The MDS Mentor - Texas Department of Aging and Disability Services
Contents
1. non compliant and invalid MDS All MDS that meet this criteria must be inactivated 3 The MDS was transmitted after it was signed as complete by anyone other than the RNAC s authorized by the facility to sign Z0500 In this case either the person who signed was not an RN or the person was an RN that was not authorized by the facility to sign Z0500 From page Z 8 of the RAIM3 Federal regulation requires the RN assessment coordi nator to sign and thereby certify that the assessment is complete A facility may have more than one RNAC Once an MDS has been inactivat ed the original ARD and completion dates must NOT be reused Anew MDS created after any windows closed re quires that an ARD be set for today s date or a date in the future but only when the resident still resides in the fa cility Also if the new MDS contains a Medicare reason for assessment the res ident must still be on Part A TMF Announces Video Series on Quality Measures TMF Health Quality Institute our Texas Quality Improvement Organization is thrilled to announce a new educational vid eo series on Quality Measures Here is the link to the TMF website http texasqio tmf org Home aspx e Join the website by creating your ac count e Join the Nursing Home Network just hit the orange Join This Network but ton which is listed as Healthcare Ac quired Conditions in Nursing Homes e Manage your notifications to tell TMF how of2. in Sec tion C on the ARD was also the staff member responsible for coding the rest of the active items in Section C and deter mined coding for those items three days after the ARD The answer is the staff member would indicate they completed the mental status interview items on the ARD and then make another entry that they completed the rest of the items in the section on the date on the calendar for three days fol lowing the ARD One more potential issue emerges when a staff member completes and en codes items on the MDS but then is not available to sign item Z0400 for the accu racy of those items The instructions on how to handle this situation are on page Z 7 of the RAIM3 If an individual who completed a portion of the MDS is not available to sign it e g in situations in which a staff member is no longer em ployed by the facility and left MDS sec tions completed but not signed for there are portions of the MDS that may be veri fied with the medical record and or resi dent staff family interview as appropri ate For these sections the person signing the attestation must review the infor mation to assure accuracy and sign for those portions on the date the review was conducted For sections requiring resident interviews the person signing the attesta tion for completion of that section should interview the resident to ensure the accu racy of information and sign on the date this verification occurred T
3. or portion s of section s they completed and the date completed As the RAIM3 notes Two or more staff members can complete items within the same section of the MDS So when staff fills in item Z0400 any staff member who coded en tire sections or any portion of any sec tion of the MDS should identify which item s he she completed within that section page Z 7 Another point made under the coding instructions from page Z 7 of the RAIM3 is If a staff member cannot sign Z0400 on the same day that he or she complet ed a section or portion of a section when the staff member signs use the date the item originally was completed Consid er the following scenario A staff mem ber is assigned to complete the mood interview in Section D The staff member is aware of the requirement that inter views must be conducted in the look back period but CMS prefers as noted on page D 4 of the RAIM3 staff conducts this interview on preferably the day before or day of the ARD Therefore the staff member conducts the interview of the resident on the ARD which happens to be a Friday and gathers all the infor mation and determines the correct cod ing of the mood interview items The staff member then departs on a three day weekend and returns on the follow ing Tuesday to encode the Section D in terview items on the MDS in the facility software Try to answer the following question Based on the scenario abo
4. vider Letter 2010 19 Provider Require ments for MDS 3 0 excerpted below Item A0100C State Provider Number In Texas the State Provider Number matches the Facility ID Vendor Number and will be four or six digits If the Facility ID ends with V01 exclude V01 from the State Provider Number Sample Facility IDs State Provider Numbers include 4611 0242 101371 and 000128 The MDS State Provider Number is not to be confused with the 9 digit Medicaid Contract Number In Texas Medicaid amp Healthcare Partnership s TMHP MESAV the 9 digit Medicaid Contract Number is called the State Provider Number but that is NOT the same number that is en tered into MDS assessments What action should staff take if the INSIDE THIS ISSUE Item A0100 Common Coding Challenges Z0400 and Z0500 Signature Guidance TMF Announces Video Series on Quality Measures MDS News in Review Contact Us Useful Web Links State Provider Number is wrong Once the error is found if your software is set up to enter the number automatically staff must notify either the software vendor and or the business office and have them correct the A0100C value for the facility s profile If the AO100C value is input manually on every MDS then staff can ensure future assessments are correct simply by finding and entering the correct number In Texas the correct State Provider Number matches the MDS Facility ID Therefore staff can verify the cor
5. DS Sign up for MDS Resource E mail updates Go to http www dads state tx us click on the Subscribe tab and follow the directions The DADS Texas Minimum Data Set MDS Resources emails are the key line of communication for MDS updates and alerts to nursing home and swing bed facilities from the DADS MDS staff Centers for Medicare amp Medicaid Services CMS MDS 3 0 website MDS 3 0 RAI Manual Item Sets forms related MDS 3 0 materials and left side table links to MDS technical infor mation and MDS 2 0 http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualityInits MDS30RAIManual html Centers for Medicare amp Medicaid Services CMS FY 2012 RUG IV Education amp Training Clarification and follow up documents related to Medicare MDS http www cms gov Medicare Medicare Fee for Service Payment SNFPPS RUGIVEdu12 html QIES Technical Support Office QTSO MDS 3 0 2 0 JRAVEN RAVEN and CMSNet Verizon information Validation Report Messages Guides Training and DAVE DAVE 2 Tip sheets https www gtso com Quality Reporting System QRS DADS information site on Texas nursing homes http facilityquality dads state tx us qrs public qrs do Nursing Home Compare CMS site that compares nursing homes in a given area http www medicare gov NHCompare Include DataSection Questions SearchCriteria asp 5 Star Technical Manual Explains data used to create th
6. RVI DNE Cheryl Shiffer BSN RN RAC CT MDS Clinical Coordinator Brian Johnson QIES amp MDS Automation Coordinator VOLUME 7 The MDS Mentor is published in March June Sep tember and December each year ACRONYMS Assessment Reference Date ARD Centers for Medicare amp Medicaid Services CMS CMS Long Term Care Facili ty Resident Assessment Instrument User s Manual Version 3 0 RAIM3 Interdisciplinary Team IDT Medicaid Eligibility Service Authorization Verification MESAV Minimum Data Set MDS Omnibus Budget Reconcili ation Act OBRA Prospective Payment Sys tem PPS Registered Nurse RN Resource Utilization Group RUG Skilled Nursing Facility Nursing Facility SNF NF ISSUE 1 Department of Aging and Disability Services BG AS JUNE 2014 Judging by a review of the questions SNF NF and Swing Bed staff have asked about Section A Identification Infor mation the item generating the most amount of inquiries in Texas is A0100 The coding instructions from page A 3 of the RAIM3 instruct staff to Enter the nursing home provider numbers A National Provider Identifier NPI B CMS Certified Number CCN C State Provider Number optional Facility staff needs to note the State Provider Number is an optional field meaning that it is not federally required However states may require the item and provide instructions as Texas did in Pro
7. e 5 Star Report http www cms gov Medicare Provider Enrollment and Certification CertificationandComplianc FSQRS html PAGE 6
8. e that ICD 11 is scheduled to be released later this year CMS has no plans to transi tion to ICD 11 at this time Processing manual change re quests for item A0410 changes and incorrect FAC IDs CMS has remind ed the states that only current change forms will be accepted As these forms change occasionally please contact Brian Johnson the MDS Auto mation Coordinator refer to Contact Us details on page 6 to get the ap proved version and the correct form for your facility Facilities which had any licensed only beds beds not ap proved for Medicare or Medicaid resi dents from the time MDS 3 0 went live October 1 2010 are required to fill out an assessment level change request one form for each assess ment involved Those that have had only certified beds in MDS 3 0 will 4 5 6 PAGE 5 complete a facility level change re quest one form per facility Appendix B RAIM3 The March 14 update of Appendix B to the RAI Manu al contains changes to the list of state RAI coordinators MDS automation co ordinators RAI panel members and regional office contacts The file is lo cated in the Downloads section at http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits MDS30RAIManual html New MDS Item Sets Staff who want to stay abreast of the proposed chang es to the MDS Item Sets and Data Speci fications for the October 1 2014 re lease
9. ess of that information American musician Pete Seeger once asked Do you know the difference between education and experience He then an swered that education was what you get when you read the fine print experience is what you get when you don t Z0400 con sists of an Attestation Statement that needs to be read and understood every time a per son gets ready to sign for the accuracy of any items on the MDS As noted on page Z 6 of the RAIM3 Each person completing a section or portion of a section of the MDS is required to sign the Attestation Statement One of many important assertions included in the Attestation Statement is to ensure staff learns they may be personally subject to or may subject my organization to sub stantial criminal civil and or administrative penalties for submitting false information A screen shot of item Z0400 from the MDS item set is on page Z 6 of the RAIM3 includ ing the complete wording of the Attestation Statement In addition page Z 7 of the RAIM3 emphasizes Read the Attestation Statement carefully You are certifying that the information you entered on the MDS to the best of your knowledge most accurately reflects the resident s status Penalties may be applied for submitting false information For item Z0400 the coding instructions from page Z 7 of the RAIM3 requires All staff who completed any part of the MDS must enter their signatures titles sections
10. his is one of the rare occasions when the signature date for the accuracy of the interviews may be after the ARD The other rare occasion when interviews may be conducted up to two days after the ARD is when it is a stand alone unscheduled Medicare MDS However in both cases as in most other cases the RN Assessment Coordinator RNAC signature and date for completion of the MDS in item Z0500 would be either on the same date but after the time or after the date all active items on the MDS were attested as accurate in 70400 It is ex tremely important that the date in ZO500B is not backdated and indicates the date the RN actually signed ZO500A Furthermore it is equally important that the person cer tifying the MDS is complete is an RN Also noteworthy it is not always an er ror when Z0400 contains a date after Z0500 Was the MDS modified If so the coder or coders must sign and date for the accuracy of Section X and the changed MDS items However unless the RN signa ture at ZO500A and or the date at Z0500B are modified the RN completion signature and date at Z0500 remains unchanged on a modified record Under what circumstances can an LVN input a date into ZO500B when the MDS has not yet been signed by the RN as com plete in ZO500A The answer is there are NO circumstances when an LVN can input a date in ZO500B when the MDS has not been signed in ZO500A by a RN As noted VOLUME 7 ISSUE Z04000 and Z0500 Signature Gu
11. idance Continued from the previous page on page Z 8 of the RAIM3 For ZO500B use the actual date that the MDS was completed reviewed and signed as complete by the RN assessment coordinator What if the facility software automatically inputs the electronic signature and date of the person who locks Section Z into ZO500A and B respectively when certifying the Section is complete Well that means the person who locks and notes Section Z is complete must be the RNAC What if the facility software requires that Section Z be locked and the date input into item ZO500B prior to the RN s signature in ZO500A in order to be able to print the MDS to be signed by facility staff when elec tronic signatures are not in use Then this is an example of software that is unusable for MDS 3 0 Staff needs to download and use JRAVEN CMS free MDS software Finally there are three Z0500 related issues requiring the inactivation of an MDS 1 The MDS was transmitted prior to the RNAC signature in ZO500A The MDS may NOT be modified to add the RN sig nature and date The MDS that was transmitted was an incomplete non compliant and invalid MDS All MDS that fit this criteria must be inactivated 2 The MDS was transmitted after the RNAC signed the MDS as complete but sections or portions of sections on the MDS were not actually complet ed The MDS may NOT be modified to add the missing items The MDS that was transmitted was an incom plete
12. rect number by running any CASPER report and using the Find by Name instead of Add Facility ID option The current MDS Facility ID will appear at the top of almost all reports Also paramount from page A 3 of the manual is e Nursing homes must have a National Provider Number NPI anda CMS Certified Number CCN Facility staff needs to ensure these items are accurate on each MDS prior to transmis sion The 10 digit NPI is numeric and always input into A0100A The CCN is only applicable to certified homes who participate in Medicare and or Medicaid and is input in item A0100B For Medi caid only homes the 6 space CCN is al phanumeric and in Texas begins with a 45 If Medicare with or without Medi caid the 6 digit CCN is numeric and begins with a 6 Only if the nursing facility or an entire wing is licensed only e g not certified is AO100B left blank VOLUME 7 ISSUE Z04000 and Z0500 Signature Guidance We started this issue addressing the cor rect coding of an item in Section A Now let s jump to covering the correct coding of a couple of items in Section Z items Z0400 and Z0500 which also applies to both SNF NF and to Swing Bed facilities Item Z0400 Signatures of Persons Com pleting the Assessment or Entry Death Re porting is the place where any person who was responsible for and determined the coding of any item on the MDS 3 0 record signs for the accuracy and truthfuln
13. should often visit http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualityInits NHQIMDS30TechnicalInfor mation html Currently the latest version of the Data Specifications is version 1 14 0 with errata and the latest version of the MDS 3 0 Item Sets is version 1 12 0 Please rem Please remember that these versions should be consid ered provisional or draft and subject to change until the final specifica tions are published New MDS Provider Training videos On March 24 2014 CMS posted updat ed training videos for several MDS sec tions Section I G M and O to YouTube They can also be found in the Related Links section at http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHOQIMDS30TrainingMaterials html VOLUME 7 ISSUE Contact Us Cheryl Shiffer BSN RN RAC CT Brian Johnson MDS Clinical Coordinator QIES and MDS Automation Coordinator 11307 Roszell Street Room 1310 DADS P O Box 149030 Mail Code 279 4 Mail Code E 345 San Antonio TX 78217 Austin TX 78714 9030 Phone 210 619 8010 Phone 512 438 2396 Fax 210 871 6484 shared fax call first Fax 512 438 4285 shared fax call first Useful Web Links DADS MDS Web Site Texas MDS site for MDS policy procedures and clinical and technical in formation including The MDS Mentor http www dads state tx us providers M
14. ten you want an email update on what s new to the website Check the box Now you have full access to the website To view the first posting in the video series Quality Measure Analysis and Im provement click the following link http texasqio tmforg Networks HealthcareAcquiredCondi tionsinNursingHomes QMVideoSeries aspx Check back often to view additional postings in the series PAGE 4 Ode to MDS Coders The RAI Manual is nota purple book and to be purple does not aspire But I can tell you anyhow Read it or retire VOLUME 7 ISSUE I 1 2 3 MDS News in Review Changes to STAR PLUS Medicaid Managed Care for Nursing Facility Residents To allow more time to address stakeholder concerns the Texas Health and Human Services Commission HHSC has postponed moving nursing facility residents into STAR PLUS Medicaid managed care to March 1 2015 HHSC will contin ue working with stakeholders to en sure a successful transition HHSC is hosting a series of infor mation sessions on several Medicaid managed care initiatives including the STAR PLUS transition Questions can be sent to Manged_Care_Initiatives hhsc state t X uS ICD 10 Delayed The ICD 10 imple mentation has been delayed by legis lative bill until October 1 2015 CMS is reviewing the impact to related changes for the October 2014 MDS update and will be issuing a state ment CMS staff are awar
15. ve what completion date is used for the mood interview items If you answered that it would be the date the items were originally complet ed which was the ARD the previous Friday you would be correct Staff only input the date MDS data was encoded as the date completed when the items are completed and encoded on the same day Otherwise staff uses the date the items originally were completed which Continued on the next page VOLUME 7 ISSUE a PAGE 3 Z04000 and Z0500 Signature Guidance Continued from the previous page was the date the data was gathered and the coding was determined In addition there is another scenario that can be easily conceived from the cod ing instructions for item Z0400 This sce nario is that only one staff member can complete an entire section of the MDS and still need to sign two or more times for that same section in item Z0400 As cov ered on the previous page staff complet ing any items on the MDS must enter their signatures titles sections or portion s of section s they completed and the date completed Because it is possible items within a section were completed on different dates the same staff member may have to sign multiple times to reflect accurate dates of completion for each sub set of items Consider an additional situation this time regarding Section C What comple tion date would be used if the staff mem ber who conducted the interview
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