Rehab Case Management for Case Mix

Successful case management for Case Mix involves the coding of the accurate minutes of care provided by therapy on the MDS for those patients seen under Medicare Part B. There is a significant opportunity to increase the case mix index with the intervention of rehabilitation during the appropriate assessment windows.  Increased communication between the Rehabilitation staff and the MDS Coordinator regarding patients receiving Medicare Part B services has the potential to increase the case mix index in two ways. 

Using the OBRA assessment schedule, the rehabilitation staff should be routinely screening patients who may benefit from Medicare Part B services.  Kris B Harmony recommends that all patients be screened on a quarterly basis, made possible with an accurate level of Rehabilitation staffing.  However, the use of the OBRA assessment schedule can lead to discussion regarding patients’ needs during the morning staff meeting and in discussions with Nursing staff. 

Secondly, the Rehabilitation staff should alert the MDS Coordinator when initiating therapy for a Medicare Part B beneficiary regardless of the OBRA assessment schedule.  It may be possible to complete an assessment early or to complete an extra assessment to capture a higher RUG category with the provision of Rehab services.  Kris B Harmony recommends that therapy should provide at least 5 days and 150 minutes of direct skilled rehabilitation to that patient during the assessment reference period. Keep in mind that for a day of therapy to count at least 15 minutes of therapy needs to have been delivered. Also, when multiple disciplines are involved in the patient’s care each discipline’s visit is counted in the 5 days of therapy.