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MDS 3.0 Vendor Questions and Answers 1 – 15 Consolidated

1. 1 One of our QA representatives noticed a change in the RUG score calculated for identical assessments dated before and after 10 01 2013 traced the issue down to the MCAR3 logic We were not able to get the same RUG score by working through the documented worksheet 20140107 003 K RUGs A submitted MDS was recalculated using RUG IV from a The submitted MDS was correctly recalculated by the QIES BA160 level to a CA160 level by the QIES system system It is true that the resident does not have a qualifier The ADL score is 0 for Clinically Complex but there are other ways to receive a Clinically Complex classification The resident has an Hand Calculation is a BA1160 level unless there was a Extensive Services qualifier 00100M2 Infection Isolation change made While a Resident An Extensive Services classification The question is M1040D E the resident doesn t have requires a minimum ADL score of 2 so the resident does M1040 D or E Checked but does have M1200H checked not qualify for Extensive Services However a resident with The D0300 score is 02 an Extensive Services qualifier and too low an ADL score The previous MDS for this resident was submitted in Aug in this case 0 qualifies for Clinically Complex instead 2012 without Recalculation This is documented in the RAI Manual on page 6 37 in the text under Step 2 Note that generally a resident classifies as Clinically Complex if there is an Extensive Services S
2. 20100926 040 K RUGs 20100926 039 K RUGs 20100926 038 K RUGs Question create a hybrid RUG III calculation code for the state The RUG III mapping specs do not include a translation from MDS 2 0 licc Traumatic Brain Injury to MDS 3 0 15500 Traumatic Brain Injury Is there a reason this no longer is used in RUG III calculation If facilities performs an OMRA start of therapy PPS for a resident and that resident qualifies for multiple RUG scores some rehab and some non rehab after applying the CMI index maximizing logic the resident RUG score ends up being a non rehab score After that we apply the logic that states that if the user is performing a OMRA start of therapy and anon rehab RUG score is achieved then we are to assign a default AAA RUG score This issue is prevalent when the resident qualifies for a non rehab RUG that has a higher index value such as ES3 vs RML RHL or RLX assuming a Rural E01 CMI Can you provide some clarification on what is desired in this case Our vendor members are in need of a decisive algorithm for the second digit of the HIPPS Al code character 5 of the HIPPS code that contains the RUG rates in Z0100A and Z0150A that accounts for all potential combinations of the assessment type fields A0310A A0310F Many combinations of the A0130 fields are going to fall through this logic and get an X If the B or F value is changed the algorithm doesn t work Our vendor membe
3. convenience of providers that need to submit MDSs to submitted assumed insurance companies In the data specs after the item Z0500B there is a list of items In the data submission specifications ZO500B is the last associated with the state or CMS side of the submission We item that is included in federal submissions to the ASAP assume that a vendor has no need for this info unless in system Filler and calculated items follow this item The conjunction with state or federal submission outside of the filler and calculated items are not included in federal normal process submissions When building a fixed format string these items should normally be blank filled except for the data end carriage return and line feed items The calculated items will be populated in files received from CMS 20121210 012 F State have questions about what the states can setup so that the The discussion below describes what the ASAP system will Options Z0200 and Z0250 RUG scores are validated by the ASAP do If the state wants to do any other type of Medicaid MDS Validation System t would be helpful to know this calculation the state must do that in their Medicaid system information so that we can mirror the available RUG setups It will not be done by the ASAP system in our products If the state wants the ASAP system to recalculate the Medicaid RUG values on an MDS 3 0 NP NQ or NC assessment the state can set up the parameters
4. lt A2100 gt lt A2200 gt lt A2200 gt lt A2300 gt 20141001 lt A2300 gt Page 11 of 60 Answer was coded as A0310F 99 Item X0700 has instructions on whether to answer A B or C based on the value in XO600F If you answered XO600F 99 to match your original A0310F 99 then you should have only answered X0700A per the item instructions and sent in blanks for X0700B and X0700C There are not any inconsistencies in the VUT and HTML data specifications for A1600 and A1900 We believe this is an instance where we have a general edit 3851 as well as specific edits that apply to the same item The record must pass all edits This occurs in many of the edits and MDS data specifications The most common case of general edit and specific edit is on coded values An example in Section A is for A0200 The general edit is 3676 Values of Code and Checklist Items Only the coded values listed in the Item Values table of the Detailed Data Specifications Report may be submitted for this item One of the specific edits is 3707 a If AO200 2 if the provider is a swing bed provider then A0410 submission requirement must equal 3 it cannot equal 1 2 20140107 008 20140107 009 Topic E Specs E Specs Question Error received in VUT for a 10 1 14 MDS with A1700 1 lt results gt lt message_number gt 2 lt message_number gt lt error_id gt 3851 lt error_id gt lt severity gt FATAL
5. An end of therapy OMRA establishes a non therapy RUG for billing days starting with the day after therapy ended A 20100820 023 20100820 022 20100820 019 Topic K RUGS Question ELSE IF A0310A 99 AN A0310B 99 OR A0310D NOT 1 THEN DO sRUGHier_NT AAA nRugHier_NT 72 sRUGMax_NT AAA nRUGMax_NT 72 D A0310B 07 AND So when the following is true A0200 1 A0310A 99 A0310B 07 A0310C 1 A0310D AND the normal RUG result is R it appears that the code requires the non therapy RUG to be AAA when it should be a 66 Group code that is NOT R Are there RUG test files Is there SAS code on the CMS site for this conversion How would we calculate PA RUG score using CMSs supplied DLLs since they are using the RUG III 5 12 44 grouper calculation Would we use the RUGIII converter and then the 5 12 DLL or the 5 20 DLL For MDS 2 0 we used our own calculator to come up with the score but for the new Page 54 of 60 Answer non therapy RUG is therefore necessary for an end of therapy OMRA For an end of therapy OMRA combined with a start of therapy OMRA the Rehabilitation Extensive or Rehabilitation classification is needed to bill days from the start of therapy date through the last day of therapy and the non therapy RUG is needed to bill from the day after therapy ended forward Version 1 00 6 of the RUG IV grouper the last public version inappropriat
6. The relational edits that are included in the data Page 20 of 60 20101101 014 E Specs 20101101 010 E How are dates supposed to be submitted when they are Specs unknown or ongoing Page 21 of 60 Question not equal b If 00400D1 0000 then if 00400D2 is active it must equal c If 00400D1 then if 00400D2 is active it must equal a If 00400E1 0001 9999 then if O0400E2 is active it must not equal b If 00400E1 0000 then if 00400E2 is active it must equal c If O0400E1 then if O0400E2 is active it must equal 00400D1 and 00400E1 are inactive on all forms except the NC With 00400D1 and 00400E1 inactive on the NQ you will never have minutes which means item B in the skip pattern is active and 00400D2 and or O0400E2 must equal Why have the fields on the NQ if they are always a caret based on the CMS skip pattern CMS specifications do not breakdown by MDS form type except for Active Inactive The instructions on the MDS for D2 and E2 plainly state record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days Maybe the minutes for respiratory and psychological are not needed but that does not help the skip pattern in CMS specifications There is a related fatal error as well 00400D1 must be greater than or equal to O0400D2 15 O0400E1 must be greater than or equal to O0400E2 15 For a PPS assessment NP where Z
7. because of Edit 3812 The scenario described coding XO900E 1 and A0310C 0 1 4 does not make sense Item XO900E should be checked only under the following scenario a an end of therapy OMRA A0310C 2 3 has been submitted and accepted by the ASAP system b there has been a subsequent resumption of therapy and c the original EOT assessment is being modified by entering 20110126 01 1 20110126 012 Topic E Specs E Specs Question A0310C is 01 Per Edit ID 3812 00450A should be skipped but according to Edit ID 3815 00450A must be equal to 1 It seems the Resumption of therapy Modification reason would be intended to only be used for an EOT where A0310C 2 or 3 but there is no edit to prevent XO900E from equaling 1 when not an EOT assessment Questions S0172B through S0172G are listed in the specifications and data dictionary files with an item type of Code Looking at the Item Values table entries listed in the specifications and data dictionary however it would appear that this field was intended to be a checklist Which is the correct type This question pertains to the timing of state Section S changes that are scheduled for April 1 2011 Is the April 1 date based on the submission date or the ARD A2300 date of the assessment For example an assessment is submitted on April 2 but has an ARD of March 25 Should that assessment follow the old pre April 1 2011 Section S specif
8. of the data specs we allowed a modification record to cross data specs boundaries i e for the modification record to change the target date and to conform to a version of the data specs which is later than the record being modified While this is allowed it must be used with caution because items and or values that are allowed on the two versions may differ An example of such a situation is where modification record has a target date on or after 10 1 2014 and conforms with V1 14 but the record to be modified has an earlier target date and has A0310B 06 In this situation you have two choices If after modification the target date will still precede 10 1 2014 then you should do the modification under the earlier version of the data specs If you are modifying the record so that the target date will be changed to a date which is on or after 10 1 2014 then your only choice would be to inactivate the original record and submit a new record under V1 14 Note that this scenario should be quite rare The ASAP system does use target date to locate the original record using item X0700 to determine the target date of the original record It only uses the date that matches the XO600F value and ignores the other two X0700 dates as they should be sent in as blank It appears from your description that the original record 20141021 010 Topic E Specs Question that if any one of those values does not match the modifica
9. ICD 9 code submitted meets the format requirement Please refer to the technical specifications for the required ID Topic Question Answer application for MDS data point 18000 are not actually allowed formatting at by CMS They referred to the following codes and their concern was that the codes with no decimal points more http www cms gov Medicare Quality Initiatives Patient generic codes are not acceptable for 18000 Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic 600 Hyperplasia Of Prostate allnformation html 707 0 Pressure Ulcer 733 0 Osteoporosis When a record is submitted and it does not meet the data 585 Chronic Kidney Disease Ckd specifications format the record will be rejected 124 0 Spinal i Mier Tan Cervical The VUT also checks the format and will issue a fatal error P eh Coe Respiratory System And just as the ASAP system does In addition the VUT Senge ype compares the ICD 9 to the official list posted on the CMS web site at They claim that they have received validation errors when es http Medi ing l i i submitting the MDS to CMS ttp www cms gov Medicare Coding ICD9ProviderDiagno sticCodes codes html e researched in the RAI manual for Section and submission specs and there is no explicit mention of what ICD9 codes can be used other than the fact that they have to be valid codes checked in All the codes you listed as not on the official list For ICD9cm site examp
10. Illinois https www qtso com download mds Additional Items Requi red by States for Nursing Home MDS 05092012 pdf In New York they are adding two Section S fields and eliminating others effective April 1 can all fields be submitted for a short period of time after April 1 It would be extremely helpful if CMS would publish which RUG each state selected for Z0200 and Z0250 States are not reporting that information accurately to us In fact one state told us version 09 and there is no 09 Since the file is being sent to CMS first and then CMS is providing the data to the states under MDS 3 0 our question is whether vendors have to filter for state excluded values such as STDs and HIV or will CMS filter those values before providing data to the states from the national system A State uses a Comprehensive without section V for their Quarterly MDS Assessment How will the ASAP computer system edits know what should be on this state s Quarterly What if someone uses jRAVEN Will CMS create a form for the specific state Quarterly Assessment If so how can get a copy Page 29 of 60 Answer Section S fields that are not active but submitted anyway as long as they are formatted correctly are ignored They are not stored edited nor receive warnings There is a RUG version 09 It is RUG Ill 53 group version 09 The grouper version code that the grouper returns found in the RUG III grouper specs posted on the CMS websit
11. MONTH A0900 MONTH A2300 AND DAY A0900 gt DAY A2300 THEN Age YEAR A2300 YEAR A0900 ELSE Age YEAR A2300 YEAR A0900 1 This specification is incorrect with the order of A0900 birthdate and A2300 assessment reference date in the 20121210 001 Topic N QMs Question IF MONTH A0900 gt MONTH A2300 OR MONTH A0900 MONTH A2300 AND DAY A0900 gt DAY A2300 THEN Age YEAR A2300 YEAR A0900 ELSE Age YEAR A2300 YEAR A0900 1 The condition is correct but the resulting age calculations should be flipped as such Age Calculation of Age based on Items A0900 Birth Date and A2300 Assessment Reference Date ARD IF MONTH A0900 gt MONTH A2300 OR MONTH A0900 MONTH A2300 AND DAY A0900 gt DAY A2300 THEN Age YEAR A2300 YEAR A0900 1 ELSE Age YEAR A2300 YEAR A0900 am trying to help a facility troubleshoot an issue where a resident doesn t trigger for Prevalence of Falls on their MDS 3 0 Resident Level Quality Measure Report as they think it should Facility ID 35403 used the report dates the facility gave me as 02 01 2012 to 07 31 2012 and the resident for resident ID 21755645 doesn t trigger unless run the same report using the default dates of 04 01 2012 and 09 30 2012 The only difference can see is where the values for A0310A for OBRA Assessments fell in the range of qualifying RFAs for the default dates 04 01 2012 and 09 30 2012 while di
12. O0400A6 O0400B6 or 00400C6 indicating on going therapy or an end of therapy date equal to the end of covered Medicare stay date A2400C These 2 requirements taken together mean that all therapy has not ended on the assessment ARD for an assessment to qualify for short stay However an EOT OMRA has an ARD 1 to 3 days after the last day that therapy was received and cannot meet these two requirements An EOT OMRA can never qualify as short stay and some developers had been confused by logic allowing A0310C to equal 3 for a short stay To avoid this confusion the logic change was made in V1 01 1 that ID Topic Question Answer 20110803 008 K RUGs For the states that use RUG IV in Z0200 and or Z0250 and The ASAP system uses the current RUG IV for all calls have set up the RUG IV score validate in the ASAP System both CMS and state sending the appropriate parameters we will need to know the correct RUG IV version that is being based on the target date of the record and the CMS and validated in ZO200B and Z0250B As of Assessment ARD of state requirements The version values for the RUG IV 10 1 2011 what is the ASAP System expected State grouper that are compared to the B RUG item are Z0200B Z0250B RUG IV version T 0166 1 0157 1 0148 20101220 014 What are the parameters for calculating the Medicare RUG IV Specifications and DLL Package V1 02 0 is RUG HIPPS value on an MDS 3 0 assessment from a swing located on
13. Report These reports will give you a description of the changes 20100114 043 E What will the new requirements be for calculating Length of The only place that an MDS 3 0 length of stay LOS Specs Stay LOS within the MDS 3 0 When can we expect this measure is used in the QIES ASAP System is in the RUG information to be finalized IV grouper In order for the Special Medicare Short Stay RUG IV rehabilitation classification to be used on an assessment the end of the Medicare stay must be no later than the 8th day of the stay This means that the Medicare End of Stay Date A2400C minus the most recent entry date A1600 must be less than or equal to 7 Page 26 of 60 ID Topic Question Answer 20100114 023 E Is an ARD A2300 required on all assessments including Item A2300 assessment reference date is an active item Specs the discharge and reentry and is required on all MDS 3 0 records except the following entry records A0310F 01 death in facility records A0310F 12 and inactivation records A0050 3 20100114 013 E Z0300A and Z0300B Insurance Rugs are on the forms but Z0300A and Z0300B insurance RUGs and version are Specs not in the data specs not submitted assumed Z0400 not included in federal submissions to the ASAP system items a l are on the form but not the specs not submitted These items are included on the printed item sets for the assumed ZO500A is on the form but not in the specs not
14. SOT MDS Page 45 of 60 Answer the RAI Users Manual 2 There is discussion of index maximizing on page 8 of the RUG IV grouper overview document in the RUG IV package and on page 18 of that document There is presentation of the standard CMI sets for index maximizing When setting the DLL sRehabType parameter the type of assessment does not matter The setting for this parameter is contingent on the MDS 3 0 RUG item e g Z0100A for normal Medicare RUG and the assessment reference date A2300 The rules are 1 For Z0100A Medicare RUGs e sRehabType MCARE for all assessments PPS and non PPS assessments with assessment reference date before 10 1 2011 sRehabType MCAR2 for all assessments with assessment reference date of 10 1 2011 or later Note that the DLL provides the value for Z0100A in sRugMax and the value for Z0150A Medicare non therapy RUG in sRugMax_NT 2 For ZO200A and Z0250A Medicaid RUGs e sRehabType Other for all assessments PPS and non PPS for all assessment reference dates To qualify as a Medicare Short Stay assessment the assessment must be an SOT assessment The difference between a Medicare Short Stay assessment and a non Short Stay SOT assessment is that the Short Stay assessment uses the average daily minutes of therapy for rehab classification The non Short Stay SOT assessment uses the normal total minutes of therapy for rehab classification In both cases short stay
15. as zero b2 00420 must contain a value that is less than or equal to sum of the days in O0400A4 00400B4 and 00400C4 When computing this sum if any of the items 00400A4 00400B4 and 00400C4 is coded with 4 count the number of days for that item as zero Are users allowed to enter a for 00420 if any of 00400A4 00400B4 and 00400C4 have a value other than The edit does not seem to restrict entry of even though there is a value present for 00400A4 00400B4 or 00400C4 Version Notes V1 13 0 New edit This edit replaces Edit 3573 for all records submitted on or after 09 15 2013 This edit differs from Edit 3573 as follows 1 Item A2200 was removed from the Group A rules 2 No changes were made to the Group B rules 3 Group C rules were added and apply only to records where A0310A 05 06 significant correction of prior comprehensive or quarterly If this is for the October 2013 MDS and this edit is for all records submitted on or after 9 15 2013 does that mean that user will need to have the program prior to the 9 15 date and be using it Answer The short question is yes the new edit 3851 replaces the old edit 3573 for all records submitted on or after 09 15 2013 Having said that the functional differences between the new and old edit are minor and we believe that they will affect only a small number of records The purpose of the new edit is to allow us to apply new logic to item A220
16. completed alone or combined with the Start of Therapy OMRA it seems like the documentation is telling us to look at previously completed assessments but the CPP code and the DLL cannot do that since it is fed only the current assessment Can you provide some clarity on this point Do we ignore that portion of the logic or do we need to find the previous assessments Page 4 of 60 Answer discharge date or the combination is not valid and will be rejected If an assessment has a reference date on or before the date of a temporary discharge with the resident later returning to the facility then that assessment and the existing OBRA assessment schedule remain in effect if the following 2 conditions are satisfied 1 The discharge was with return anticipated A0310F 12 and the resident returns within 30 days of discharge 2 A significant change in status has NOT occurred If the discharge was with return not anticipated A0310F 11 then a new admission assessment is due after the resident returns and the OBRA assessment schedule restarts If the resident was discharged with return anticipated but has been out of the facility for more than 30 days then a new admission assessment is due after the resident returns and the OBRA assessment schedule restarts If the discharge was with return anticipated and the resident returns within 30 days with a significant change in status then a significant change in status assessment is due af
17. have a way to make the remaining subsets except XX guess active 20100926 017 Is it possible to get a copy of your state optional info as we The document Additional Items Required by States for Page 30 of 60 Topic State options ID 20100926 016 20100820 016 G Section F State options S 20100820 015 G Section S Question did the Section S info Will there be an alternate Item Subset posted for a full Quarterly ISC NQ without Section V So far 2 states have elected to utilize all state optional items except Section V If not which subset are we to use for the printed MDS 3 0 NQ when the state requires a full quarterly How will the ASAP system edit Section S items with an Item Type of TEXT If a state asks for items where the instructions or intent requires a skip what is expected in the data For instance S6050 is asking if Isolation Precautions are needed and if you answer Yes then you answer S6051A B C D checkboxes The specs allow for a 0 1 in the checkboxes But if they are skipped should they be blank or contain a caret How will the VUT handle cases where the value is out of the range of the specs in a case like this Page 31 of 60 Answer Nursing Home MDS 3 0 Assessments is posted on the vendor link of the QIES Technical Support Office website https www qtso com vendormds html This document lists the States that have been approved for additional CMS defined items on
18. or other SOT the indexed maximized Medicare RUG Z0100A group must be a 20110803 006 Topic K RUGs Question Assuming the FY2012 rule is approved and the v1 01 1 RUG IV code is implemented on October 1 have a question regarding the correction for the short stay indicator and the potential for rejected assessments Will the correction in the Medicare Short Stay Indicator calculation apply to all MDS Assessments regardless of Target Date Per the code Set Medicare Short Stay Indicator _Mcare_short_stay V 1 01 1 CHANGES 1 A03100C must 1 rather than 1 or 3 2 sRehabType can MCARE or MCAR2 rather than just MCARE There are 2 potential scenarios that are of concern 1 If the assessment where A0310C 3 is completed prior to the October 2011 implementation it could calculate the Short Stay Indicator 1 utilizing the v1 00 9 code This could result in a valid RUG calculation where the first letter is R due to the special Medicare short stay calculation If the submission file is submitted on October 1 2011 will the RUG group be recalculated using the v1 01 0 code and the assessment be rejected 2 It appears that a Modification could be rejected if the assessment is a Modification with the original assessment A0310C 3 that was accepted prior to October 1 The Short Stay Indicator 1 AND resulted in a RUG calculation with where the first letter is R due to th
19. that item to We want to make sure we are calculating the therapy days be considered in the RUG III MDS 3 0 to MDS 2 0 correctly for the states that require a RUG III calculation in crosswalk The use of 00420 is limited to RUG IV applied Z0200 A to Medicare The attached cross walk does not appear to include the new field 00420 in calculating distinct rehab days that is now used for RUG IV Can you please clarify if this cross walk is still accurate or will a new updated cross walk be posted since the new field was added for RUG IV Thanks in advance for clarifying 20140107 012 K In the document Chapter 6 of the RAI Manual provides information for the RUGs 11139_MDS_3 0_Chapter_6_V1 11_Oct_2013 pdf MEDICARE SKILLED NURSING FACILITY on pages 6 32 and 6 33 reads as follows PROSPECTIVE PAYMENT SYSTEM SNF PPS as indicated by the chapter title The October 2013 version of Medium Intensity Criteria the resident qualifies if either 1 chapter 6 applies to the SNF rules and policies in effect for or 2 is satisfied FY2014 The RUG worksheet in Chapter 6 only applies to 1 In the last 7 days the current Medicare SNF RUG classification in effect for Total Therapy Minutes calculated on page 6 25 6 28 of FY2014 An earlier version of Chapter 6 and the RUG 150 minutes or more worksheet for a previous year apply to the Medicare SNF and RUG classification in effect for that previous year At least 5 distinct calendar days of any combination of
20. the three disciplines O0400A4 plus 00400B4 plus 00400C4 In contrast the standard RUG grouper code as represented by either the SAS or C code is more Page 38 of 60 Topic Question Low Intensity Criteria the resident qualifies if either 1 or 2 is satisfied 1 In the last 7 days Total Therapy Minutes calculated on page 6 25 6 28 of 45 minutes or more and At least 3 distinct calendar days of any combination of the 3 disciplines 00400A4 plus 00400B4 plus 00400C4 and Two or more restorative nursing services received for 6 or more days for at least 15 minutes a day However in the SAS code the logic is different depending on the sRehabType variable Determine Medium Therapy indicator _rehab_medium rehab_medium 0 V1 03 0 CHANGE to accomodate new sRehabType MCAR3 IF sRehabType MCARE OR sRehabType MCAR2 OR sRehabType OTHER AND n_tot_rehab_min gt 150 AND i_tot_rehab_days gt 5 THEN _rehab_medium 1 V1 03 0 CHANGE to include new sRehabType MCAR3 ELSE IF sRehabType MCAR3 AND n_tot_rehab_min gt 150 AND 00420 gt 5 THEN _rehab_medium 1 ELSE IF I_Mcare_short_stay 1 AND n_avg_rehab_min gt 30 THEN _rehab_medium 1 Determine Low Therapy indicator _rehab_low rehab_low 0 Page 39 of 60 Answer general and handles Medicare SNF RUG classification for all years since the implementation of
21. the CMS MDS 3 0 Technical website bed http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html The download is RUG III files amp RUG IV files The RUGIV grouper overview in this download explains the calling the RUG dll The RUGIV DLL user doc explains each parameter 20101220 016 K RUGs Where do find the RUG version code to submit in Z0100B The RUG version code required in the submission record is Z0200B and Z0250B calculated and returned by the RUG III or RUG IV grouper either the dll or the SAS code in both cases This information is found in the RUG specifications for the particular RUG system being used This version is dependent on the RUG system RUG III or RUG IV and the model within a system number of groups used Z0100B and Z0150B The first 3 characters of ZO100A and Z0150A are always a Medicare RUG IV group code and the corresponding version code in Z0100B and Z0150B is 1 0066 as CMS uses the 66 group model Z0200B and Z0250B The RUG group reported in Z0200A and Z0250A can be RUG III or RUG IV as required by the specific state If the state is using RUG III then the version code in ZO200B or Z0250B is 07 for the 44 group model 08 for the 34 group model and 09 for the 53 group model If the state is using RUG IV then the version code in ZO200B or Z0250B is 1 0066 Page 47 of 60 Topic Question Answer ID ree
22. to verify one way or another whether the recalculated Medicaid RUGs groups are Does it make a difference whether the state uses RUGs III or RUGs IV A client is having 3 MDS assessments rejected by the QIES system and being recalculated at the default rate According to our calculations the resident qualifies for the short stay criteria Answer The 3 assessments in question were all rejected because of fatal edit 3804 If an assessment is coded as a Medicare start of therapy assessment A0310C 1 then it must result in a RUG IV rehabilitation therapy group starting with R in the Medicare HIPPS code item Z0100A None of the assessments can qualify for the special Medicare short stay provision They all are missing a condition that is necessary for the short stay provision that at least one of the 3 therapies must end on the therapy reference date therapy end date must equal the assessment reference date A2300 or the end date for a therapy must be coded as on going coded as 8 dashes on the assessment reference date For all 3 assessments the therapy end dates e g O0400B6 are coded as a single dash meaning not assessed or unknown So all 3 assessments fall the short stay provisions and must meet the regular therapy minutes days and restorative nursing requirements for rehabilitation classification Using the regular criteria for rehab the first 2 assessments fail to qualify for rehab class
23. 0 previous ARD for significant correction The old edit 3573 constrained this date so that it must always be greater than or equal to A1600 entry date and A2300 assessment reference date This relationship is correct for an when the new record is an admission but can be incorrect when it is a reentry where the ARD that is referenced in A2200 applies to a previous stay that preceded the current entry date It is for this reason that we created the new edit which has separate conditions for significant corrections that are coded in an admission vs a reentry record see the Group C rules So to be clear the only time the new edit will differ from the old edit will be when a new record is a significant correction to a prior comprehensive A0310 04 05 and the record is areentry A1700 2 and the significant correction applies to a comprehensive or quarterly assessment from a prior stay This is quite a rare combination of events and was only brought to our attention several months ago after three full years of MDS 3 0 data submissions ID 20140107 002 20121210 007 Topic E Specs E Specs Question the reasoning behind allowing the changes to the target date and or reasons for assessment on modifications as long as the ISC is not changed as long as the ISC isn t changed the modification is still using the same fields so the modification can still proceed There is an exception to this logic however If the
24. 0 027 K RUGS Question Do you happen to know where you can determine what type of rehab should be used when figuring the RUG IV That parameter is passed in and it is expected to be other or mcare but do not see where this value is specified in MDS 3 0 Since they are doing the Z0100A and Z0150A does that mean that passing in the RehabType to the RUG dll s is obsolete since when using RUG IV you get the Medicare Rate and the Non Therapy Rate Please clarify the calculation of the sRUGHier_NT when the assessment is a SOT or SOT EOT not combined with OBRA or other PPS However would expect that the Non Therapy RUG would be a nursing RUG to allow for the billable days outside of the therapy date range Specifically would expect the SOT to provide a nursing RUG for the days prior to start of therapy and the EOT to provide a nursing RUG for the days after therapy The RUG IV v1 00 6 section Adjustment in RUG group for a start of therapy OMRA A0310C 1 or 3 per the code If start of therapy OMRA gives a 66 group index maximized Rehabilitation Plus Extensive Services or a Rehabilitation Group and is not combined with OBRA or other PPS assessment then reset all non therapy RUG results to the AAA default group Page 53 of 60 Answer 48 group Rehabilitation group based on ADL score as follows RAE if ADL score is 15 16 RAD if ADL score is 11 14 RAC if ADL score is 6 10 RAB if ADL score is 2 5 RAA if ADL score is 0
25. 01 Edit 3535b enforces this instruction Edit 3535a handles the converse situation where A0310A is equal to a value other than 01 Since GO900A and GO900B are active only on NC some of the values listed for A0310A in edit 3535a are not really necessary For example if A0310A is equal to 02 quarterly assessment then GO900A and GO900B are not active However like most skip pattern edits edits 3535a and 20141021 005 20141021 006 Topic E Specs E Specs Question have a situation with a client relating to a SoT and which dates are to be entered in 00400 Our understanding is that the Start of Therapy Dates items 00400A5 00400B5 amp O0400C5 should be for the current Therapy period being started Our client continues to enter Start End Dates related to an earlier reported EOT which conflict with the actual new Start of Therapy date One of our customers is getting an MDS rejected due to a RUG score issue The MDS is a 5 day SOT Discharge Return Not Anticipated The Z0100 RUG is RMB and the Z0150 non therapy is LC1 The error they are getting is 3804 Inconsistent HIPPS code If A0310C equals 1 or 3 then the first character of Z0100A calculated by the QIES Page 8 of 60 Answer 3535b contain the phrase all active items This means that if the referenced item is not active for a particular ISC then the edit does not apply Edit 3535a includes the extra values of A0310A so tha
26. 03 04 05 06 anda discharge A0310F 10 11 it would qualify both as a regular OBRA assessment and as a discharge Note that the assessment reference date must equal the 20100720 035 Topic A Policy Question Significant Correction to prior comprehensive assessment or 06 Significant Correction to prior Quarterly assessment AND A0310F set to 10 Discharge return not anticipated or 11 Discharge return anticipated 1 How is this assessment viewed As a discharge As a regular assessment Or as both 2 When a combined assessment is submitted that resident is discharged So when if the resident returns would the facility submit an entire new assessment on that resident OR would the facility retrieve the combined assessment that contained the discharge and update and re submit that one i e remove the A0310F code of discharge and then continue on with the full assessment with a 99 in the A0310F field If combined assessment reused 2a If the combined assessment is re used is there a time limit on when it can be re used 2b Also if combined assessment re used how does that affect the ASSESSMENT_ID field Is a new ID assigned to it Or does the ASSESSMENT_ID remain the same The short stay documentation refers to previous assessments In the text A PPS 5 day A0310B 01 or readmission return assessment A0310B 06 has been completed The PPS 5 day or readmission return assessment may be
27. 06 07 this is a PPS assessment then submission date Z0500B assessment completion date should be less than or equal to 14 days d If AO310F is equal to 10 11 this is a discharge assessment then submission date Z0500B assessment completion date should be less than or equal to 14 days e If A0310F is equal to 01 this is an entry record then submission date A1600 entry date should be less than or equal to 14 days f If AO310F is equal to 12 this is a death in facility record then submission date A2000 discharge date should be less than or equal to 14 days Since can have an NC record where A0310A 1 and A0310F 10 for example which rule applies a or d Answer using the lookup table the programmer can implement the logic that is shown in Appendix B This appendix contains the source code for a Visual Basic function that accepts the values of the six RFA items as string input and returns the ISC value as a string If the RFA combination is invalid the function will return dashes In your example where a discharge is combined with a comprehensive assessment both rules would apply Each of these rules is applied independently 20100114 062 E Will there be documentation on what has changed in the new Yes When you download the new version of the Specs version of the specs specifications you will see there are two new reports a Item Change Report and a Edit Change
28. 1 4 Proceed with Special Care High and the lower classifications in the normal way Note that the 57 group classification for RUG IV mirrors the 44 group classification for RUG III and the 48 group classification for RUG IV mirrors the 34 group classification for RUG III There are classification worksheets for the RUG III 34 and 44 group models at http www cms gov MDS20SWSpecs 12_RUG lIIVersion5 asp TopOfPage For Medicare calculations the ASAP system always sets the rehab type to MCARE for FY2011 October 1 2010 September 30 2011 MCAR2 for FY2012 and FY2013 October 1 2011 September 30 2013 MCARS for FY2014 October 1 2014 until changed A start of therapy assessment cannot be used to establish anon therapy RUG for billing the days prior to start of therapy SNF PPS Policy is that a start of therapy OMRA only influences billing from the start of therapy services forward The days prior to the start of therapy must be billed based upon another PPS assessment that established a billing rate for those prior days This other assessment may be combined with the start of therapy OMRA If there is no other PPS assessment establishing a billing rate for those prior days then those days cannot be billed Given this policy it is appropriate that the RUG IV grouper set the non therapy RUG classification for a stand alone start of therapy OMRA not combined with another OBRA or PPS assessment to the AAA default group
29. 1 is not there it is not on the print how is 00100 A1 Z1 coded if the assessment is done within the first 13 days Answer specifications apply only to items that are active fora particular item subset Items that are not active ona particular item subset should not be submitted and are not edited even if they are submitted For example consider an edit that says If Item A 1 then all active Items B C and D must equal 2 If Item A was equal to 1 then any of the items B C and D that were active must equal 2 However if any of these three items e g Item B was inactive it would not be submitted would not have a value and would not be edited The edit would therefore not apply to the inactive item but would continue to apply to the remaining active items if any Similarly if Item A was not active the entire edit would not apply Let s use respiratory therapy O0400D as an example On an NC both 00400D1 minutes and O0400D2 days are active Therefore Edit 3560 which deals with the skip pattern and Edit 3699 which describes the mathematical relationship between days and minutes both apply However on an NQ only the days item is active Therefore both of these edits are suspended The only remaining rules for the days item are the formatting rules and the allowable range of values Thus the days item would not always be skipped on an NP or NQ as was stated in the question On an NP being com
30. 114 039 Can you please tell us where to get specific information regarding quality measures for MDS 3 0 would like to clarify something related to the use of the MDS 3 0 forms We would like to use the MDS 3 0 PDF forms as they are formatted in our software Would there be any copy write restrictions related to that Our intent is to simply allow the user to fill out the PDF to complete the MDS None of the copy written material currently a part of the MDS would be used outside of the PDF form Is there a regulation that assessments must be submitted in order Example The resident is discharged for 1 day The Entry record is submitted on the Entry Date 14 The Discharge Assessment is submitted later the same day OR submitted 7 days after the Entry record Since both were submitted within the required submission period is there an issue with their being submitted out of order What is the definition of the start of a therapy regimen Is it the Initial Eval Re eval date or the date that the 1st therapy treatment was given We see that the MDS form has copyright information at the bottom of some section pages For example Section D has Copyright Pfizer Inc All rights reserved Reproduced with permission Does Copyright information need to appear on entry screens that we develop or only on printed forms If a correction needs to be submitted for an MDS assessment that CMS has already accepted is there a time limit on sub
31. 18 K RUGs Question version code 1 0266 for Z100B and Z150B effective as of 7 18 2012 have an assessment that was accepted but with a warning 3616a The QIES ASAP system recalculated a submitted score of RHC04 which is correct by the hierarchical method with a score of HD2 which is correct as the non therapy RUG Why would CMS replace a rehab score with a lower ranking one Some of our clients are starting to get validation report Warnings for EOT R assessments and MDS 3 0 item Z0100 In one case we calculated a RHAOA and it was recalculated to HB10A Page 42 of 60 Answer have CMI values All of the other rehab groups are zero This is because the F01 set is for the 48 group model which only uses the rehab groups RAE RAD RAC RAB RAA Similarly looking at the F02 code set used with the 57 group model the only RU rehab groups used are RUA RUB and RUC and these have CMI values greater than zero The RUX and RUL rehab groups are not used in the 57 group model have values of zero The Medicare RUG IV logic version continues to be 1 02 with the implementation of the new 1 02 1 code version of the DLL The Medicare RUG IV version code Z0100B and Z0150B of 1 0266 is not changed with the new DLL The DLL code version of 1 02 1 continues to use logic version 1 02 and corrects a rare problem that occurred with code version 1 02 0 For future issues you should contact your State Automation coordinator CMS uses th
32. 2 version code 20100720 027 20100720 026 Topic K RUGS K RUGS Question MDS 3 0 we are trying to make it a little easier on ourselves Am I correct that Z0100A is always populated and that when Z0100A represents a non therapy code that code will also appear in Z0150A but when Z0100A represents a therapy RUGS code Z0150A will be populated with a non therapy RUGS ignoring the therapies used to calculate the therapy RUGS in Z0100A The spec for the 2nd digit of the HIPPS Al code on page 6 9 of the RAI manual seems to allow for many assessment type combinations to fall through the logic without qualifying for any of the listed code values An example of section A values that result in this as understand it is listed below A0200 1 A0310A 01 A0310B 01 A0310C 0 A0310D A0310F 99 Can you please indicate what the code should be for the second digit of the HIPPS Al code for the above assessment type combination and why Page 55 of 60 Answer Please note that the CMI array has 49 elements for 5 12 but 58 elements for 5 20 the additional 9 elements corresponding to the additional 9 Rehabilitation Extensive groups added with the 53 group model This assumption is correct ZO0100A always contains the normal Medicare HIPPS code including a normal RUG code can be therapy or non therapy group Z0150A always contains a Medicare HIPPS code restricted to non therapy groups classification made
33. 36 20131118 001 Topic Question Will both RUG III and RUG IV systems need to be maintained for a period of time once RUG IV is in place What is the sort order for submitted records Page 56 of 60 Answer PPS are the significant change assessment indicated by A0310A 04 and significant correction of prior comprehensive indicated by A0310A 05 Since this assessment is a scheduled PPS assessment but not also an unscheduled PPS assessment or unscheduled OBRA assessment used for PPS the second Al digit will be 0 as stated in the first row of Table 3 on Page 6 9 Scheduled PPS assessment not replaced or combined with an unscheduled PPS assessment or OBRA assessment used for PPS The only time that the second Al digit will not be 0 is when the assessment is a PPS OMRA OBRA significant change or OBRA significant correction of prior comprehensive The QIES MDS 3 0 ASAP System will support the current RUG IV Version for both Medicare and Medicaid and RUG Ill version 5 20 for Medicaid States have the option to remain with RUG III classification and RUG III will be a permanent feature of the MDS 3 0 system The sort orders for the submitted records and the facility Final Validation Report have been updated since 2010 We are removing question 20101220 020 and replacing it with this question The current ASAP sort order for submitted records is as follows State code STATE_CD ascending Facility internal ID asc
34. DS_RUG_CLSFCTN_TYPE_CD Z0200A or Z0250A cRugMax Z0200B or Z0250B cRugVersion If MDS_RUG_CLSFCTN_TYPE_CD Z0200A or Z0250A cRugHier Z0200B or Z0250B cRugVersion Currently the only documentation for the RUG IV 48 and 57 group models is in the RUG IV SAS code and C code in the Grouper Package Here is a quick description INDEX HIER INDEX HIER 57 Group Model To achieve the 57 group models 1 Simply leave out the 9 Rehabilitation Extensive groups from the 66 group model 2 Begin classification with the Ultra High Rehab category 3 Proceed with Extensive Services and the lower classifications in the normal way 48 Group Model To achieve the 48 group model 1 Leave out the 9 Rehabilitation Extensive and the following 14 Rehabilitation groups from the 66 group model 2 Start with the Extensive Services groups 3 After the Extensive Services groups check to see if the resident would qualify for the 66 group Medium or Low Rehabilitation categories as follows a If total therapy minutes across Speech OT and PT are greater than or equal to 150 and the total days of therapy across Speech OT and PT are greater than or equal to 5 OR b If total therapy minutes across Speech OT and PT are greater than or equal to 45 and 2 or more restorative nursing services received for 6 or more days If either a or b is true then the resident qualifies for a ID Topic 20100820 043 K RUGS 2010082
35. If an OMRA assessment is run through the RUG III MDS 3 0 crosswalk the MDS 2 0 record that is produced will not support RUG Ill If this MDS 2 0 record is run through the RUG III grouper the grouper will not compute a RUG III group The reason that OMRA assessments do not support RUG lll is that they are to be used only for RUG IV SNF PPS purposes The RUG IV grouper does produce RUG IV groups for NO NOD NS and NSD Start of therapy OMRAs NS and NSD are valid only if they produce a rehabilitation or rehabilitation plus extensive RUG IV group NS and NSD therefore do not contain all of the RUG IV items Instead they contain only those RUG IV items that are required to produce rehabilitation or rehabilitation plus extensive RUG IV groups NO and NOD assessments in contrast contain the complete set of RUG IV items and can produce any of the RUG IV groups including non rehabilitation groups A non therapy RUG classification is not possible on a stand alone start of therapy OMRA because almost all of the items necessary for non therapy classification are inactive The grouper sets the non therapy RUG group to AAA for a stand alone start of therapy OMRA However it does not adjust the Al code The Al code describes the type of assessment based on reasons for assessment with a code of 02 for a standalone start of therapy OMRA As a result the non therapy HIPPS code for a stand alone start of therapy OMRA is AAAO2 The 02 allows ide
36. MDS 3 0 FY2011 through FY2014 in addition to non Medicare classification The type of classification performed by the grouper is based on the sRehabType parameter as follows sRehabType MCARE for Medicare SNF classification for FY2011 sRehabType MCAR2 for Medicare SNF classification for FY2012 and FY2013 sRehabType MCARE for Medicare SNF classification for FY2014 sRehabType OTHER for non Medicare classification If you apply the RUG logic to identical assessments dated before 10 1 2013 MCAR2 and after 10 01 2013 MCAR3 you can get different classification results because different Medicare logic is used for these two time periods for accounting days of therapy This is intended to conform to changed Medicare SNF policy and rules In addition to the change in accounting days of therapy for Medicare SNF FY2014 classification there is also a change in the non oral nourishment logic Before 10 1 2013 the non oral nourishment items KO700A and K0700B are used but after 10 1 2013 the new K0710A3 and K0710B3 items are used ID Topic Question Answer V1 03 0 CHANGE to accomodate new sRehabType MCAR3 IF SRehabType MCARE OR sRehabType MCAR2 OR sRehabType OTHER AND n_tot_rehab_min gt 45 AND i_tot_rehab_days gt 3 AND i_rnursing_cnt gt 2 THEN _rehab_low 1 ELSE IF sRehabType MCAR3 AND n_tot_rehab_min gt 45 AND 00420 gt 3 AND i_rnursing_cnt gt 2 THEN _rehab_low
37. MDS 3 0 Vendor Questions and Answers 1 15 Consolidated October 21 2014 ID 20141021 001 20110126 002 Topic A Policy A Policy Question A third party private insurance company requires that facilities complete and submit an assessment to them for reimbursement Since the beneficiary does not have a Health Insurance Claim Number HICN to enter into Item AO600B the new edit for this item is causing a problem with our software in that the facility cannot lock the assessment in order to generate a RUG What can a vendor do to assist the facility in order to generate a RUG to send to the third party insurance company Will anything be done to verify that the therapy dates are correct when flagging A0310C as an SOT or EOT OMRA For example Page 1 of 60 Answer Edit 3571 for Item AO600B states If this is a PPS assessment A0310B 01 02 03 04 05 06 07 then the Medicare or comparable railroad insurance number AO600B must be present not Thus the submission will be rejected if this is a PPS assessment and AO600B is equal to In effect if an assessment is coded as a PPS assessment it will fail edit 3571 if the HICN or comparable Railroad Insurance number is not present left blank in Item AO600B Rationale Assessments that are being completed for third party billing must NOT be submitted to the QIES ASAP system Marking assessments as a PPS assessment when it is not for a Me
38. RUG code 20121210 013 F We are software vendors in the state of Illinois We have a The Additional Items Required by States that is a link State question regarding items collected for NQ ISC for the state of published on the Vendor Section of the QTSO website Options Illinois https www qtso com vendormds html is correct Illinois collects all CMS defined items As per the Additional items required document published by EXCEPT for GO900A GO900B and the CMS it is required to include all V section elements in the also except for all Section V items NQ assessment When one of our clients checked with the state coordinator then have indicated that there is no need to All Section V items are within this exception list so are not submit V sections in NQ collected Following are my questions In the future for state specific issues questions please contact the state directly Is there any other document besides the one published by the CMS Is it mandatory to submit the V sections in the NQ for the state of Illinois If the MDS is submitted without V section will it be rejected Moreover in the RAVEN software V section is not included for the state of Illinois Please clarify whether to include the V section or not in the Page 28 of 60 Topic 20110126 016 F State Options 20101220 013 F State Options 20100820 030 options 20100820 009 ID options Question NQ assessment for the state of
39. ally set sRehabType to MCAR3 uses distinct calendar days of therapy if the assessment reference date A2300 is on or after 10 1 2013 While that is appropriate for SNF Medicare Part A classification the grouper will allow other sRehabType values for assessments on or after 10 1 2013 The grouper has been designed to allow use for purposes other than Medicare Part A classification The grouper can also be used for Medicaid classification other payer classification or ID Topic 20140107 017 K RUGs 20140107 013 K RUGs 20140107 014 K RUGs Question Regarding the RUGs version 1 00 4 don t see any updated sas file Unfortunately we do not have the ability to call DLL s from our programming language so we normally do our coding based on the sas file So far can see only RUG520 sas dated 08 04 2005 Am missing something or will there be an updated sas file Is the RUG III converter v1 00 4 backwards compatible Will you be putting out a new version of the RUG IV grouper to handle the thirteen day transition period from 10 1 2013 thru 10 13 2013 Or will it be up to the software developers who use your provided RUG IV grouper to handle Page 37 of 60 Answer research To allow such flexibility the sRehabType parameter can be set to any value irregardless of the assessment reference date The test file in question 00420_mcar2_test_v2 txt was designed to test MCAR2 classification when the assessment re
40. alues are allowed depend upon the specs for the individual item you re talking about If you look at the specs for A2400C you ll see that eight dashes are allowed but a single dash is not If you look at 00400B5 you ll see that a single dash is allowed but eight dashes are not Finally if you look at O0400B6 you ll see that either a single dash or eight dashes are allowed The general rule for these date items is that a single dash is used the same way as on most other items to indicate that the item was not assessed or that information was not available The use of eight dashes is generally reserved for special meanings For example for OO400B6 eight dashes indicate that therapy is ongoing There is no order requirement for items on the submitted XML records The items in the XML file can be submitted in any order As long as all the items active on the ISC are submitted the order doesn t matter There are several other items on different MDS 3 0 item sets where a None of Above item is not active or is missing from the item listing This was intentional as the definition of the None of the Above depends on what items are in the list In the cases where the None of the Above item is active on the NC and not active on the NQ the NQ does not contain all of the items in the list The item list referred to in Section N is NO400A G and N0400Z None of the Above In the item set NO400Z is defined as not having NO400A NO400G On the q
41. an server to validate assessments be used to validate MDS 3 0 submission files in XML format but it is not used as part of the ASAP system 20100820 041 H VUT Could you provide the edits you used for your utility tool in a If you haven t done so try looking through the MDS 3 0 20121210 014 H VUT Can you help me understand why the VUT is telling me that The VUT determines what items should be present in the 3676 invalid value A0050 is failing when the following is assessment based on the target date not the true SPEC_VRSN_CD SPEC_VRSN_CD 1 02 X0100 1 e A0050 is NOT PRESENT If the VUT is applying 1 02 rules for the submission specifications cannot see how error 3676 would apply since it was not added until 1 10 Does the VUT only support a single version of the submission specifications 1 10 or does it look at SPEC_VRSN_CD to determine which version to apply document want to compare them to our edits to be sure Technical Information page It has information on the MDS that they are complete and accurate edits as well as data specs http Awww cms gov Medicare Quality Initiatives Patient Page 32 of 60 20100720 022 H VUT 20100820 049 Question Do you have the actual code that performs the VScan We would like to start with whatever code pseudo code there is Will swing bed providers still be able to use the RAVEN software If not does CMS have a vendor similar to RAVEN Trying to determ
42. assification Index maximized Rehab type Other Please note that a CMI set code will only have 1 value for each RUG group It is not possible to have SSB and RAC to have multiple values as stated below For the D01 set code RAC CMI value 1 31 SSB CMI value 1 33 Since the SSB CMI value is greater than the RAC CMI value the indexed maximized RUG group for these 2 RUG groups is SSB Please check your software to insure that the RUG parameters are correct if using the CMS supplied RUG DLL If not using the CMS supplied DLL please check your software RUG code If these parameters do not match the ones you understand that you should be using for GA please contact the state The CMI sets contain RUG values for ALL models of the RUG For RUG IV this includes the 66 57 and 48 models of the grouper All CMI sets for the RUG IV grouper contain 72 entries As a note all grouper CMI sets for the RUG III grouper 53 44 and 34 models contain 58 entries The CMI values not used for that model have a CMI value of zero 0 00 The CMI value for RAE RAD RAC RAB RAA in the CMI sets E01 E02 E03 and E04 are zero because these RUG groups are not returned for the 66 group model and CMI sets E01 E02 E03 and E04 are CMI sets for the 66 group model For code set F01 only RAE RAD RAC RAB and RAA Topic Does the RUGS DLL version code v1 02 1 replace the RUGS 20121210 016 K RUGs 20121210 017 K RUGs 20121210 0
43. at when XO900E is 1 00450A should also be 1 Now what would happen if XO900E is 1 and the value in Page 18 of 60 Answer successful submission to the QIES ASAP system Providers are not required to use the CMS software however they must ensure that the product they use meets CMS requirements for submission Vendors may choose to provide features above the CMS requirements Item XO900E should be checked only under the following scenario a an end of therapy OMRA A0310C 2 3 has been submitted and accepted by the ASAP system b there has been a subsequent resumption of therapy c the original EOT assessment is being modified by entering appropriate information in 00450A and O0450B Under this scenario XO900E should be checked equal to 1 and items 00450A and 00450B should be completed The question concerns a change of therapy not an end of therapy resumption of therapy combination Item XO900E therefore does not apply to the scenario that is described The edit that prevents XO900E from being checked is therefore appropriate We presume the inquirer is asking what would happen if XO900E is 1 and the value in A0310C 0 1 4 There is not an edit that directly controls the relationship between A0310C and XO900E However both of these items are related to O0450A O00450B If O0450A B were skipped then a fatal error would result because of Edit 3815 If 00450A B were not skipped then a fatal error would result
44. both the Start of Therapy OMRA and the 5 Day or Readmission Return assessment must be satisfied It is the facility s responsibility to insure compliance with these requirements Any Start of Therapy OMRA assessment that complies with these requirements will automatically satisfy the Medicare Short Stay Assessment condition 2 above It is not necessary that the standard RUG IV grouper DLL or SAS code actually test the second condition since it should always be true Private software vendors who develop their own RUG IV classification code need not test the second condition when classifying a Start of Therapy OMRA assessment as a Medicare Short Stay assessment However software vendors may want to alert the facility when a Start of Therapy OMRA precedes the 5 Day or Readmission Return assessment The facility would be advised that this is not allowed and the facility must combine the Start of Therapy OMRA assessment with the scheduled 5 Day or Readmission Return assessment CMS has no requirements for printed documentation When surveyors go out and want to see documentation at a facility CMS has no particular formatting requirements in that environment We simply have the requirement that the data has to be available It is not our call to take on the role of dictating what printed copy should look like ID Question Answer 20100420 35 20100420 18 20100225 094 20100225 084 20100225 053 20100225 005 20100
45. ccommodate the specific state s quarterly additional items CMS does not create state specific printable item subsets 1 When A0050 1 the values for both the MDS_ASMT_ID and ORGNL_ASMT_ID will be the same value 2 When A0050 2 Modify existing record the ORGNL_ASMT_ID will always equal the original value assigned when the assessment was first added regardless of how many modifications were submitted 3 There is no sort order on the state extract file Note If the state wants to process them in a certain order then they can sort them prior to processing With MDS 3 0 submitters were not required to put a zero in X0800 Correction Number for original records If it is an original record X0800 is part of a skip pattern so is a caret The values of X0800 are caret for an original record and 1 through 99 for a modification or inactivation record Z0250 If a state sets up parameters for the ASAP system to perform Medicaid RUGS calculation 2 Z0250A then the ASAP system will recalculate the Z0250A value and issue warning edit 3616 if they do not match This includes issuing the edit if a blank is submitted and the state sets up Z0250A to be calculated by the ASAP system No states can only add items to the NQ and NP ISCs They cannot add non section S items to any other ISC 20100720 014 20100720 01 1 F State options Z0250 is active on the NC NQ and NP subsets but is inactive on the remaining subsets Do the states
46. d specifically The isc_val table contains values for a0310a which are not allowed specifically The isc_val table contains values for a0310b which are not allowed specifically The isc_val table contains values for a0310c which are not allowed specifically The isc_val table contains values for a0310f which are not allowed specifically Page 25 of 60 Answer this modification inactivation The information in Section A on a modification record X0100 2 is the new information for the modification They are informational only and are not included in the MDS 3 0 submission system edits or messages CMS has decided to leave this edit unchanged Vendors are free to enforce a more restrictive edit on this item if they wish The isc_val table includes all possible combinations of the fields A0200 A0310A A0310B A0310C A0310D and A0310F Edit 3607 defines the allowed combinations which will produce a valid ISC The invalid ISC s are noted in the table by a This table is for the convenience of developers if they wish to use it Per the MDS 3 0 Data Specifications Overview document posted on the CMS MDS 3 0 Technical page There are 3 360 combinations of the possible values of these six RFA items Most of these 2 542 are combinations of values that are not allowed i e that will lead to record rejection The remaining combinations can be mapped onto the ISC codes described above Unfortunately the logic
47. d on to share so others might use ICD version detection in their target date not submission date after the ICD 10 own coding implementation date a provider probably will still be submitting records with a target date prior to the ICD 10 implementation date Records with a target date prior to the ICD 10 implementation date currently scheduled to be October 1 2014 would submit ICD 9 codes regardless of when they were submitted 20121210 010 E Specs Ona discharge assessment section O If there are no Edits 3557 3558 and 3559 address this issue minutes in the look back can enter a zero for the days For consistency fatal skip pattern Please refer to the error the dates PT OT ST is blank a valid answer Or must message chapter of the Provider Users Manual as well as enter a dash the data specifications If an item is active it may not be left blank An active item must contain a valid response value If an active item is left blank the record will be rejected When we refer to blank we are saying that the item does not contain a valid response value which in some instances the caret may be a valid value 20111110 007 E Specs In previous releases of item set PDF documents there were CMS is required to meet 508 requirements which allows field misnaming errors in terms of data tags applied to PDF the item sets to be read and navigated by assistive fields that required hand adjustment to allow automatic t
48. d submission 3 Federal required submission Our software was designed so that if a MDS has a SUB REQ 2 or 3 then the record is included in the EDT file and is transmitted to CMS If the SUB REQ field 1 then the MDS does not get included in the EDT file We do not allow any other way to remove records from the EDT file ACTUAL DEFINITION The actual RAI manual definition of the SUB REQ field differs from the MDS descriptions That definition states the value is based on whether the resident is in a Medicare or Medicaid certified bed All of our beds are certified so based on the RAI manual all of our MDS s must have SUB REQ 3 We vendor have a central database and we must use automated scripting what are you suggesting we do to replace that In 2003 CMS required nursing homes to backup their local database to safeguard their MDS 2 0 information Is this required for MDS 3 0 When a facility sends in a combined assessment A0310A set to 01 Admission or 02 Quarterly or 03 Annual or 04 Significant Change in Status or 05 Page 3 of 60 Answer The requirement for SUB REQ has not changed with MDS 3 0 With MDS 3 0 CMS created an item specific for the sub req The sub req is determined by the type of unit the resident is on and which entities have the authority to collect the assessment data It is not at all related to payment type Page A 6 states Code 1 when the unit the resident is on is n
49. date is changed so that a different submission specification version should be used the ISC may not change but the modification could then require a different set of fields I m guessing that is not what was intended to occur with this edit As per the MDS 3 0 data specs overview v1 12 0 09 18 2012 pdf document it specifically states Note that the deletion of edit 3811 the addition of edit 3839 and the change to item A0800 are retroactive once V1 12 of the data specs is implemented This means that edit 3811 will no longer apply edit 3839 will apply and a dash will not be allowed for item A0800 for every record that is submitted on or after the implementation date 05 19 2013 regardless of the record s target date The way our team is interpreting this is that all MDS assessments submitted on or after 5 19 13 will have the new edit changes and the A0800 changes These changes will also be retroactive regardless of the MDS s ARD date So if an MDS with an ARD of 9 30 12 is submitted on or after 5 19 13 it should have the latest edits and changes to A0800 A highly unlikely scenario to submit such an old assessment but we want to make sure our understanding is correct Can you confirm this is correct Also the document does not explicitly say that WHEN the new SPEC_VRSN_CD should be updated In past revisions the SPEC_VRSN_CD has been based on the assessment s target date However this revision s edits are based on sub
50. dicare part A Stay does not follow RAI coding instructions Submitting assessments marked as PPS to CMS when a facility is not seeking payment for a Medicare part A stay is a violation of HIPAA s minimum necessary standard Vendors should work with their providers to meet their needs How these needs are met are between the provider and the vendor i e a business arrangement A vendor is permitted and encouraged to add additional functionality that the free CMS provided software JRAVEN does not provide An example of a possible vendor solution to the question above The vendor may choose to not enforce this edit until the RUG has been generated since the assessment is for third party insurance purposes and would not be submitted to CMS CMS will consider edits to the OMRAs However due to midnight rule leaves of absences and other issues some edits would be too firm and may prevent a provider from completing and submitting an accurate and required assessment Topic Question 1 that there are start dates if an SOT OMRA is specified 2 that there is at least one end date and that all therapies have end dates and not dashes if an EOT OMRA is specified 3 for an SOT OMRA that the earliest therapy start date is no more than 7 days prior to the ARD What happens if this information is incorrect and the assessment is accepted as is Note that the Al code generated uses A0310C and does not verify the dates This mak
51. discounting any therapy Note that these values are expected on OBRA assessments in addition to PPS assessments In some cases an OBRA assessment can be used for Medicare PPS billing when Part A coverage was not initially known Also there may be cases where both the normal HIPPS code Z0100A and the non therapy HIPPS code Z0150A from the same assessment are both used for Medicare billing This can happen if a PPS 5 day assessment is combined with an end of therapy OMRA In this case the normal HIPPS code Z0100A is billed for day 1 through the day that all therapy ended and the non therapy HIPPS code Z0150A is billed starting on the day after all therapy ended See the Al coding section in Chapter 6 of the RAI manual or the SNF provider manual for more detail The example given is for a nursing home A0200 1 OBRA admission assessment A031 0A 01 combined with a 5 day PPS assessment A0310B 01 and no OMRA assessment A0310C 0 The first Al digit indicates the type of PPS scheduled assessment and will be a 1 since this is a 5 day assessment see Table 2 on Page 6 8 Chapter 6 of the MDS 3 0 RAI Manual The entry for the second Al digit indicates if the assessment is an unscheduled PPS assessment or an unscheduled OBRA assessment used for PPS As indicated on Page 6 8 the unscheduled PPS assessments are the OMRA assessments indicated by A0310C 1 2 3 The unscheduled OBRA assessments used for 20100114 0
52. dn t between dates 02 01 2012 to 07 31 2012 The facility completed PPS only assessments within the report dates 02 01 2012 to 07 31 2012 where J1800 1 looked at the QM Manual at http Awww cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualityInits Downloads MDS 30 QM Users Manual V60 pdf and see on page 7 that the qualifying RFAs are Qualifying RFAs A0310A 01 02 03 04 05 06 or A0310B 01 02 03 04 05 06 or Page 59 of 60 Answer IF clause being reversed The correct specification is IF MONTH A2300 gt MONTH A0900 OR MONTH A2300 MONTH A0900 AND DAY A2300 gt DAY A0900 THEN Age YEAR A2300 YEAR A0900 ELSE Age YEAR A2300 YEAR A0900 1 Appendix F will be corrected Please note that the actual age calculation in CMS systems is correct The error is only in the documentation for that calculation The resident that you wrote about had an admission date of 5 1 2012 Residents are classified as short stay or long stay depending upon the number of days they resided in the facility as of the report s ending date Residents with 100 or fewer days are classified as short stay while residents with 101 or more days are classified as long stay This resident would have reached their 101st day on 8 9 2012 This means that when you ran the report ending 7 31 2012 they were still classified as short stay and were therefore not included in the long stay falls mea
53. e number of days of therapy requirement was 5 or more days across the disciplines sum of O0400A4 O0400B4 00400C4 After 10 1 2013 the number of days of therapy requirement changed to 5 distinct calendar days of therapy ID Topic 20141021 007 E Specs 20141021 008 Question ASAP System must equal R According to the v1 14 1 specifications the O6 or 6 value for A0310B has been removed The isc_val v1 14 1 05 08 2014 csv file still contains ICS combinations for A0310B 6 1 Will the A0310B 6 combinations be removed from the ISC_VAL set 2 What further documentation about the effect of removing 06 Readmission Return will be provided either in the form of RAI updates or other specific documentation of Medicare PPS Scheduled assessments and when can Vendors expect that information In the Oct 2014 draft data specs answer 6 Readmission is removed from XO600B but it is not removed from V0100B Normally for Prior assessment information in section X the Page 9 of 60 Answer 00420 While this assessment has 2 days of therapy for each discipline speech PT OT giving a sum of 6 there were only 3 distinct calendar days of therapy reported in 00420 With only 3 distinct days the assessment is not classified as Medium Rehab The fatal error 3804 was reported because this is a Start of Therapy SOT OMRA and the normal Medicare classification must be in a Rehab Extensive or Rehab gro
54. e will be 07 08 or 09 depending upon the number of groups It is the state regulation law statute that requires NO submission of identified HIV and or STD diagnosis therefore providers should take the appropriate editing to prevent this from happening The QIES system will edit out a specific ICD 9 code that the state determines inappropriate and designates as such in the CMS QIES system This does not supersede the provider from submitting the banned codes i e the state may inadvertently miss adding such banned codes in the CMS QIES system The onus is on the provider to ensure they are compliant with state specific requirements States can request CMS to add items to the OBRA quarterly NQ and or PPS NP assessment for their state The items available for addition to these ISCs are identified by an s lower case letter s under the ISC column in the MDS 3 0 Data Specification s file itm_sbst csv or by having the NQ and NP item subset codes listed in the State optional NQ NP line for the item in the MDS 3 0 Data Specifications Detailed data specs report After approval by CMS CMS will update the ASAP system to add the requested items to the requested NQ or NP assessments for that state as active items As active items they will be edited and stored by the ASAP system If any of these active items are missing or fail a fatal edit the record will be rejected For example a state has requested and been approved to have all the a
55. e indexed maximized method not the hierarchical method of RUG calculation Since CMS uses index maximizing you should reference the payment rates for each of the RUG categories for the appropriate CMI set There are several times when the non Rehab RUG has a higher CMI value When this is the case Z0100A will return a non therapy RUG If the facility associated with this MDS is classified as urban then HD2 does have a higher CMI than RHC If the facility is rural then RHC has the higher CMI Please verify that your software is set properly urban vs rural for the proper CMI and it is using index maximization not hierarchical method For the assessment provided the manually calculated RUG RMB is the same as the ASAP system or recalculated Z0100 RUG value Since the submitted Z0100 value of RVBO1 did not match the system recalculated RUG the ASAP system correctly returned the warning error message on the Final Validation Report To be an RV_ very high RUG group for a non short stay assessment 2 criteria must be met see page 6 34 and 6 35 of the MDS RAI manual Topic 20121210 019 K RUGs Question There seems to be an issue with the RUG IV grouper program where it won t recognize an assessment as a RMA RUG IV Class instead its returning an error The assessment in question is an NP PPS 5 day start of therapy short stay assessment To test this only used the Speech Therapy Individual Minutes set the numbe
56. e special Medicare short stay calculation If the Modification is created on or after October 1 2011 the v1 01 1 calculation will return the Short Stay Indicator 0 AND the default AAA RUG calculation Note Version 1 02 0 of the MDS 3 0 Data Specifications will be implemented in October 2011 This final version has been updated with the errata from version 1 01 1 Page 46 of 60 Answer rehab group starting with an R Any SOT will be rejected unless the Z0100A value recalculated by the ASAP system using index maximizing is a group starting with R The change in the Medicare Short Stay assessment indicator logic with RUG IV V1 01 1 only affects whether the short stay indicator is set and not whether an assessment is accepted or rejected by the ASAP system The short stay logic change is to only set the indicator if A0310C 1 SOT OMRA rather than if A0310C 1 SOT OMRA or 3 SOT and EOT OMRA Actually this coding change has NO impact on whether the indicator is set or not Other requirements for a short stay assessment are 4 The Medicare Part A covered stay must end on the assessment reference date A2300 of the Start of Therapy OMRA That assessment reference date must equal the end of Medicare stay date A2400C 6 Rehabilitation therapy must not have ended before the last day of the Medicare Part A covered stay That is at least one of the therapy disciplines must have a dash filled end of therapy date
57. e the system does not enforce relational edits for Section S This is something that the State might choose to enforce in its Medicaid processing system We ID Topic Question Answer therefore recommend that the vendor contact the State responsible for the items in question to find out how they should be handled in the situation he describes 20100420 Ad G Will vendors be required to contact States to find out what Yes contact state agencies We did include item text for Hoc21 Section the Section S format should look like Section S items in the new version 1 00 2 of the data S specs CMS has been reminding state agencies they need communicate with vendors about Section S 20100926 019 How will CMS transmit Section S data to the various states CMS will supply the accepted MDS 3 0 records to the Section We are hearing terms like the translator Is this an individual appropriate state in a standard process This includes all state program which would receive the Section S data then data in the record including Section S create a RUGs Ill reimbursement rate for Medicaid residents How exactly does this work G S 20100926 021 H VUT also want to know if there is any variance that would justify The VUT could be utilized for testing Section S and state testing in multiple states optional items 20100926 020 H VUT Is the VUT tool the exact same software used on the CMS No the VUT enforces the edits as part of JRAVEN and c
58. echnology Our software meets the requirements for Page 17 of 60 ID 20110803 002 20110803 003 Topic E Specs E Specs Question printing of the PDFs Each of the data fields has an implicit defined data tag that is part of the PDF structure and therefore you can write programs that fill them in automatically but 3 of the fields data tags are incorrect The programs we write allow for hard copy printing Will there be any attempt to put in a QA effort with the next release to correct those mistakes have a question about editing 00450A Edit 3812 b states If A0310C 0 1 4 or AO310F 01 10 11 12 then all active items from 00450A through 00450B must equal But then Edit 3815 states If XOQ900E 1 then 00450A must equal 1 So if make a modification of an Admission 14 day Change of therapy assessment 01 02 4 which is a valid assessment combination and then check XO900E as yes will have conflicting edits since A0310C 4 00450A through 00450B must be blank but if XO900E is checked then 00450A must equal 1 This query is related to two Edit IDs 3812 and 3815 Per Edit ID 3812 b If AO310C 0 1 4 or AO310F 01 10 11 12 then all active items from 00450A through 00450B must equal This means that 00450A will be skipped in case either A0310C or A0310F have above mentioned values Per Edit ID 3815 If XO900E 1 then 00450A must equal 1 This means th
59. ed 20121210 008 E Specs When ICD 10 is implemented we have questions regarding The formatting of ICD 9 and ICD 10 do differ ICD 10 ICD 10 use in MDS am aware that 18000 is already requirement will be based on target date of the designed to allow for ICD 10 values Will an additional assessment Prior to the implementation of ICD 10 indicator item calculated field or control field be added to today s world the specifications require the ICD 9 format indicate whether 18000 is coded as ICD 9 or ICD 10 In other and thus the ASAP edit checks any codes entered in 18000 words will something be added to the state extract file that meet the ICD 9 format described in the Data will indicate whether 18000 is coded with ICD 9 or ICD 10 Specifications When ICD 10 is in place the Data Specifications will be updated for the ICD 10 release to How does CMS plan to identify which ICD code was describe the ICD 10 format expected The ASAP edit will submitted ICD 9 vs ICD 10 in 18000 Has ICD version check the code to ensure it meets ICD 10 format From a detection been developed based on the first character the CMS perspective for MDS 3 0 the ICD 10 implementation number of total characters or some other means of will be based on target date of the assessment A2300 distinguishing ICD 9 vs ICD 10 If not do you plan to develop one at some point in the future that you will be able As the expected ICD code ICD 9 or ICD 10 is base
60. ee PER and 1 0048 for the 48 group model 20101101 024 K My state is not having me submit Medicaid RUGs in Z0200 The Medicaid RUGs items Z0200A Z0200B Z0250A and nor Z0250 Do need to submit those items in my XML file Z0250B are always active on NC NQ and NP assessments As active items these items must be included in your XML file with valid values Per the MDS 3 0 Data Specifications the valid values for these items are TEXT or If the state requires the Medicaid RUGs item to be submitted then the item value should be the appropriate RUG TEXT value If the state does not require the Medicaid RUGs item to be submitted then the item value should be a 4 blank 20101101 023 K What versions of the RUG DLLs should we use The most current versions should be used The RUG RUGS documentation and DLLs are posted on the MDS 3 0 Technical website Please check this site frequently for updates 20101101 020 K The distinction for rural and urban is urban over 10 000 To distinguish between rural and urban you must use RUGS OMB s Core Based Statistical Area CBSA definition Facilities that are geographically located in a CBSA are urban those outside of a CBSA are non urban or considered rural this includes Micropolitan Areas CBSA s are established on a county level K 20101101 017 Could you explain the ASAP setups for the state with regards The ASAP system will validate the Medicaid RUG items RUGS to valida
61. ely sets the non therapy RUG to the AAA default group for a start of therapy OMRA combined with an end of therapy OMRA In this case the non therapy RUG is needed for the end of therapy OMRA billing of days after therapy ended Version 1 00 8 corrects this problem and does not reset the non therapy RUG to the AAA default group for a start of therapy OMRA combined with an end of therapy OMRA RUG test files are available in the RUGIII files amp RUGIV files download on the CMS MDS 3 0 Technical Information website http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html There is no SAS code for the conversion of MDS 3 0 items to the MDS 2 0 items needed for RUG III However there is a RUG III MDS 3 0 Mapping Specifications document that includes a Logic section for each MDS 2 0 RUG III item This Logic is actually tested Visual Basic code and one should be able to convert this to SAS code This document is available from the CMS MDS 3 0 Technical Information website http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html Use the 5 20 DLL There is no DLL for the 5 12 version Using the 5 20 DLL should not lead to different 44 group classifications than your custom 5 12 version application as long as your custom application strictly mirrored the logic in the CMS 5 1
62. ending Target date TARGET_DATE when X0100 1 or Attestation date X1100E when X0100 2 3 ascending Trans_type_cd X0100 1 first then 2 then 3 Entry discharge code A0310F 01 values first 10 11 or 12 values last and all other codes 99 will come in between Correction number X0800 ascending The current sort order for the facility s FVR records is as follows Last Name 20140107 018 Topic L ASAP Question Answer First Name Submission Processing Order MDS_ASMT_ID Fatal errors then warning errors Item in error with Fatal or warning There are several changes for the October 2013 release that Version 1 13 1 of the data submission specs needs to be in appear to be required by 9 15 2013 Specifically place as of October 1 2013 and will be applied to MDS records with target date on or after October 1 target date Edit 3851 V1 13 0 New edit This edit replaces assessment reference date for assessments entry date for Edit 3573 for all records submitted on or after 09 15 2013 entry tracking records and discharge date for death in facility records The ASAP system update for Version The T test value for PRODN_TEST_CD was 1 13 1 will be installed on September 15 2013 There are removed which means that beginning 09 15 2013 test only 2 provisions that will be effective as of the September records will no longer be accepted by the ASAP system 15 2013
63. er for FY2013 by setting the grouper sRehT ype Topic Question Answer Pe ee ol parameter to MCAR2 the FY2013 setting 20140107 015 K Will the user receive the 1067 message for all assessments The Final Validation Report will include an FY2013 RUGs with ARDs during the transition window or only those that Medicare Transition RUG based on MCAR2 in the 1067 calculate different RUG scores using MCAR2 and MCAR3 message for all assessments with ARDs during the What type of warning message will the user see in the Final transition window 10 1 2013 10 13 2013 whether or not Validation report if the submitted RUG does not match the the transition RUG is the same as the submitted Medicare calculated RUG the ASAP system generates RUG in Z0100A based on MCAR3 Using the FY2013 Medicare RUG based on MCAR2 for submission and billing until ARDs of 10 14 12013 is completely inappropriate All Medicare Part A days of service beginning with 10 1 2013 must be billed with the FY2014 Medicare RUG based on MCAR39 If the FY2014 RUG is different than the FY2013 RUG then an assessment with ARD on or after 10 1 2013 will receive an incorrect RUG warning and a claim for a day of service on or after 10 1 2013 can be rejected for Medicare payment 20140107 01 1 K RUGs Attached is the current RUG III mapping from the CMS MDS The RUG III classification does not use distinct days of technical web page therapy 00420 at all It is not necessary for
64. es the logic for billing unusable Page 2 of 60 Answer The provider is responsible for ensuring that assessment data is accurate When a provider enters inaccurate information the provider must determine what should be done to rectify the assessment In some instances a significant correction assessment should be completed a modification of the existing assessment or an inactivation of the assessment CMS specifications for the MDS 3 0 meet OBRA and SNF PPS assessment requirements they don t meet billing needs A provider must ensure that claims are accurate For example if a provider completes a late SNF PPS assessment the provider must follow the late assessment policy which is bill default for the appropriate number of days Keep in mind that assignment of a RUG IV HIPPS does not mean that SNF coverage requirements have been met the provider must ensure all requirements are met not the assessment tool ID 20110126 003 20101220 001 20100926 004 Topic A Policy A Policy A Policy 20100926 002 A Policy Question INTERPRETING THE SUB REQ FIELD With the implementation of MDS 3 0 our organization interpreted the SUB REQ field to be the deciding factor on whether a record should be included in the EDT file That interpretation was based on the actual MDS description of the SUB REQ field which states 1 Neither federal nor state required submission 2 State but not federal require
65. essment PPS only assessment etc Is there a specific program that we need to use to create the zip submission file Page 23 of 60 Answer Specifications The target date is defined in the MDS 3 0 Data Specifications under edits 3658 and 3762 as well as under information 9017 under target date in the Calc section The calculated effective_date is not calculated and will always be blank filled See information 9018 under effective_date in the Calc section of the MDS 3 0 Data Specifications A new sequence will be used for the MDS 3 0 assessment IDs This sequence will be for all MDS 3 0 records submitted from all states both NH and SB Each MDS 3 0 Assessment ID will be unique An MDS 3 0 assessment id may have the same value number as an MDS 2 0 assessment_internal_id in one or more states The answer to both questions is yes It is a required on all types of assessments except on an inactivation Yes continue to enter it during the course of the stay You indicate the start and end date of most recent Medicare coverage stay Go to http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation htm website download the current version of the MDS 3 0 Data Submission Specifications Open the data specs CSV files zip file The information is in the itm sbst csv file It has a title row of all the item subsets abbreviated and a column with all of the i
66. ference date is on or after 10 1 2013 To match the known classification results in the test file the input parameters for classification must be sRehabType MCAR2 sModel 66 nCmiArray set all 72 elements to 0 0 This is explained in the test data documentation on page 21 CMS does not provide a SAS version of the RUG III Conversion The RUG III conversion logic is documented in the MDS 3 0 Conversion download package and may be used to write you own SAS code Yes the RUG III converter v1 00 4 is backwardly compatible The converter includes date controls to determine which items to use For example for assessment reference dates before 10 1 2013 the MDS non oral nourishment item KO700A is used by the converter On or after 10 1 2013 the new replacement item K0710A3 is used For assessments with assessment reference date target date from 10 1 2013 through 10 13 2013 an FY2013 Medicare transition RUG will appear on the Final Validation Report under error message number 1067 This transition RUG is to be used to bill any days of service before 10 1 2013 for that assessment No FY2014 Medicare transition RUG can be calculated for assessments with assessment reference date before 10 1 2013 because MDS Items used in the calculation are not available The standard RUG IV grouper can be used to calculate the FY2013 Medicare transition RUGs for assessments on or after 10 1 2013 by using the Medicare classification paramet
67. for determining the ISC is not straightforward and cannot be reduced to a set of simple rules To assist programmers we have provided two options for determining the ISC code from the RFA items The first option is to use a lookup table that is supplied with the data specifications In the Access database this table is called isc_val The contents of this table are supplied with the data specs in a comma separated value file called isc_val csv This table contains one record for each of the 3 360 combinations of the ISC items It also includes one additional record that corresponds to an inactivation ISC XX Each record contains a unique combination of the RFA items in the fields named _val i e in AO200_val A0310A_val etc The ISC that is associated with the RFA combination is in the field called isc_id If this field contains dashes the combination of RFA values is not allowed Instead of 20100225 015 Topic E Specs Question Edit 3789 states RULES FOR NEW RECORDS WHERE X0100 1 a If A0310A is equal to 01 03 04 05 this is a comprehensive assessment then submission date V0200C2 care plan completion date should be less than or equal to 14 days b If A0310A is equal to 02 06 this is a quarterly assessment then submission date Z0500B assessment completion date should be less than or equal to 14 days c If A0310A is equal to 99 and A0310B is equal to 01 02 03 04 05
68. hab extensive or rehab group It is useful to retain information concerning the cause for an AAA classification rather than always resetting the Al code 00 for any AAA classification The RUG IV documentation located on the CMS technical website http www cms gov nursinghomequailityinits 30_nhgimds30 technicalinformation asp explains the RUG IV calculations The following relates the parameters returned by the RUG IV code to the items on the MDS 3 0 item set Medicare RUG IV returned grouper items when RUG IV call did not return an error Z0100A sRugMax concatenated with sAl_code Z0100B sRugsVersion FYI Only current value for Medicare is 100 66 Z0100C _Mcare_short_stay If A0310C 1 or 3 then if the first character of C_MDCR_HIPPS_TXT is not equal R then the SOT assessment did not produce the required rehab group Z0150A sRugMax_NT concatenated with sAl_code Z0150B sRugsVersion State Medicaid RUG III or RUG IV per state option returned grouper items when RUG III call did not return an error Topic 20100820 047 K RUGS Question could not answer the question about calculations for 66 groups which is translated easily to the 57 group but not to the 48 group Page 52 of 60 Answer RUG IV MDS_RUG_CLSFCTN_TYPE_CD Z0200A or Z0250B sRugMax Z0200B or Z0250B sRugsVersion lf MDS_RUG_CLSFCTN_TYPE_CD ZO200A or Z0250A sRugHier Z0200B or Z0250B sRugsVersion RUG III lf M
69. he reason that it would return a class if the minutes are 65 or higher but will return an error if the minutes are 64 or less The assessment meets all the requirements for the RUG IV Group RMA17 so then why is it returning an error For the October 1 2012 release am not finding anywhere in the documentation on the RUG information where it says how to set the sRehabType when using the RUG dll s Is the following a correct assumption for setting these values If the ARD Date is greater than or equal to 10 1 2011 Page 44 of 60 Answer Here are locations of documentation concerning index maximizing 1 There is an Index Maximizing section in Chapter 6 of 20111110 011 Topic K RUGs Question and it is a Medicare assessment then sRehabType MCAR2 i If the ARD Date is less than or equal to 9 30 2011 and itis a Medicare assessment then the sRehabType MCARE If not a Medicare assessment then the RehabType OTHER realize that a Short Stay MDS or an SOT MDS will be rejected from the system if the Z0100A data does not begin with an R for a Rehab group 3804 FATAL Error have an odd situation where a Short Stay MDS RUG score otherwise qualifies for a non rehab group because of index maximization CC1 vs RLA believe that this could potentially be the same situation for an SOT assessment Can you confirm for me that we should not be considering index maximization in this situation for a Short Stay or an
70. ications Or should it follow the new post April 1 2011 Section S specifications Will software vendors need to support both versions of section S for a state that has made changes For example if on April 5th the facility needs to correct an MDS from March 25th must the vendor bring up the old section S or is the new one acceptable Do users get warnings if a Section S question is missing or not marked or would they get a rejection fatal error message Page 19 of 60 Answer appropriate information in 00450A and O0450B Under this scenario XO900E should be checked equal to 1 and items 00450A and 00450B should be completed The scenario described by the inquirer involves coding X0900E 1 when A0310C does not indicate an end of therapy Because this scenario does not make sense the record would be rejected The Section S items that you mention could probably be considered checklist items However we probably will not change their item types for two reasons First when States submit items for addition to Section S we typically do not see their data collection forms and therefore deal with the items as discrete entities With the information provided it is sometimes difficult to determine what logical connections if any there may be among a State s items Second and perhaps more importantly unlike the Federally required items there are no inter item edits applied to Section S Thus even if a Section S checkl
71. if the recalculated codes do not match the submitted codes Based on this information it sounds like the recalculated information is on the Final Validation Report know that recalculated Medicare RUGs groups are on the Final Page 33 of 60 The application will provide the user the ability to export zipped XML files and the capability to export files as standard fixed text files There is not a test system available to send test assessments through to the new MDS 3 0 system There is however a Validation Utility Tool VUT that can be used to validate MDS 3 0 submission files in XML format The tool enforces the edits that are mapped to the MDS 3 0 items as published in the MDS 3 0 specifications If the state has set up for the ASAP system to recalculate Z0200 and also if desired Z0250 then the ASAP system will do the recalculation and issue 3616 if the submitted value differs from the recalculated value Both the submitted value and the recalculated values are displayed after the Item Values heading of the message The MDS 3 0 Item s heading lists the RUG calculation s that did not match The 3616 message is formatted the same with the same information for all RUG items Z0100 Z0150 Z0200 20250 20141021 012 K RUGs 20141021 013 Our assessment is being rejected with fatal error 3804 The First the error message does not say that the submitted Page 34 of 60 Question Validation Report but I d like
72. ification because the distinct calendar days of therapy 00420 are only 2 days but at least 3 days are required for the lowest rehab category The third assessment fails rehab classification because while it has 3 calendar days of therapy and could qualify for low rehab the 2 restorative nursing procedures required for low rehab are not present To qualify as start of therapy assessments these 3 assessments should have therapy end dates indicating that therapy ended on the assessment reference date e g 00400B6 A2300 or therapy was ongoing on the therapy reference date coded as Topic Question error says that Z0100A must begin with the letter R The submitted RUG is RVA17 We are unclear what the issue is amp need assistance The assessment values are as followed A0310A Type of assessment OBRA 01 Admission assessment required by day 14 A0310B Type of assessment 01 5 day scheduled assessment A0310C Type of assessment OMRA 3 Start amp End of Therapy A0310E First assessment since most recent entry 1 Yes A0310F Entry discharge reporting 99 None of the above A1600 Entry date date of admission reentry in facility 9 5 2014 A2300 Assessment reference date 9 10 2014 A2400A Has resident had Medicare covered stay 1 Yes A2400B Start date of most recent Medicare stay 9 5 2014 A2400C End date of most recent Medicare stay 9 10 2014 00400A1 Speech language audiology individ minutes 0104 00400A2 Speech lang
73. implementation The effective date for the data specs is October 1 yet it 1 Test records will no longer be processed regardless of appears that some things will be expected to be done or target date the PRODN_TEST_CD can no longer T ready by September 15 indicating a test record There is no need to implement Version 1 13 1 earlier than 10 1 2013 for this change Test So is the October 2013 software needing to be in place by records will simply be rejected starting 9 15 2013 September 15 2 Anew edit 3851 replaces Edit 3573 in the prior specs versions These are involved edits checking the sequence of anumber of dates on the MDS record The new edit fixes a problem in the handling of the prior record date A2200 for a significant correction assessment The previous edit did not allow a significant correction assessment to be accepted if a reentry intervened between the prior assessment and the significant correction assessment Edit 3851 fixes that problem Any record that will pass the prior edit should also pass the new edit There is no need to implement Version 1 13 1 earlier than 10 1 2013 for this correction 20101220 018 L ASAP What characters will be accepted in the file name Only printable ASCII characters except apostrophes are accepted in the file name Do not use an apostrophe as a character within file name L ASAP 20100225 055 sae 20100926 046 L ASAP What resident matching algorithm will be used The
74. in the MDS 3 0 DMS This set up of parameters in the MDS 3 0 DMS will cause the ASAP system to recalculate the Medicaid RUG submitted based on the parameters entered by the state into the MDS 3 0 DMS The parameters that the state can set in the ASAP system are listed in the consolidated Q amp A s on the MDS Vendor page in question 20101101 025 The ASAP system only allows the state to choose the following parameters when having the ASAP system recalculate Medicaid RUGs 1 Choose RUG IV version 1 00 model 66 57 or 48 or RUG III version 5 20 model 53 44 or 34 Page 27 of 60 ID Topic Question Answer 2 Choose a CMS defined CMI code set s or create a specific state defined CMI code set s for urban and for rural for the calculation 3 Choose the beginning and ending effective dates for which the Medicaid RUGS will be calculated The target date of the assessment will be compared to the beginning and ending effective dates for the RUG calculation If the target date is equal to or greater than the beginning date and equal to or less than the ending date the RUG will be calculated At this time the state cannot choose the rehab parameter in the MDS 3 0 DMS The ASAP system always uses OTHER for the rehab parameter in recalculating the Medicaid RUGs Beginning on October 1 2014 states will have the option to select any rehabilitation parameter for their Medicaid RUG calculations that is supported by the standard CMS
75. ine transition Answer Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html The VUT uses the specs MDB for just about everything except it also has an ICD9 lookup the CAA rules and it has configuration files to know what Section S and extra quarterly items are active for each state CMS will not be providing source code for the VUT Historically we did not provide source code for the MDS 2 0 validation DLLs of the past either Yes a single install of j RAVEN supports both nursing homes and Swing bed facilities 20100820 046 l What are the system requirements for j RAVEN jRAVEN requirements are located on the QTSO website jRAVEN www QTSO com 20100114 033 Will the new version of RAVEN support other file formats jRAVEN 20100926 025 20141021 011 K RUGs We are a software vendor that would like to begin file submission testing with the MDS 3 0 Can you please advise us on how to do this have a question regarding Medicaid RUGs data in Z0200A and Z0250A If a facility submits an incorrectly calculated RUGs group in either of these fields will the recalculated RUGs group s be included in the Final Validation Report The CMS submission specs for edit 3616 states the following For items Z0200A Z0200B Z0250A and Z0250B the submission system will recalculate the submitted RUGs code and RUG version code if the State is using a CMS supported RUG model A warning will be issued
76. ing based on A0310a Form for A1550 A1550 Conditions Related to ID DD Status Ifthe resident is 22 years of age or older complete only if AO310A 01 Ifthe resident is 21 years of age or younger complete only if A0310A 01 03 04 or 05 In RLTN_ITM_TXT because of its complexity based on age shows It as a consistency remark yet in the case of A0310a 02 for my example it really is a skip But it is still better than how you are dealing with A1510 at least there is a mention of dependency on A0310a within these checks Question about Edit 3846 in V1 13 2 Consistency between therapy days within types of therapy and distinct days across types of therapy Item 00420 must conform with the following rules a If O0400A4 00400B4 and 00400C4 are all equal to then 00420 must equal b If 00420 is not equal to then both of the following rules apply b1 00420 must contain a value that is greater than or equal to the largest value in O0400A4 00400B4 and 00400C4 When determining this value if any of the items 00400A4 O0400B4 and 00400C4 is coded with count the number of Page 13 of 60 Answer Yes a user is allowed to enter a dash in 00420 even if 00400A4 00400B4 and 00400C4 have numeric values 20140107 010 20140107 001 have a question regarding the new edit 3839 understand Version 1 12 of the MDS data specs will allow the user to Page 14 of 60 Question days for that item
77. ist contains a none of the above item we do not enforce the expected logic between the none of the above item and the remaining items on the checklist Therefore there is no functional difference on Section S between checklist items and items with type Code The new version of the data specs V1 01 takes effect on 4 1 2011 This means that all submitted records with target dates on or after 4 1 2011 must conform to V1 01 Submitted records with target dates on or before 3 31 2011 must conform to V1 00 Please refer to the new document Data specs version summary that has been posted on the MDS 3 0 technical information web page for details about version control Only warnings are issued for section S items when item is missing or the response is missing or invalid Topic Question Answer 201 01220 007 E For the xml format what coding should we use ASCII is the character set the ASAP system will accept Specs This is found in the MDS 3 0 Data Specifications Overview 20101220 009 E If the tags for an item are sent in but no value is included or If there is no value or the value is all spaces not caret but Specs the value is all spaces what error will occur space then the record will be rejected with a 1003 Required Field Missing or Invalid or a 1030 Missing Item fatal error depending on which item is missing 20101220 01 1 E What characters can be used in the name item The ASAP system supports ASCII encoding
78. le 600 is not an official ICD 9 but 600 00 is http icd9cm chrisendres com index php action chil d amp recordid 5909 and confirmed that the codes At this time the ASAP doesn t compare the ICD 9 to the listed above are valid ICD9 codes official list posted on the CMs site Regardless of the When imported a test file into JRAVEN didn t checks CMS has in place for ICD 9 codes it is the receive any validation errors stating that these codes provider s responsibility to ensure they are using proper were not allowed ICD 9 codes whether it be for the MDs or a claim or other also tried using the VUT tool from QTSO document https www gtso com vendormds html and did not receive a FATAL error from this tool either however received the following warning message for each ICD code lt results gt lt message_number gt 146 lt message_number gt lt error_id gt 3591 lt error_id gt lt severity gt W ARNING lt severity gt lt text gt The ICD 9 code could not be found in the official ICD 9 diagnosis codes for 2011 lt text gt lt item gt I8000A lt item gt lt item_value gt 4600 44 lt item_value gt lt results gt If the record contains an ICD 9 that is not listed a warning is issued Page 16 of 60 ID Topic Question Answer lt results gt can t find documentation anywhere that specifically speak to this issue so was wondering if perhaps you can provide some insight Are these types of codes not allow
79. licies in place that meet any and all state and federal privacy and security requirements to ensure proper security measures to protect the use of an electronic signature by anyone other than the person to whom the electronic signature belongs Although the use of electronic signatures for the MDS does not require that the entire record be maintained electronically most facilities have the option to maintain a resident s record by computer rather than hard copy The 3606 warning edit always fires If the value submitted is a caret and the state has a blank null for the field in the database then they match otherwise the error is issued The item in error contains A0100C Current Value and the value in error contains the caret xxxxx where XXXXxX IS the state provider number stored in the database For both ICD 9 and ICD 10 states are responsible for identifying the prohibited STD and or HIV ICD codes prohibited by their state and to update the MDS Data Management System DMS with these codes Your question assumes that the skip pattern for the GO900 items is based upon the ISC i e the GO900 items are completed if the ISC NC but this assumption is incorrect If you look at the printable item sets you ll see the following instruction G0900 Functional Rehabilitation Potential Complete only if A0310A 01 The instructions that are printed on the item set state that GO900A and GOS00B are completed only if A0310A
80. lt severity gt lt text gt Date A1600 09 01 2014 must be the same as or later than date A1900 09 02 201 4 lt text gt lt item gt A1600 lt item gt lt item_value gt 20140901 lt item_value gt lt results gt A1600 and A1900 edits as shown in the MDS HTML file specs for 10 1 14 3860 If A1700 1 then A1600 must equal A1900 3861 If A1700 2 then A1600 must be greater than A1900 In the recent Errata document MDS 3 0 data specs errata v1 13 2 08 12 2013 pdf for some of the issues it was mentioned that the Edit check will not be implemented by CMS but software vendors can implement these edits We are planning to implement this Edit in our software The question is Do we need to consider these edits as Fatal or Warning am looking for some consistency within the specifications Example being the way that the files are set up to deal with A1500 A1510 and A1550 Form for A1500 A1500 Preadmission Screening and Resident Review PASRR Complete only if A0310A 01 03 04 or 05 Says skip if say A0310a 02 There is a record within RLTN_ITM_TXT to deal with this Page 12 of 60 Answer b If AO200 1 the provider is a nursing home then A0410 must equal 2 3 c For both nursing homes and swing bed providers A0410 must not be equal to 1 The value of A0200 must be one of the listed value values but it also must obey the specific edits in 3707 It is up to the software developer whether
81. mission date So we want to get validation of when the SPEC_VRSN_CD should be updated from 1 11 to 1 12 Should the value sent in SPEC_VRSN_CD be based on the assessment s target date or submission date have a question and was wondering if you could provide me with some insight on ICD 9 codes A facility has brought up the fact that some of the ICD 9 codes that we allow in our Page 15 of 60 Answer change the assessment reference date ARD item A2300 on a modification record It is possible that the ARD could be changed to a date for which a different version of the data specifications was in effect If this were to occur the version of the data specs that was in effect on the new date would apply to the modified record In some cases this could mean that an item was active for the modified record that was not active in the original record If the facility had not assessed that new item they would need to submit a dash for that item to indicate that it was not assessed Here is a summary of the implementation dates 1 The changes to edits 3811 and 3839 are effective 5 19 2013 and will apply to all records regardless of their target date 2 The change to item A0800 is effective 5 19 2013 and will apply to all records regardless of their target date 3 The new value for SPEC_VRSN_CD 1 12 will become valid for assessments with target dates on or after 5 19 2013 The ASAP system checks the record to determine whether the
82. mitting such correction i e only have X months to submit corrections for accepted MDS forms Same question for rejected assessments does a hospital need to submit within a certain time frame after an MDS is rejected by CMS We have heard that the 3 0 assessment is meant to be an on line assessment Does that mean a printed copy will not be required in the chart How will signatures be handled Page 6 of 60 Information on the MDS3 0 Quality Measure can be found on the CMS website http Awww cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIQualityMeasur es html You would not be infringing on any copyrights by using our PDF version of the form Records submitted in the same file are sorted by target date prior to processing Records submitted in separate files on the same day are processed in order of submission date and time If 2 records have the same target date and are submitted in the same file or in separate files with the earlier one submitted prior to the later one or if they are submitted in files with different user IDs then there is a possibility of receiving sequencing warning messages from the submission system Evaluation date The copyright needs to appear on all versions of the MDS 3 0 either on screen or on paper As of September 21 2014 the following new edits will be enforced Records with a target date more than 3 years prior to the
83. ned in the RUG IV SAS code and the RUG IV C code provided in the RUG IV grouper package The DLL in that package implements this algorithm Note that there is no Al code for all combinations of the reason for assessment fields A0310A A0310F A RUG code and an Al code are not computed for discharge or entry records Also all other combinations of A0310A A0310F are not valid Please consult the data submission specifications for the valid combinations The Al logic will not work with an invalid combination 20100926 037 20100926 035 Topic K RUGs K RUGs Question The NO NS NOD and NSD forms do not have all of the RUG III 5 20 34 grouper RUG items Do these forms have all of the RUG IV items We have a scenario in which we need clarification A0310A 99 A0310B 07 A0310C 1 We have a code for Z0100A RMA02 But for the Non Therapy calculation Z0150A we have hit a default rug condition AAA and so our value being calculated for Z0150A AAAO2 It is our understanding that if the RUG IV group is AAA default then the Al code should be reset to 00 The v1 00 8 SAS code provided does this perfectly if Page 50 of 60 Answer SUMMARY The Al code definition in Chapter 6 will allow correct determination of the Al code for all appropriate assessments OMRA assessments NO NOD NS and NSD do not support calculation of RUG III The RUG III MDS 3 0 crosswalk logic explicitly states this
84. ntered then the discharge date A2000 must be the same date as the ARD A2300 Two assessments may not be combined into one record if they have two different target dates Hence if submitted in the same record and both dates are not skipped they must be equal Yes Section X is used to identify the Type of Record in X0100 add modify inactivate and to identify the record to be modified inactivated X0100 2 3 and the reasons for ID 20100225 029 E Specs 20100225 027 Topic J to identify the assessment for which to modify or inactivate 20100225 050 E Specs E Specs Question There is a short list of 9000 series informational edits in the specs Some of these imply that a possible edit could be in place Are these part of the standard validation edits or are these not included in the validation process The specs for the item a0500b resident middle initial has a maximum length of 1 Edit 3691 says that if a0500b is not a special value that it must only the following characters 0 9 a z A Z _ These characters are listed below What middle initial would be a number or one of the special characters Why does the isc_val database table include entries for the ISC of which is invalid The pseudo code assumes that all other combinations are to be assigned so why have these entries The isc_val table contains values for a0200 which are not allowe
85. ntification of the reason for the AAA group code The other cases where the HIPPS code contains an AAA classification are AAA with a blank Al code when a grouper parameter is in error 20100926 030 Topic K RUGs Question the Medicare Part A RUG IV group is AAA but doesn t seem to do the same for the NT calculation The NT calculated group is set in a variable sRugHier_NT not in sRugHier Is there supposed to be only one Al calculation that gets set as part of both Z0100A and Z0150A as we have currently or should the code be independent and have separate reset conditions for each calculation have the returned data from the RUG calculations and would like to know what returned calc values are used to populate all the Z fields Z0100a b c Z0150a b Z0200a b Z0250a b and Z0300a b do understand that the RUG code returned and the Al code are combined and placed in the fields just don t know which one Page 51 of 60 Answer AAAX when the type of record does not support RUG classification e g entry record or there the combination of reasons for assessment is invalid AAAOO normal and non therapy RUG for any start of therapy OMRA where the normal RUG was below the rehab groups AAAO2 non therapy RUG for a standalone start of therapy OMRA where the normal RUG was a rehab extensive or rehab group AAA07 non therapy RUG for a Medicare short stay assessment where the normal RUG was a re
86. on does the edit only look at the first 3 characters of ZO200A or does it look beyond that A state is adding a HIPPS modifier for a state rug do not know if they will want the HIPPS code which is A0310A value appended to the 34 RUG or not but if they do want to know if there will be issues with MDS submission In the file 00420 mcar2_test_v2 txt record 2 A2300 20131001 I m having trouble since my RUG calculation program treats any assessment with A2300 gt 20131001 as having srehabtype MCAR83 Because of this l m getting _rehab_medium 0 and the value in the record is 1 Should A2300 gt 20131001 be the trigger for srehabtype MCAR3 or is there some other way to determine the value Page 36 of 60 Answer The state can require anything to be submitted in the Medicaid RUG fields Z0200A and Z0250A It could be a standard RUG group code a standard RUG group code with a HIPPS modifier or any other code In all cases the submitted value will be accepted stored in the QIES database and sent to the state with the MDS record The only issue arises if the state has opted to have the QIES system verify a standard RUG code In that case the facility will get a warning if the submitted RUG value does not match the correct standard RUG value So if the state opts for Medicaid RUG verification a submitted RUG code with a HIPPS modifier will always produce a RUG warning for every record You should not automatic
87. only Specs The data spec has all validation rules defined using printable ASCII characters any other character in any item will be rejected with validation error File submitted with non ASCII special characters will be rejected with 1004 parsing error The edit on name characters is 3690 Formatting of Alphanumeric Text Items That Can Contain Dashes Spaces and Special Characters If this item is not equal to one of the special values if any that are listed in the Item Values table of the Detailed Data Specifications Report then it must contain a text string This text string may contain only the following characters a The numeric characters 0 through 9 b The letters A through Z and a through z The character d The following special characters at sign single quote forward slash PA sign a underscore e Embedded spaces spaces surrounded by any of the characters listed above For example LEGAL TEXT would be allowed 20101101 015 E On the NQ and NP forms 00400D2 days of respiratory The answer to this question can be found on page 10 of Specs therapy and O0400E2 days of psychological therapy are the data specifications overview document MDS 3 0 data both active The CMS specifications include this skip pattern specs overview v1 00 3 06 01 2010 pdf Towards the bottom of the page the document says the following a If 00400D1 0001 9999 then if O0400D2 is active it must
88. or 5 does indicate a Start of Therapy assessment that does not yield a rehab extensive or rehab classification group does not start with R for the Medicare HIPPS Code in Z0100 With 64 average rehab minutes the Start of Therapy assessment will qualify for Medium Rehab However a lower non rehab Medicare classification can occur because of Medicare index maximizing When a resident qualifies for multiple groups index maximizing assigns the group with the highest CMI the highest payment rate With ADL 4 the RMA group will index maximize to any of the following groups HB2 HB1 and LB2 If the resident has appropriate qualifiers for any of these groups then classification will be that group not RMA and an Error 5 will be returned by the grouper 20111110 010 Topic K RUGs Question A2400C End date of most recent Medicare stay 05 14 12 ADL Score 4 00400A4 Days 1 00400A5 Therapy Start Date 05 14 12 O0400A6 Therapy End Date 05 14 12 Individual Minutes RUG IV Class Returned Is this a Medicare Short Stay Assessment Individual RUG IV Class _ Is this a Medicare Short Stay Minutes Returned Assessment 144 RUA17 Yes 100 RVA17 Yes 65 RHA17 Yes 30 Error 5 15 Error 5 The error that is being returned is Z0100 A start of therapy OMRA does not result in a Rehabilitation plus Extensive or Rehabilitation group Error 5 have gone through the worksheet to calculate the RUG Group and can t find t
89. ot Medicare or Medicaid certified unit AND the State does not have the authority to collect MDS information for residents on this unit Code 2 when the unit the resident is on is not Medicare or Medicaid certified AND the state does have the authority to collect MDS information for residents on this unit Code 3 when the unit the resident is on is Medicare and or Medicaid certified CMS requires that assessments required to meet OBRA and or SNF PPS requirements are submitted sub req 3 and when a State has the authority to collect but unit is not certified sub req 2 Thus CMS specifications meet only these requirements A provider may choose to complete an assessment for other purposes such as HMO billing However if the provider completed item A0310 accurately which they should A0310A 99 A0310B 99 A0310C 0 and A0310F 99 a CMS item set would not be generated Thus this not an assessment to submit CMS is not suggesting an alternative simply advising that the system was not designed for automated scripting and we must insist that vendors stop using it 20101220 004 Can additional lines be added in Z0400 for staff signatures Yes additional signature lines may be added Policy Yes Nursing Homes should back up their local databases jRAVEN has a backup utility for the provider to use to back up their database Other vendor software should also have a method of backing up the data If a record had A0310A 01 02
90. pecial Care High or Special Care Low qualifier AND an ADL score of 0 or 1 The facility should bill the Recalculated A0100A Medicare HIPPs provided on the Final Validation Report 20140107 004 K RUGs When we transmit from the state of Georgia we are getting For state RUG calculation 1 Z0200A Georgia GA has this error Warning 3616a the following parameters set in the ASAP system Page 40 of 60 20121210 015 Topic K RUGs Question We have checked our Software and GA CMI and based on the information our RUG in Z0200A is correct Could there possible be a problem CMI RAC 1 936 or 1 975 SSB 1 736 or 1 771 MDS 3 0 Item s ZO200A RECALCULATED_Z0200A Invalid Data Submitted RAC SSB Message Number 3616a WARNING Message Incorrect HIPPS RUG Value The submitted value of the HIPPS RUG code does not match the value calculated by the QIES ASAP System Our QA department found new RUGs in the latest DLL that was sent out RAE RAD RAC RAB RAA And there 72 RUGS not 66 At first they thought it was a fluke this is the urban special Medicare in the example but it appears in other groupers in the RUGS IV groupers don t recall hearing about new RUGS Did miss something We are trying to get our programming ready for Oct and this is a problem Page 41 of 60 Answer RUG version RUG III RUG Logic version 5 20 Urban CMI set code D01 Rural CMI set Code DO1 Rug Model 34 group RUG cl
91. pleted within the 14 day lookback period O100A1 01001 would be assessed individually and only checked code value 1 if the treatment occurred prior to admission reentry to the facility and within the 14 day lookback period If the item is assessed and it is determined that the treatment did not occur prior to admission and within the 14 day lookback period then the item then is not checked code value 0 The item 0010021 is not active on an NP so it is not answered Not answering 0010021 does not affect the answers to O100A1 01001 The values in the items 00100A1 00100J1 are coded per the 1 00 3 data specifications Dates must be submitted based on the submission specifications for the particular date item and instructions from the MDS 3 0 RAI Manual Depending upon the ID Topic 20101101 006 20100926 012 20100926 01 1 es E Question Is there a standard as to where Section S items should be submitted on an xml file Should the items be submitted in alphabetical order or should Section S be after Section Z Section N on the NQ set doesn t have a Z None of the Is this an oversight It has the None of the Above on the NC set The tracking forms Entry and Death in Facility do not have an A2300 or a Z0500B date required on the form will the Page 22 of 60 Answer particular date fields the data specs can allow either a single dash or a string of eight dashes Whether either or both of these v
92. r of days as 1 set the therapy start date at 5 14 2012 and therapy end date as 5 14 2012 so there is only 1 day on which therapy was performed then changed the amount of therapy minutes to see which class it returned Below are the values used a table of the minutes that used and the values got back A2000 Discharge Date 05 14 12 A2300 Assessment Reference Date 05 14 12 A2400B Start date of most recent Medicare stay 05 10 12 Page 43 of 60 Answer Total Therapy minutes of 500 minutes or more and At least 1 discipline O0400A4 00400B4 00400C4 for at least 5 days This record in question had over 500 minutes of therapy but did not have any discipline for at least 5 days Both disciplines were for 4 days The RH_ high RUG group for a non short stay assessment has the same number of days criterion so this assessment did not qualify for the high rehab group see page 6 35 of the MDS RAI Manual To be an RV_ very high RUG group for a non short stay Please note The VUT Validation Utility Tool does not Recalculate RUG values which is why no error was returned when the record was run through the tool The following message displays with the Validation Utility Tool posting on the QTSO website The VUT does not currently interface with the RUG III and IV DLLs therefore it does not recalculate nor confirm that RUG values are correct The CMS Medicare RUG calculation uses Index Maximizing Grouper Err
93. rs would appreciate CMS recommendation on the criteria that produce a valid second digit of the HIPPS Al code We appreciate your hard work and prompt response Page 49 of 60 Answer RUG calculation the ASAP system will not recalculate the state Medicaid RUG Z0200 Maine will have to do all recalculations on their own state Medicaid system The current MDS 2 0 Medicaid RUG calculation settings for Maine have the Calculate Medicaid RUG option set to Y but there are no RUG calculations entered so the MDS 2 0 state system does not recalculate RUGs for Maine on the MDS 2 0 assessments The MDS 2 0 item l1cc Traumatic Brain Injury is not used by the RUG III grouper It is therefore not necessary to include a translation between 15500 and l1cc in the RUG III mapping specs The requirement is that a start of therapy OMRA must produced a Medicare index maximized RUG IV classification in a rehabilitation plus extensive group or a rehabilitation group This means that the Medicare classification in Z0100A must be a rehabilitation plus extensive group or a rehabilitation group That classification is based on the 66 group model the Medicare rehabilitation classification type and the appropriate Medicare CMI set E01 for rural and E02 for urban If the Z0100A RUG IV classification is a group below the rehabilitation category then the record will be rejected by the CMS MDS 3 0 system A decisive algorithm for the Al code is contai
94. s the new data for the assessment and section X is only used Page 24 of 60 Answer the submission system Developers can also use the JAVA UTIL ZIP class to ZIP their own files The class files can be found in the Sun JVM We believe the implementation is the same across the different versions of Java Developers should consult their Sun Java documentation for specifics Yesterday we completed a test using the Microsoft Folder Compression The submission was successfully unzipped with 3 files for processing According to Microsoft their folder compression comes in 2 flavors based on the FAT32 or NTFS file system We tested with NTFS Microsoft says the folder compression creates a compliant ZIP file We were able to successfully unzip the file created with the MS Folder Compression using WinZip Microsoft added one caveat with respect to its use The Folder Compression is meant to be used from the OS Microsoft does not provide any means to call this compression from any other program Do not zip the individual records before including them in the final zip file The FAC_ID is the same FAC_ID as for MDS 2 0 state assigned facility identifier It is the No There will not be an Item subset for an inactivation Inactivation records only have control items and Section X items active There are no active Section A items for an inactivation If the discharge record is combined with another assessment that requires an ARD to be e
95. same resident matching algorithm as is used for MDS 2 0 OASIS MDS Swing Bed 2 0 and IRF PAI assessment collection What happens when extra items XML tags are sent in the Extra items that are sent in an XML file but are not active XML submission file on that ISC will be ignored They are not edited not stored and will not be in the state assessment extract file Page 57 of 60 20101101 034 20140107 005 20140107 006 Topic M Browser N QMs N QMs Question Answer for that record No errors messages are sent about any ignored field Providers have been prevented from uploading their MDS 3 0 To correct the issue IE settings should be changed as files Instead of a successful upload they are receiving the following message Upload file name is not in the correct format Browse for the file and upload again The users are using IE 7 and their TLS 1 0 is on ran the following Quality Measure reports for my facility and believe that some residents should not have triggered for the following measures Report Period 7 01 12 10 31 12 Run Date 11 07 12 Measures in Question Falls Catheter Inserted and Left in Resident IDs 1 xxx 2 yyy 3 zzz 4 www Expectation 1 Should not have triggered for Falls 2 3 4 Should have triggered for Catheter Inserted and Left in The resident age calculation specification on page F 3 of the http www cms gov Medicare Quality Initiatives Pa
96. submission date will be rejected Records submitted more than 2 years after the closed date of the facility will be rejected Records with a target date after the closed date of the facility will be rejected From section Z in the RAI manual Nursing homes may use electronic signatures for medical record documentation including the MDS when permitted to do so by state and local law and when authorized by the nursing home s policy Nursing homes must have written Topic Question Answer 20141021 002 20141021 003 20141021 004 E Specs E Specs E Specs If AO100C is blank does the 3606 fire or is the edit contingent on data in A0100C 3806 Consistency Warning If AO200 1 the provider is a nursing home the value submitted for A0100C State Provider Number will be compared with the value that is currently in the MDS Submission System database If the values do not match a warning will be issued Note that this edit does not apply to swing bed providers A0200 2 When ICD 10 is implemented does CMS have a master list of state s prohibited ICD 10 codes believe edit 3535 either has a mistake or worded incorrectly The edit states it is active in the NC item subsets but when you read the instructions it states it is skipping several of the NC subsets such as 03 annual NC 04 significant change in status NC 05 significant correction to a prior nursing comprehensive Page 7 of 60 po
97. submitted after the October 1 2014 release during the September 2014 downtime 20141021 009 Topic E Specs Question exact answers are pulled from the original MDS so that the ASAP system is able to make a match for a modification or inactivation Are vendors to convert XO600B 6 to be 1 after October Alternatively V0100B has not removed the answer 6 It seems that the answer would be removed consistently It has always been our understanding based on the MDS 3 0 Provider User s Guide pg 5 102 that MDS modifications and inactivations are matched by ensuring that X0150 X0200A X0200C X0300 x0400 X0500 XO600A XO600B XO600C X0600D XO600F X0700A X0700B and X0700C values in section X exactly match a previous accepted assessment s corresponding Section A values We have always assumed Page 10 of 60 Answer We believe that the data specs are correct as written with regard to V0100B and XO600B Records submitted under V1 14 of the data specs must have target dates on or after 10 1 2014 Item V0100B is used to indicate the PPS reason for assessment for the prior PPS assessment if one exists The prior PPS assessment could have been submitted under V1 13 of the data specs and could therefore have a value of 06 in A0310B Item V0100B in the new data specs must therefore allow a value of 06 However the situation is different for a modification record where X0600B would be completed Beginning with V1 12
98. sure When you ran the report ending on 9 30 2012 they would have been classified as long stay and would therefore have been included in the measure If you have questions about the details of how residents are classified as long or short stay please refer to page 1 of the current QM User s Manual version 6 Please let us know if you still have questions about this ID Topic Question Answer A0310F 10 11 It seems like this measure is not calculating for the look back scan when A0310B 01 02 03 04 05 06 and A0310A is not 01 02 03 04 05 06 Page 60 of 60
99. t the edit doesn t have to be revised if the ISCs for GO900A and or G0900B change in future versions of the data specs Your understanding of the therapy period is incorrect The incorrect concept is that the therapy start and end dates are only completed for a current period of therapy where any of the therapy disciplines ST OT and or PT are being provided The start and end dates for a discipline are defined in the RAI Manual Chapter 3 as follows e Therapy Start Date Record the date the most recent therapy regimen since the most recent entry reentry started This is the date the initial therapy evaluation is conducted regardless if treatment was rendered or not or the date of resumption O0450B on the resident s EOT OMRA in cases where the resident discontinued and then resumed therapy e Therapy End Date Record the date the most recent therapy regimen since the most recent entry ended This is the last date the resident received skilled therapy treatment Enter dashes if therapy is ongoing The dates to be entered are dates for the most recent therapy regimen since the most recent entry reentry So the therapy dates for ST could be from two years ago as long as the resident was not discharged after that It does not matter that there is a new current regime for another discipline e g OT Starting 10 1 2013 Medicare classification requirements for Medium Rehabilitation were changed Before that th
100. tem names There is an x at the intersection of item row and ISC column which indicates that item is in that ISC The MDS 3 0 submission system uses a Java stored procedure to unzip the submission files The utility is implemented using the Java 1 5 0_11 b03 Java virtual machine included with the Oracle database The Java utility class is called JAVA UTIL ZIP Although we have not been able to find a specific listing of support for other zipping tools we found recommendations to use normal PKZIP and WINZIP applications There are many ZIP programs on the market and many of them have added their own proprietary SUPER COMPRESSION which will NOT be supported by Topic 20100225 085 Ss 20100225 080 om 20100225 062 eae 20100225 054 an Question Sres a is the FAC_ID Assigned facility provider submission ID and how is it obtained Is this the same value as the MDS 2 0 FAC_ID Since the Inactivation has active items for sections A and X only can we expect an Item Subset document that includes only those 2 sections Edit id 3573 in the Group A Rules there is an entry A2300 assessment reference date A2000 discharge date that don t fully understand What logic does the stand for in this case Does the mean that the ARD should be the same as the Discharge date Will section X of MDS 3 0 be used in the same way as the MDS 2 0 prior section so that MDS 3 0 section A contain
101. ter return and the existing OBRA assessment schedule continues Each submitted record is assigned a unique ASSESSMENT _ID value The second condition for an assessment to be classified as a Medicare Short Stay Assessment is as follows 2 A PPS 5 day A0310B 01 or readmission return assessment A0310B 06 has been completed The PPS 5 day or readmission return assessment may be completed alone or combined with the Start of Therapy OMRA According to Medicare SNF PPS assessment requirements a stand alone Start of Therapy OMRA should never be performed before the 5 Day or Readmission Return assessment for a Medicare stay If a Start of Therapy OMRA is performed and the 5 Day or 20100420 Ad Hoc18 Topic Question Will CMS offer any guidance in printing rules Is there any concern by CMS whether or not sections break in the same place if the same fonts are used or if an entire section is not printed when it is not actually part of that particular assessment Page 5 of 60 Answer Readmission Return assessment has not yet been performed then the following Medicare SNF PPS requirements apply a That unscheduled Start of Therapy OMRA assessment replaces the scheduled 5 Day or Readmission Return assessment A subsequent 5 Day or Readmission Return assessment is not allowed b The assessment should be coded as both a Start of Therapy OMRA and a 5 Day or Readmission Return assessment c All requirements for
102. their Quarterly NQ or PPS NP assessments CMS does not create state specific printable item subsets The ASAP system edit for Section S items with an Item Type of TEXT S0140 S0141 S0150 S6100F1 S6100F2 6100F3 S8050B S8050C S9020 S9080C accepts all printable characters as valid values The submitted values are trimmed of all leading and trailing blanks ASCII hex 20 If all characters in the submitted value are blanks ASCII hex 20 they will be trimmed off and the value of the item would be considered missing A missing value will receive the 3808 warning message To designate that the item has been addressed and is blank a caret should be sent as the value for the Section S TEXT item values A caret is accepted by the ASAP system as a valid character and no warning message is issued Note The ASAP system will edit items per the MDS 3 0 Data Specifications The States can implement additional requirements for Medicaid purposes however the ASAP system will edit based on MDS 3 0 Data Specifications The response options that are listed in the data specs for the Section S items were provided to CMS by the States A skip caret is not listed as a valid response for the 6051A D items and should therefore not be submitted If a caret was submitted for these items it would trigger Edit 3808 resulting in a warning Furthermore enforcement of a skip pattern like the one mentioned is outside the scope of ASAP becaus
103. tient Assessment Instruments NursingHomeQualitylnits Downloads MDS30 QM Manual Appendix F Facility Characteristics Report V10 pdf appears to be wrong Age Calculation of Age based on Items A0900 Birth Date and A2300 Assessment Reference Date ARD Page 58 of 60 follows Select Tools gt Internet Options Select the Security tab Select Custom Level button Locate the setting for Include local directory path when uploading files to the server The Disable option will cause a problem so it should be enabled We have investigated the four cases that you described and found no problems with the reports Case 1 Target assessment date 8 16 2012 and there was a fall reported on the assessment with target date 11 24 2011 This is a difference of 266 days and so is just within the lookback period which is 275 days Case 2 Day 101 of the resident s stay is 1 2 2013 so they re a short stay resident on the report This resident is therefore not included in the long stay measures Case 3 Day 101 of the resident s stay is 12 23 2012 so they re a short stay resident on the report This resident is therefore not included in the long stay measures Case 4 The resident did have H0100A 1 on the target assessment but is excluded from the measure due to a value of 1 for 11650 The resident age calculation specification on page F 3 of Appendix F to the QM Users Manual is IF MONTH A0900 gt MONTH A2300 OR
104. tion of the state RUGs Are the state options to Z0200 and Z0250 on NC NQ and NP ISCs if the state validate or not validate or is there an option to validate if data has set up the options to do the evaluation in the MDS 3 0 is present DMS If a facility submits a RUG in Z0200 or Z0250 and the state If a facility submits a RUG in Z0200 and or Z0250 and the does not require submission does the ASAP RUG validation state does not require submission based on the state run based on the state setups in the ASAP system or does it setups in the ASAP system then the ASAP system does run based on the presence of data not recalculate these values Regardless of the flag all submitted items are always saved as long as they are active for the ISC and the assessment is accepted For NC NQ and NP items Z0200 and Z0250A are active so the submitted values are stored in the database regardless of whether the recalculation is done 20100926 041 K Do we have a misunderstanding of the MDS 3 0 to RUG III CMS does not dictate to States how to calculate their State RUGs regulations It was our understanding that the states are not reimbursement methodology or payment rates including permitted to alter the RUG III crosswalk or code We have payment for Medicaid residents in a long term care stay in just been notified by the State of Maine that they are going to a nursing home Since this is a non standard use of the Page 48 of 60 ID Topic
105. tion would not match with the original assessment in the ASAP system However we ve come across an interesting scenario where not all of the items in Section X match their corresponding fields in Section A yet the assessment was accepted into the ASAP system Specifically all the values match except X0700C Correction Entry Date on the modification does not match A1600 Entry Date on the original assessment The assessment s value for A0310F 99 which indicates the ARD is the target date for the assessment In this case the target date calculated based on Section X fields on the modification does match the target date calculated based on Section A of the original assessment This seems to indicate that the ASAP system matches modifications inactivations to their original assessments based on the Target Date instead of requiring an exact match for XO700A X0700B and X0700C to their respective corresponding fields in Section A There seems to be a small inconsistency in the error message displayed in the VUT output For the comparison of A1600 Entry date and A1900 Admit date when A1700 1 Specs seem to indicate dates MUST EQUAL but error message says EQUAL OR GREATER Can you clarify which is correct Extract of data elements in MDS XML file passed to VUT lt A1600 gt 20140901 lt A1600 gt lt A1700 gt 1 lt A1700 gt lt A1800 gt 01 lt A1800 gt lt A1900 gt 20140902 lt A1900 gt lt A2000 gt lt A2000 gt lt A2100 gt
106. to make the recommended edits warnings or fatal edits For now the VUT that is provided by CMS will implement these edits as warnings so that records are not rejected if they do not comply with the recommended edits However we anticipate that when these edits are added as real edits to the data specs and implemented by ASAP they will be fatal edits You may want to implement them as fatal edits now so users won t have to be retrained at a future date The edits for A1500 A1510 and A1550 are different from one another It is true that all three items contain the instruction on the item set complete only if AO310A 01 03 04 or 05 However the logic for completing the three items is different Item A1500 is dependent solely upon the value of A0310A The logic of A1510 depends upon the response to A1500 The logic for A1550 depends upon A0310A plus the resident s age Since the completion logic for these three items is different the edits must be different It is therefore not possible for the specifications to be consistent for these three items Consistency is applied to all of the specifications when possible 20140107 007 Topic E Specs Question Form for A1510 A1510 Level Il Preadmission Screening and Resident Review PASRR Conditions Complete only if A0310A 01 03 04 or 05 Form looks to have the same issue Yet the records in RLTN_ITM_TXT Set up the relation between A1500 and A1510 rather than anyth
107. uage audiology concur minutes 0000 00400A3 Speech language audiology group minutes 0000 00400A4 Speech language audiology number of days 3 00400A5 Speech language audiology start date 9 8 2014 00400A6 Speech language audiology end date 9 10 2014 00400B1 Occupational therapy individ minutes 0132 00400B2 Occupational therapy concur minutes 0000 00400B3 Occupational therapy group minutes 0000 00400B3A Occupational therapy co minutes 0000 00400B4 Occupational therapy number of days 3 00400B5 Occupational therapy start date 9 8 2014 O0400B6 Occupational therapy end date 9 10 2014 00400C1 Physical therapy individ minutes 0139 00400C2 Physical therapy concur minutes 0000 00400C3 Physical therapy group minutes 0000 00400C4 Occupational therapy number of days 3 00400C5 Occupational therapy start date 9 8 2014 00400C6 Occupational therapy end date 9 10 2014 Page 35 of 60 Answer Z0100A value must start with an R Rather it says that the value of Z0100A Medicare Part A HIPPS code calculated by the QIES ASAP System must begin with the letter R if the value submitted in item A0310C PPS Other Medicare Required Assessment is 1 or 3 The problem with the record is that the submitted Z0100A value of RVA17 is incorrect The correct value calculated by the QIES system did not start with an R To qualify in the RV category there must be 5 distinct calendar days of therapy 00420 and the value on this assessment is onl
108. uarterly only N0400A NO400D are active and NO400E N0400G are not active For the quarterly a None of the Above item would be defined as referring to NO400A NO400D If N0400Z was used then this is a different definition of the same item If states choose to add all three items NO400E N0400G to their NQ or NP assessments as state optional fields then they can also add NO400Z as all the items in the list will be active so the None of the Above will have the correct meaning The ASAP system will only edit a checklist if all possible items are active within that checklist CMS will calculate a target date for all records except for inactivation requests based on the MDS 3 0 Data Topic Specs 20100720 047 E Specs 20100420 Ad Hoc11 20100420 37 20100420 33 E Specs E Specs E Specs Question CMS system calculate either a target date or an effective date for either of these forms How will the assessment internal ids be assigned Will you re use any numbers previously used in MDS 2 0 or will the numbering scheme be totally different We need to find this out in order to design the database Is A2400 Medicare start of stay a required field that has to be entered Will that date whatever the date is be entered for each assessment until such time as the stay ends Where can find a listing of the items that are included on the different MDS assessment types like Discharge Assessment Quarterly Ass
109. up Since the correct classification is not ina Rehab Extensive or Rehab group the record cannot be a coded as an SOT OMRA and the record is rejected When this error occurs the grouper returns AAA for the system recalculated RUG This record cannot be submitted as a Start of Therapy OMRA To make the record acceptable change the SOT OMRA indicator A0310C to 0 Also the grouper is using the wrong therapy classification type The grouper parameter sRehabType must MCAR3 to apply the correct rehab classification type for Medicare in FY2014 With this correct parameter setting the classification will be below the Rehab groups Yes the ISC_VAL v1 14 1 05 08 2014 csv file still contains ICS combinations for A0310B 6 Columns H and contain values for A0310B and include the discontinued values 6 or 06 The values of 6 or 06 in the ISC_VAL table will not be removed These rows of the table were retained to allow the determination of the ISC for older assessments where A0310B can equal 6 or 06 For newer assessments where this value is not allowed these rows can be ignored No further documentation about the effect of removing the discontinued values 6 or 06 is anticipated however will have this question posted on the MDS 3 0 Vendor section of the QIES Technical Support Office Website https www qtso com vendormds html AO600B will not be allowed to be equal to 06 on records new or modified
110. vailable items that are not in Section V added 20100720 040 ID Question have a couple of questions on how corrections will be handled in the daily file that will be pushed down to CMS QIES servers at each state Each record has aMDS _ASMT_ID and an ORGNL_ASMT_ID 1 When A0050 1 Add new record are the values for both the MDS_ASMT_ID and ORGNL_ASMT_ID the same 2 When A0050 2 Modify existing record is the ORGNL_ASMT_ID always equal to the value assigned when the assessment was first added regardless of how many modifications are submitted 3 If anursing home adds an assessment record and on the same day submits two modifications of this record what order will these records be listed in the daily file What will be the sort order of records in the daily file Z0250 Alternate State Medicaid Billing RUG and RUG version Do the states have a way to set up this field so that the Blank not available or unknown is not a valid option Answer to their OBRA quarterly NQ records effective October 1 2010 All NQ records submitted in this state with a target date on or after October 1 2010 will have these requested items active This is a change to the items on the state s OBRA quarterly NQ record It is not a different type of comprehensive NC If providers send in an NC that is missing the Section V items it will be rejected Section V items are active on NC records JRAVEN has functionality to a
111. y 3 In fact 5 distinct calendar days of therapy are also required for the RU RH and RM categories The only rehab category that allows the 3 distinct days of therapy on this record is RL The RL category also requires 2 or more restorative nursing services at 6 or 7 days a week Although the restorative nursing values were not provided this assessment obviously does not have the 2 restorative nursing services The correct RUG group falls below the rehabilitation categories so the record was rejected as the correct RUG is not a rehabilitation RUG first letter R 20141021 014 20140107 016 Topic K RUGs K RUGs Question Total therapy minutes 375 00420 Distinct Calendar Days of Therapy 3 G0110A1 3 Extensive assistance resident involved in activity staff provide weight bearing support G0110A2 2 One person physical assist G0110B1 3 Extensive assistance resident involved inactivity staff provide weight bearing support G0110B2 2 Two persons physical assist GO011011 2 Extensive assistance resident involved inactivity staff provide weight bearing support G011012 2 One person physical assist G0110H1 1 Supervision oversight encouragement or cueing G0110H2 1 Setup help only Total ADL 5 Z0100A RVA17 Question on Z0200A The State Rug on the MDS can be anything the state wants but if the state is using a Rug Ill 34 for instance and the state is recalculating the RUG III for verificati

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