Hey all up to how high of a functional level do you guys admit patients? I don't admit beyond a min A (ie I don't admit CGA or SBA). At times I say no to these types of high functioning patients and I get flack.
Thoughts?
Thoughts?
Functional levels
- Thread starter Iamnew2
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I think we had this discussion before.
Anyways, yes there is nothing wrong with admitting a patient at a true CGA or S level. If they lived alone, CGA or S or SBA means they can’t go back home. If they have needs of 2 therapy disciplines and have medical need then they should qualify for IPR.
Usually as long as they will need at least 5 days of acute rehab. If it’s going to be shorter than usually not as time efficient.
I am not an insurance reviewer. I am just trying to get people better and back home in a short period of time. There is nothing in Medicare guidelines that says they have to be min or mod A or something like that.
Much better than going to a SNF and the patient signing out after 5 days of not getting any therapy.
Anyways, yes there is nothing wrong with admitting a patient at a true CGA or S level. If they lived alone, CGA or S or SBA means they can’t go back home. If they have needs of 2 therapy disciplines and have medical need then they should qualify for IPR.
Usually as long as they will need at least 5 days of acute rehab. If it’s going to be shorter than usually not as time efficient.
I am not an insurance reviewer. I am just trying to get people better and back home in a short period of time. There is nothing in Medicare guidelines that says they have to be min or mod A or something like that.
Much better than going to a SNF and the patient signing out after 5 days of not getting any therapy.
Well CGA/SBA means by definition that they don't need hands on assistance. So I can't/don't see how that makes sense in my mind.
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This is how I feel. Are there reasonable goals? Admit to rehab!
5 day minimum is my criteria as well.
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I read the therapy notes.
If they are listed CGA but walked 500 feet with no AD and no OT needs then of course not. If they are listed as CGA for 15 feet with 2 LOB episodes and have a humerus fracture and mod A for dressing then yes. If they have Alzheimer’s disease and listed as a full S then no.
If they are independent walking 500 feet, but need acute care speech and O&P then you can admit.
Ultimately the company you work for is trying to feed you patients. Your screeners should have a good idea what patients you and the PD are comfortable taking. The acute care therapists should also have a good idea who to send to you. Maybe talk to your screeners and PD, see what levels they have taken historically and look at the outcome data. Also consider, maybe that patient should have been admitted a week ago and they stayed too long in acute care.
Of course, mod A seems to be the gold standard for managed Medicare. But not always.
If they are listed CGA but walked 500 feet with no AD and no OT needs then of course not. If they are listed as CGA for 15 feet with 2 LOB episodes and have a humerus fracture and mod A for dressing then yes. If they have Alzheimer’s disease and listed as a full S then no.
If they are independent walking 500 feet, but need acute care speech and O&P then you can admit.
Ultimately the company you work for is trying to feed you patients. Your screeners should have a good idea what patients you and the PD are comfortable taking. The acute care therapists should also have a good idea who to send to you. Maybe talk to your screeners and PD, see what levels they have taken historically and look at the outcome data. Also consider, maybe that patient should have been admitted a week ago and they stayed too long in acute care.
Of course, mod A seems to be the gold standard for managed Medicare. But not always.
