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Will you sink or swim with post-acute documentation?

In the post-acute world, providers will sink or swim based on their success with documentation. Unfortunately, many organizations get bogged down in the complex requirements to verify a patient’s need for care, comply with regulations and receive payments.

Madonna Rehabilitation Hospitals (Lincoln and Omaha, Nebraska, U.S.A.) recognizes that a solid documentation system can buoy both patient access to care and reimbursements. The organization developed the first rehabilitation content solution in the United States, and it has been so successful, it is now available to other Allscripts clients as Sunrise Rehabilitation.

Swim with the tide by automating complex scoring

In a recent case study, Madonna Rehabilitation Hospitals describes how it uses the flexible Allscripts Sunrise™ platform to design workflows for nurses and physical therapists. It includes automated Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) scoring and in-depth use of evidence-based interpretations of patient evaluation results.

The solution helped improve the organization’s Functional Independent Measurement scores (FIM), which the Centers for Medicare & Medicaid Services (CMS) uses to determine reimbursements for acute-care rehabilitation facilities. Madonna Rehabilitation Hospitals uses an algorithm to determine scores based on the comprehensive patient record.

“Automated scoring for IRF-PAI really helped the nursing workflow,” Senior Nurse Therapist Terasa Farlin, RN, said. “The expectation of a paper-based system was that nurses would review documentation and follow decision rules to come up with scores. Nurses on the floor don’t have time for that…After we went live with the EHR documentation and automatic scoring, nurses could fully focus on doing what they do best – caring for patients.”

This innovative package reflects the organization’s priority of keeping patients at the center of its revised workflows. “Documentation is efficient, it drives a score, but it also tells the patient’s story,” Farlin said. “The documentation captures everything we need to know about the patient and ensures all clinicians are on the same page.”

Float on with a reconciliation process for better billing

Director of Hospital Applications Roberta Steinhauser shared another accomplishment enabled by its flexible technology foundation. “We’ve written a complete charging module. Now therapists use a simple interface and identify charges during each encounter, directly linking each charge to the clinical documentation,” she said. “That solves the biggest challenge of any audit – from CMS down to internal procedures.”

A reconciliation process helps ensure that Madonna Rehabilitation Hospitals does not overlook billing patients for services rendered. For example, the organization has provided tools for therapists to submit charges for every encounter. If clinical notes do not have associated charges, they are reported to supervisors to ensure the organization is collecting payments efficiently.


“Everything we do is now 100% backed by documentation…demonstrating compliance with standards set by both accrediting bodies and third-party payers,” Steinhauser said.

Don’t leave patients up a creek without a paddle

Patients always rise to the top of the priority list at Madonna Rehabilitation Hospitals. Dedication to patients drives the organization’s efforts to automate and customize processes to support its wide range of post-acute services.

“Documentation is about patient care, because it’s about access to care. Without it, patients may not receive the services they need,” Physical Therapist Marilyn Dongilli said. “This is a technology solution that works well, across nursing and therapy disciplines, for four major hospitals and multiple outpatient sites.”

To learn more about Madonna Rehabilitation Hospitals and its success, download a free case study.

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