Use These Quick Litmus Tests to Flag Incorrect ADL Scoring
Do this before you code the MDS or discharge a resident. Undercoding activities of daily living (ADLs) can cost your SNF a ton of money. Overcoding opens the door to overpayments. And in both cases, the care plan won't be on the mark. Smart move: To assess whether staff may be under- or overcoding ADLs, look to see if the resident is more dependent on the evening and night shift, advises Gail Robison, RN, RAC-CT, a consultant with Boyer and Associates in Brookfield, Wis. If so, that may be appropriately driving the coding, she says. But if the ADL scoring doesn't include that help, the facility is undercoding. And "as a result, the facility is letting people go to discharge who aren't able to function in their home" as they do during the day and in therapy, cautions Robison. Tip: Bed mobility is the No. 1 undercoded ADL when you look at the evening and night shifts, in the view of Sheryl Rosenfield, RN, BC, a consultant with Zimmet Healthcare Services Group in Morganville, N.J. That's especially true in facilities that have two-person teams that go around to do "check and change" and repositioning, she adds.
