Archive for 'MDS Minute'

How Risky Is Your Pressure-Ulcer Prevention and Related MDS Coding and Documentation?

Posted on 02. Mar, 2010 by .

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Close these 4 common gaps in the assessment and implementation areas.

Prevention is the name of the game in any arena, especially in heading off pressure ulcers. But a few easily overlooked omissions in your preventive program will derail your efforts.

The reality: Very few pressure ulcers are truly unavoidable if you have the right prevention measures in place, emphasized Nancy Augustine, MSN, RN, in a presentation on risk management at the American Association of Homes & Services for the Aging annual meeting. And your facility can sidestep the pitfalls most likely to trip you up in heading off pressure ulcers, she told AAHSA conferees.

Consider these 4 strategies to cover the risk-management bases:

1. Identify and address sometimes overlooked risk factors. Pay special attention to these key risk factors, advise experts: (more…)

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SNF Medicare Reimbursement: Triple-Check Method Ends Unpaid Claims

Posted on 21. Feb, 2010 by .

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Address these 6 elements before they add up to big payment denials.

What’s the best way to keep your payment and compliance record on track? Do a careful prepay review of claims to make sure they will fly with the MAC, RAC and other government auditors.

Pivotal: In performing a triple check of each claim, the operative word is “claim,” says Victor Kintz, MBA, CHC, LNHA, RAC-CT, CCA, managing director of operations for the Polaris Group based in Tampa, Fla.

You want nursing, therapy, and billing to compare the claim to the medical record and all supportive documentation, he says.

Kintz suggests taking a look at the following six items for Part A claims.

1. The RUG score(s) on the claim. Is the RUG score correct and are you using the proper HIPPS (Health Insurance PPS) codes for that MDS? (more…)

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Know How the MDS 3.0 Transition QI/QM ‘Blackout’ Impacts the Survey Process

Posted on 15. Feb, 2010 by .

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For facilities receiving a traditional survey, it won’t be business as usual.

Wondering how surveyors will manage without facilities’ QI/QM reports, which the Centers for Medicare & Medicaid Services says won’t be available for a number of months after the MDS 3.0 rolls out?

The basics: Surveyors performing the traditional survey use the computer-generated reports to focus on concerns and help select a resident sample for the survey. And during the MDS transition period when QIs/QMs won’t be available, the traditional survey will “revert to the survey process in place before the MDS database became automated in 1998,” reported CMS’ Karen Schoeneman, in a CMS Webinar on the MDS 3.0.

That means surveyors will arrive at the facility and ask you to complete the roster/sample matrix (CMS 802). “This is part of the survey process now,” noted Schoeneman. Once enough MDS 3.0 data is available, “the traditional survey process will resume” using the QI/QM reports, she said.

Good news: The lack of QI/QM reports won’t affect how surveyors select residents for the Quality Indicator Survey. That’s because the QIS randomly identifies residents for the sample for surveyors’ Stage 1 assessments, says Cindy Mason, RN, VP of provider services for Nursing Home Quality in Denver, Colo. And facilities don’t complete the CMS 802 for the QIS, Schoeneman noted.

The QIS software does use MDS data to “calculate issues for further investigation,” said Schoeneman. And “CMS has its contractors busy redesigning the QIS to match the data coming in from the MDS 3.0.” “The MDS 2.0 data elements for the QIS and the MDS 3.0 data elements are different — so there will be some changes,” says QIS expert Kenneth Daily, LNHA, founder and president of Elder Care Systems Group. “But based on everything I have seen and heard, the change shouldn’t interfere with the QIS process,” he says.

Don’t miss: Read “Keep the Spotlight on Quality Assurance During the MDS 3.0 QI/QM ‘Blackout’” in MDS Alert, Vol.8, No. 2, available online immediately when you subscribe.

AUDIO: What you need to know about MDS 3.0. With Marilyn Mines, RN, BC, RAC-C.

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Who Signs the Attestation Statement (AA9) on the MDS 2.0 and What Date Should the Person Use?

Posted on 08. Feb, 2010 by .

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Question: If the MDS nurse completes the entire MDS but uses data collected/documented by other disciplines to complete the mood, therapy, and certain other sections, who should sign the attestation statement for those sections?

Answer: The person who actually codes the section signs the attestation. That person is using documented information to make coding decisions. If the interdisciplinary team member completes  section of the MDS (that is, enters the coding), then that person signs the attestation.

Reviewing the RAI User’s Manual directions for AA9 can help: AA9. Signatures of Persons Completing These Items “Coding: All staff responsible for completing any part of the MDS, MPAF, and/or tracking forms must enter their signatures, titles, sections they completed, and the date they completed those sections. Read the Attestation Statement carefully. You are certifying that  he information you entered on the MDS, MPAF, and/or tracking form is correct. Penalties may be applied for submitting false information.”

As for what date to use when signing the attestation: Use the date upon which the sections were completed on the MDS. That issue comes up now related to electronic MDS forms where a person completes his or her section using the electronic version. When signing the attestation on the printed form a few days later, the person should use the date that he or she actually completed that section on the MDS.

Source: Ronald A. Orth, RN, NHA, CPC, RAC-MT President Clinical Reimbursement Solutions Milwaukee, Wis.

© Long-Term Care Survey Alert.

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Don’t Let ‘Phantom Orders’ Come Back to Haunt Your Professional License or Facility

Posted on 07. Feb, 2010 by .

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Photo: Paul Sapiano, Wikimedia Commons

Photo: Paul Sapiano, Wikimedia Commons

If your POS has these on them, watch out for this compliance risk.

To give your nursing facility’s medical records a quick compliance checkup, take a look to see if staff, including nurses, therapists, and dietitians, are writing orders for patient care without the physician’s knowledge in some cases.

A big problem: “At times, the physician order sheet is being used to practice medicine without a license,” says Steven Levenson, MD, CMD, a multi-facility medical director of nursing homes and past president of the American Medical Directors Association (AMDA). He calls these orders “phantom orders” because staff members write them and sign the physician’s name “without having a conversation with the physician about the patient.”

Examples include the following, according to Levenson:

• dietitians ordering specific lab tests; (more…)

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AANAC Survey Quantifies Time MDS Nurses Spend on Assessments

Posted on 01. Feb, 2010 by .

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Find out how you might use this data for your own facility.

If you are wondering how much time doing an MDS typically requires and whether MDS nurses appear to be spending more or less time on various assessment types than in years past, you’re in luck.

The time that facilities spend on some types of MDS assessment has increased somewhat, according to a recent American Association of Nurse Assessment Coordinators’ member survey.

A comparison of the results of AANAC’s 2007 and 2009 surveys in terms of hours spent on surveys are as follows, according to a press release from the organization:

Admission assessment 2.62 (2007) 2.85 (2009)

Annual assessment 2.03 (2007) 2.06 (2009)

Significant change in condition assessment 2.23 (2007) 2.17 (2009)

Quarterly assessment 0.97 1.13

“[The times recorded for] completion of the MDS would include reviewing records, interviewing the resident, and observation — anything it takes to answer questions on the forms,” says Diane Carter, RN, MSN, RAC-CT, C-NE, AANAC president and CEO. “It does not include the time to complete the RAPs or care plan,” she tells Eli.


“Doing a RAP assessment and care planning on an admission assessment would take more time than it would on a significant change assessment,” she points out.


“The AANAC survey information about the time required to complete the MDS 2.0 assessments is not based on scientific research,” says consultant Rena Shephard, MHA, RN, RAC-MT, C-NE, founding chair and executive editor for AANAC. “But it is based on responses from our members, who are the ones in a position to know,” she says. “And this is the best information available on this topic in the country.”


Shephard advises her clients to use the AANAC survey information in combination with data from their facility’s software that tells them how many different types of assessments they’ve done over a year’s time. That can help them calculate the amount of MDS staff time they need, she says.

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MDS: Navigate Significant Change in Status Assessments to Improve Your Facility’s Survey and Payment Status

Posted on 18. Jan, 2010 by .

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Defuse the confusion about this OBRA-required MDS assessment.

True or false? You should definitely do a significant change in status assessment if a resident declines in two or more areas.

Unfortunately, the answer isn’t so cut and dried. The RAI User’s Manual does, however, provide some parameters for when to do an SCSA, which is a comprehensive assessment requiring RAPs and care planning. Keeping those guideposts in mind, you can steer clear of survey land mines and make sure payment keeps pace with a resident’s resource requirements and acuity level.

Nail down the basics … (more…)

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MDS 3.0: Manual Instructions Define Isolation as Provided in a Private Room

Posted on 10. Jan, 2010 by .

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Some experts, however, think it may not be crystal clear.

Before the final MDS 3.0 and RAI User’s Manual came out, people speculated about what would count for coding infection isolation, which is an Extensive Services qualifier under RUG-IV.

And the newly released MDS 3.0 manual’s chapter three (Section O) includes a sentence that seems to be clear that only strict isolation in a private room will count:

“Code only when the resident requires strict isolation or quarantine in a separate room because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with a communicable disease, in an attempt to prevent spread of illness,” states the manual.

Don’t code if the resident only has a history of an infectious disease, such as C. difficile or MRSA without active symptoms, but the facility requires cohorting residents with similar infectious disease conditions, the manual directs. And “do not code this item if the ‘isolation’ primarily consists of body/fluid precautions, because these types of precautions apply to everyone. Transmission-Based Precautions must also be considered regarding the type and clinical presentation related to the specific communicable disease. The three types of transmission-based precautions are contact, droplet, and airborne.

More information related to the types of transmission-based precautions can be found in the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

Extra Verbiage Creates Confusion … (more…)

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Predictive Model Flags SNF Residents at Risk for Unrelieved Pain

Posted on 04. Jan, 2010 by .

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If a skilled nursing facility resident coded without pain has these conditions, take a closer look.

Quick Tip: To identify residents who may need more in-depth pain assessment or treatment, compare the pain coding in MDS Section J to certain diagnoses and conditions on the MDS.

That’s what an MDS-driven computerized program provided by the New York Association of Homes & Services for the Aging (NYAHSA) does, although anyone can use the data to perform the double check manually, reported Christie Teigland, PhD, director of Health Informatics and Research at NYAHSA, in a presentation at the recent American Association of Homes & Services for the Aging annual meeting.

For details, see Long-Term Care Survey Alert, Vol. 12, No. 1, available immediately online when you subscribe.

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SNF Reimbursement: Coding ADL Help Provided With Mechanical Lifts

Posted on 07. Dec, 2009 by .

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Find out when you would not code total dependence in G1.

Suppose a resident requires a Hoyer lift for transfers. How would you code this ADL in Section G1 of the MDS 2.0?

When using a Hoyer lift, “someone usually operates the lift and another person helps position the resident in the sling,” says Christine Twombly, RN, a consultant with Reingruber & Company in St. Petersburg, Fla. “Both of those staff members are physically assisting the resident. Thus, you’d code for two people” in Column B. (more…)

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