Nursing Home Case Study: Increasing Reimbursements

This case study showcases elevating clinical documentation and enhancing reimbursements for an Ohio skilled nursing facility. Facing documentation issues with Certified Nursing Assistants (CNAs), the facility experienced a rise in "Do Not Returns" (DNRs), a problem pervasive among both full-time and agency staff. 
The study reveals the core issue within the facility's data management system – glitches that led CNAs to miss crucial care documentation. Further investigation unearthed log-in problems, causing undocumented downtimes, and issues with assignment changes. 
While CNA documentation doesn't directly determine reimbursement, it significantly impacts it.
Accurate documentation informs care levels and subsequent reimbursement. CNAs document Activities of Daily Living (ADLs) and patient abilities, driving further assessments by the care team. Centers for Medicare and Medicaid (CMS) strictly adhere to reimbursement rules, emphasizing documentation's billing importance. 
Through collaboration, various systemic improvements were implemented that provided:
  • A 57% reduction in documentation related DNRs
  • Enhanced messaging capabilities, reminders, and training modules to prioritize documentation for nurses.
  • Efficient incident resolution, investigation, and prevention while helping to improve documentation and drive reimbursements for its partner facilities. 

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