“MDS 3.0 Updates-Are You Ready for April 1st?”
Contents
1. Current assessment maximum 111 questions e April 1 2012 Unplanned discharge maximum 77 questions Planned discharge maximum 89 questions Standalone Unscheduled PPS Assessment Interviews Effective Apni1 2012 when coding a standalone unscheduled PPS assessment COT EOT SOT the interview items may be coded using the responses provided by the resident on a previous scheduled assessment if the interview responses from the scheduled assessment were obtained no more than 14 days prior to the ARD of the unscheduled assessment on which those responses will be used ARD of Unscheduled PPS Assessment Effective April 1 2012 facilities are permitted to set the ARD onan unscheduled PPS assessment fora day within the allowable ARD window for that assessment no more than 2 days afterthe window has passed 3 21 2012 12 QMs Survey and Public Reporting QMs Percent of residents experiencing one ormore falls with major injury long stay Percent of residents who self report moderate to severe pain short stay Percent of residents who self report moderate to severe pain long stay Perc ent of residents with pressure ulcers that are new orworsened short stay Survey and Public Reporting QMs Percent of residents with a urinary tract infection long stay Percent of low risk residents who lose control of their bowels or bladder long stay Percent of residents who have had a catheter inse2. 2 802 672 Itemsthe same instructions updated with MDS 3 0 fields 802 Same fields as MDS 2 0 plus additional ones surveyors wanted Instructions updated to MDS 3 0 fields Facility Reports e Facility Characteristics e Facility QM Report e Resident QM Report 15 3 21 2012 Notice of Medicare Non Coverage orNOMNC New combined Notice of Medicare Non C overage This notice will replace the CMS 10123 Original Medicare notice and the CMS 10095 Medicare Advantage notice Form Number 100123 Must use this form no laterthan May 1 2012 Detailed Explanation of Non Coverage or DENC New 100124 Notice has been issued e Must use this form no laterthan May 1 2012 https www cms qgov BNI 06_FFSEDNotic es asp lopOfPage Assessment Combination Combining Scheduled and Unscheduled PPS Assessments Ifthe ARD of an unscheduled PPS assessment fails within the ARD window including grace days of a scheduled PPS assessment and the ARD for the scheduled assessment would be set fora day afterthat of the unscheduled assessment then the assessments must be combined 16 3 21 2012 Assessment Combination Combining Scheduled and Unscheduled PPS Assessments Forexample if the ARD of an EOTOMBRA is Day 14 ofa resident sstay and the 14 day scheduled PPS assessment is not set for priorto Day 14 then the assessments must be combined and facilities should use the appropriate Al code to indicate t
3. 3 21 2012 MDS 3 0 Updates Are You Ready for April 14 Carol Hill RN BSN RAC MT C NE CDP Objectives By the end of this seminar participants will be able to Recognize MDS 3 0 changes that will become effective on April 1 2012 Distinguish between late vs missed COT assessments Identify MDS 3 0 quality measures used for survey process Recognize changesto the CMS672 State processforcompletion of resident interviews on unplanned discharges Recognize potential financial implications related to inactivation of PPS assessments The following slides contain an overview of some of the RAI manual updates that will begin April 1 2012 It is recommended that you obtain and review all the updates released e The most recent RAI manualcan be downloaded at http www cms gov NursingHomeQ ualityIni ty 45_NHQ IM DS30TrainingMaterials asp 3 21 2012 APRIL 1 2012 RAI Manual V1 08 Item Sets Version 1 10 4 April 2012 Changes e A0050 Type of Record 1 Add new record 2 Modify existing record 3 Inactivate existing record e A0310 G Type of Discharge 1 Planned 2 Unplanned April 2012 Changes e A1500 Preadmission Screening and Resident Review Now complete on Admission Annual Significant Change Significant Correction to Prior Comprehensive Assessment 3 21 2012 April 2012 Changes A1510 Level Il PASRR Conditions A Serious mental illness B Intell
4. B Ask the resident or family or significant other if resident is unable to respond Do you want to talk to someone about the possibility of leaving this facility and retuming to live and receive servicesin the community April 2012 Changes Q0550 Resident s Preference to Avoid Being Asked Question Q0500B Again Q0600 Referral Hasa referral been made to the local contactagency 0 No referral not needed e 1 No referral is or may be needed e 2 Yesreferral made Apni 2012 Changes e V0200 CAAsand Care Planning B Column heading changed to Care Planning Decision Now reads location and date of CAA documentation April 2012 Changes X0600 Type of Assessment A Federal OBRA Reason for Assessment 99 None of the above B PPS Assessment e 99 None of the above C PPS Other Medicare Required Assessment O MRA e 4 Change of therapy assessment 3 21 2012 10 3 21 2012 Apni 2012 Changes e 20300 Insurance Billing A RUG billing code B RUG billing version April 2012 Changes e Urinary Incontinence CAA Trigger Resident has moisture associated skin damage M1040H 1 Nutritional CAA Trigger Any planned orunplanned weight gain Apni 2012 Changes e Definition Changes in Appendix A Most Recent Medicare Stay Nursing Monitoring e Appendix C Worksheets Changes made to reflect new numbering of MDS items 11 Discharge Assessments e
5. Invalid Item 3573a Inconsistent Dates 3693a Invalid Fac ID Error Messages Common Fatal Enors 3693b Unauthorized Submitter 3658 No Authority to Collect Data 1004 Invalid HML File Format 3668b Inconsistent O Items 3783 Inc onsistent X0800 22 Error Messages Common Waming Messages 3806 Inc onsistent A0100C 1031 Resident Information Updated 1032 Resident Provider Updated 1060 Medicare FY2011 Rug IV Transition RUG Calculated 3616b Incorect RUG Logic Version Error Messages Common Waming Messages 3808 Missing Invalid Data 3616a Incormect HIPPS RUG Value 3810d Record Submitted Late 1019 Inconsistent Record Sequence 3749a Assessment Completed Late Casper Reports Activity Report MDS 3 0 Admission Reentry MDS 3 0 Assessments with Error Number MDS 3 0 Disc harges MDS 3 0 Eror Detail by Facility MDS 3 0 Errors by Field by Facility 3 21 2012 23 3 21 2012 Casper Reports MDS 3 0 Missing Assessments MDS 3 0 NH Assessment Print MDS 3 0 RFA Statistics MDS 3 0 Roster MDS 3 0 Submission Statistics by Facility MDS 3 0 Vendor List SECTION Q Section Q e Discharge Planning When the facility anticipates discharge a resdent must have a discharge summary that indicates e A recapitulation of the resident s stay A final summary of the resident s status A post discharge plan of care 24 3 21 2012 Section
6. Q e If resident wants to speak to someone regarding services available in the community Complete the Nursing Home Discharge Planning Checklist Manual Changes Erata document released March 12 2012 Additional emata documents to be released asneeded Next item set and manual update scheduled for September 2012 References MDS3 0 Manual http www cms gov NursingHomeQ ualitylnits 45_NHQI MDS30TrainingMaterials asp TopOfPage MDS3 0 QM Users Manual http www cms gov Nursing Home Q ualitylnits 30_NHQI MDS30Technicallnformation asp TopOfPage RAI and MDS Conference 2012 St Louis MO MDS 3 0 Provider User s Manual http s www qtso com mds30 html 25 Hill Educational Services Inc Carol Hill RN BSN RAC MT C NE CDP 9406 Asbeny Road Wamior AL 35180 Phone 205 337 1807 Fax 205 647 0717 chill hilledservices com www hilledservices com 3 21 2012 26
7. Ulcer Treatments E Pressure ulcercare N0410 Medications Received Indicate the number of days the resident received the following medications during the last 7 daysorsince admission entry or reentry if less than 7 days 3 21 2012 April 2012 Changes 00250 Influenza Vaccine Influenza season ends when Influenza is no longer active in yourgeographic area Once the influenza vaccination hasbeen administered to a resident forthe current Influenza season this value is camed forward until the new influenza season begins Aprl 2012 Changes e 00600 Physic ian Examinations e 00700 Physician Orders Removed the statement cannot be an employee of the facility April 2012 Changes Q0300 Resident s Overall Expectation A Select one for resident s overall goal established during assessment process 3 21 2012 April 2012 Changes e Q0400 Discharge Plan Removed B What determination was made by the resident and the care planning team regarding discharge to the community Active discharge planning already occuning April 2012 Changes Q0490 Resident s Preference to Avoid Being Asked Question Q0500B Does the resident s clinical record documenta request that this question be asked only on comprehensive assessments April 2012 Changes e Q0500 Retum to Community Question A Has the resident been asked about retuming to the community This question was deleted
8. ectual Disability mental retardation in Federal regulations C Other related conditions Apni 2012 Changes e A1800 Entered From 09 Long Term Care Hospital LTC H e A2100 Discharge Status 09 Long Term Care Hospital LTC H April 2012 Changes e E0100 New heading title Potential Indic ators of Psychosis e E0800 Rejection of Care Presence amp Frequency Took the word or out of the definition e E1100 Change in Behavior or Other Symptoms Compare to prior OBRA orscheduled PPS Apni 2012 Changes e G0110 Activities of Daily Living ADL Assistance 8 Activity did not occur activity did not occuror family and or non facility staff provided care 100 of the time forthat activity overthe entire 7 day period April 2012 Changes e GO300E Surface to Surface Transfer Transfer between bed and chair or wheelchair April 2012 Changes e Section 14800 added Lewy body dementia Nursing Monitoring includesclinical monitoring by a licensed nurse e g serial blood pressure evaluations medication management etc 3 21 2012 April 2012 Changes e J 1900 Number of Falls Since Admission Entry or Reentry or Prior Assessment O BRA or Scheduled PPS whichever is more recent Apni 2012 Changes e K0200 Height and Weight Base height on most recent height since the most recent admission entry or reentry Base weight on the most recent measure in the last 30 day
9. he combined assessment Assessment Combination Ifa scheduled assessment ARD is set fora day that isafterthe ARD set for an unscheduled assessment and the ARD for the unscheduled assessment is set fora day within the scheduled assessment ARD window then the scheduled assessment is not used for payment pumoses COTOMRA amp Other Assessments If the ARD of a PPS assessment used for payment isset for on or priorto Day 7 of the COTobservation period then no COTOMRA would be required 17 3 21 2012 Early Unscheduled Assessment Policy COT OMRA e Ifthe ARD fora COTOMRA isset for priorto Day 7 of the COTobservation period the facility must bill default rate the total number of days the assessment is out of compliance the number of days by which this assessment is early Early Unscheduled Assessment Policy COT OMRA The default rate is effective from Day 1 of the COTobservation period and is billed forthe number of days that the assessment is out of compliance Facility may then bill the RUG from the early COTOMRA forthe remainder of the COT observation period until the next scheduled or unscheduled assessment used for payment Late Unscheduled Assessment Policy If the SNF fails to set the ARD foran unscheduled PPS assessment within the defined ARD window for that assessment and the resident being assessed is still on Part A the ARD cannot be set for any earlier than the day the omission was identif
10. ied 18 Late Unscheduled Assessment Policy e The total number of days the assessment is out of compliance including the late ARD must be billed at default beginning on the day that the assessment would have controlled payment Missed Unscheduled Assessment If the SNF fails to set the ARD foran unscheduled PPS assessment within the defined ARD window for that assessment and the resident has been discharged from Part A the assessment cannot be completed Alldays which would have been paid by the missed assessment had it been completed timely are considered provider liable and may not be billed Compounding Effects In each case of an eanly late or missed unscheduled assessment SNFs must consider the degree to which the untimely assessments affect other assessment requirements 3 21 2012 19 3 21 2012 Compounding Effects e A COTOMRA iscompleted with an ARD set for Day 35 while Day 7 of the COTobservation period was Day 37 The SNF then completesa subsequent COTOMRA with an ARD set for Day 42 7 days from early COTARD while the subsequent COTARD should have been Day 44 7 days from approprate COTARD Inactivations Once an assessment is completed edited and accepted into the QIES ASAP system providers may not change a previously completed MDS assessment asthe resident s tatus changesduring the course of the resident sstay the MDS must be accurate asof the date of the ARD establi
11. rted and left in theirbladder long stay Percent of residents who were physically restrained long stay 3 21 2012 13 Survey and Public Reporting QMs Percent of residents whose need for help with activities of daily living hasincreased long stay Percent of residents who lose too much weight long stay Percent of residents who have depressive symptoms long stay Perc ent of high risk residents with pressure ulcers long stay Survey QMs Percentage of long stay residents who have had a fall during their episode of care Percentage of long stay residents who are receiving psychoactive drugs but do not have evidence of psychotic or related conditions in the target period Survey QMs Percentage of long stay residents who are receiving anti anxiety medications orhypnotics but do not have evidence of psychotic orrelated conditions in the target period Percentage of long stay residents who have behaviorsymptoms that affect others during the target period 3 21 2012 14 3 21 2012 Public Reporting QMs Percent of residents assessed and appropriately given the seasonal influenza vaccine during the flu season short stay Percent of residents assessed and appropriately given the seasonal influenza vaccine long stay Percent of residents assessed and appropriately given the pneumococcal vaccine short stay Percent of residents assessed and appropriately given the pneumococcal vaccine long stay 67
12. s April 2012 Changes K0310 Weight Gain 0 No 1 Yes on physician prescribed weight gain regimen 2 Yes not on physician prescribed weight gain regimen 3 21 2012 3 21 2012 April 2012 Changes e KO510 Nutritional Approaches Item number changed Now two columns e While nota resident e While a resdent April 2012 Changes e M0700 Most Severe Tissue Type for Any Pressure Ulcer 9 None of the Above e Stage 1 e Stage 2 with intact blister e Unstageable due to non removable dressing device e Unstageable due to suspected deep tissue injury April 2012 Changes e M0800 Worsening in Pressure Ulcer Status Since Prior Assessment O BRA or scheduled PPS or Last Admission Entry or Reentry e M0900 Healed Pressure Ulcers A Were pressure ulcers present on the prior assessment O BRA or scheduled PPS 3 21 2012 April 2012 Changes e M1040 Other Ulcers Wounds and Skin Problems G Skin tear s H Moisture Associated Skin Damage MASD i e incontinence IAD perspiration drainage April 2012 Changes e M1040H Moisture Associated Skin Damage MASD Moisture associated skin damage isa result of skin damage caused by moisture rather than pressure It iscaused by sustained exposure to moisture which can be caused forexample by incontinence wound exudate and perspiration MASD is also referred to as incontinence demnatitis April 2012 Changes e M1200 Skin and
13. shed by the time of the assessment Inactivations e When the providerdetermines that an event date ARD of any clinical assessment entry date and discharge date or item A0310 type of assessment is inaccurate the provider must inactivate the record in the QIESASAP system then complete and submit a new MDS3 0 record with the corect event date ortype of assessment ensuring that the clinical information is accurate RAI Manual 5 12 20 Inactivations e If the ARD or Type of assessment is entered incorrectly and the provider does not corect it within the encoding period the provider must complete and submit a new MDS3 0 record Inactivations In this instance a new ARD date must be established based on MDSrequirements which isthe date the erorsdetemmined or later but not earlier The new MDS3 0 record being submitted to replace the inactivated record must include new signature and dates forall items based on the look back period established by the new ARD and according to established MDS assessment completion requirements ERROR MESSAGES 3 21 2012 21 3 21 2012 Error Messages e Section 5 MDS 3 0 Provider User s Manual Error Messages Passwords for transmission are individual passwords not facility passwords Need to have more than one person with a password for transmission Error Messages Common Fatal Enors 1007 Duplicate Assessment 1030 Missing Item 3676
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