“Employees want to know why they have to produce and deliver services by using certain methods. To be good at holding your staff accountable, you must be good at teaching. Teach about the consequences.” — Crucial Accountability

Did you know that poor documentation quality has a bigger financial impact than productivity does? It’s true! In general, while you save $0.02 for every 1 percent productivity increase, billing minutes pulled out during an audit will have a much greater financial loss:

RUC x 14 days (647.94/day = $9,071.16)

RVC x 14 days ($555.85/day = $7,781.90)

In conclusion, one billing minute removed due to unskilled documentation could result in a $1,289.26 loss.

DOR Role

What is the role of the DOR? We define it as follows:

  • Commit to auditing documentation
  • Set expectations at the interview
  • Give positive feedback as often as constructive feedback
  • Audit evaluations and MD orders to catch errors and monitor trends
  • Initiate a “standardized test” day
  • Include standardized test in “precautions” on POCs, to ensure staff re-test
  • Monitor progress notes to look for trends

UR prep and care plans must:

  • Create effective care plan process
  • Frequently attend care plans to review weekly documentation
  • Prep for UR using the “weekly status report”
  • Ensure therapists are testing goal-related areas and that discharge dates are
  • appropriate
  • Report standardized test scores/ADL score during UR

Teach the Why

In order to hold staff accountable for skilled documentation, it’s important to engage your team in dynamic thinking about the “why” behind what they do. That is, educate them as to why quality documentation is important, as it not only reflects their clinical skill, but also ensures we can be billed for services and therefore has a financial impact. Finally, provide lists of commonly used skilled terms descriptive of therapists’ actions.


Skilled documentation is a critical part of our systems at Granite Creek Health and Rehabilitation. By implementing training in this area, we saw an improvement in the MSCA therapy score and a decrease in the financial error rate:

By Larissa Osio, DOR, MS OTR/L, Granite Creek Health and Rehabilitation, Prescott, AZ

View full poster here: Accountability and Skilled Documentation -Granite Creek