDS's Section G (Functional Status) creates an Activities of Daily Living score. Within the two levels of ADL coding, the scores for bed mobility, eating, toilet use and transferring “have to be pristinely accurate because it drives the payment,” emphasized Leah Klusch, RN, BSN, FACHA, the head of the Alliance Training Center. The other parts of the section are used to create a resident's care plan, but it is those four areas where providers run into significant billing problems, Klusch hammered home to attendees at the annual meeting of the American College of Health Care Administrators in Nashville. 

“There's a tremendous risk. We have a responsibility to code exactly what happened, and you need backup,” Klusch said. “It writes our ticket, it writes our survey, it writes Nursing Home Compare. If those ADLs aren't right, you can have a payment denial.”

Klusch said it's estimated that the number of assessments has gone up more than one-third since last fall, which puts even more pressure on the MDS assessment coordinators.

“Nurses have to be involved. MDS managers are working two to three more hours than a year ago,” she said. “The workload has exploded.” In fact, some facilities have hired a seven-day-a week full-time staff monitor to overseeing ADL coding for the MDS office, she said.

In the behavior section of the MDS, she added, administrators must be clear with staff on their clinical definition of wandering, which is “locomotion with no discernible purpose.” That means “Mrs. Jones was wandering around looking for food,” doesn't qualify.

“When you put someone as ‘wandering' it's a high-risk care delivery,” Klusch elaborated. Additionally, caregivers must be clear on the definitions of “hallucinations” versus “delusions,” on the form.

Klusch has been conducting numerous sessions on MDS 3.0 at the ACHCA convocation, which began Saturday and ends Tuesday.