Long-Term Care Survey Alert

Getting paid for restorative services means your facility will have more resources to invest in caring for residents, which translates into better quality and survey outcomes.

"Many facilities are doing restorative activities but not taking credit for them under the Medicare PPS or Medicaid case-mix systems," says Cheryl Field, a rehabilitation nurse specialist and director of clinical and reimbursement systems with LTCQ Inc. in Bedford, MA. The reimbursement under RUG-based Medicaid case-mix systems can be substantial. Under Medicare, facilities get payment for restorative nursing under the Rehabilitation Low Resource Utilization Group.

Facilities must follow the Resident Assessment Instrument Users Manual requirements in order to check restorative nursing on the MDS for payment purposes. "The requirements include evidence of training the CNA staff on restorative nursing techniques, a plan of care that addresses the restorative needs and a periodic review by a licensed nurse of the program," Field says.