Home

MDS 3.0 Vendor Q & A Consolidated 11-2-2010

1. 20100225 065 20100225 045 20100225 007 20101101 003 Topic Policy 10 01 2 010 C Policy 10 01 2 010 Question 3 0 through the end of 2010 Oct Dec to allow providers time needed to transition their systems and software have been reading all available documentation on the MDS 3 0 submission file changes and cannot find a hard rule that states MDS 2 0 and MDS 3 0 assessments must be submitted separately Although with the change from ASCII to zipped XML am making the assumption that a facility must separate the two groups and submit MDS 2 0 assessments separately from MDS 3 0 assessments Is this a correct assumption How will corrections and deletions for MDS 2 0 Assessments be handled after October 1 understand that as of 10 01 2010 using the ARD entry date discharge date an MDS submitted with that date or beyond must be MDS 3 0 My question is how do we know which date to use when an assessment has all three of the above dates included in it In several places in the specs a target date is defined as follows a If AO310F is equal to 01 then the target date is equal to A1600 entry date b If AO310F is equal to 10 11 12 then the target date is equal to A2000 discharge date c If AO310F is equal to 99 then the target date is equal to A2300 assessment reference date Is this target date logic to be used to determine which date to evaluate against the 10 01 2010 date and thus wh
2. c If O0400E1 then if O0400E2 is active it must equal 00400D1 and O0400E1 are inactive on all forms except the NC With 00400D1 and O0400E1 inactive on the NQ you will never have minutes which means item B in the skip pattern is active and O0400D2 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 Z1 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 Page 34 of 100 Answer for two reasons a they exceed the maximum length of 8 characters and b they are not in YYYYMMDD format The use of not assessed is not a valid value for A2400 If ongoing dates are needed then the data specifications require a string of eight dashes for A2400 The answer to this question can be found on page 10 of the data specifications overview docume
3. 20100720 005 G Section S 20100420 Ad G Will vendors be required to contact States to find out what Hoc21 Section the Section S format should look like S Page 60 of 100 Question wording for the NYS Questions Responses for S0520 does not match the wording posted by CMS for S0520 This discrepancy is required to fix a MDS transition problem All systems and documentation for NYS providers MUST use the NYS wording The April 1 2011 correction for this discrepancy WILL require minor changes to software systems intended for use by NYS providers Their form also seems to have slightly different verbiage for S8010A3 and S801013 responses slightly different verbiage for the question text on S9060 and include inter item edits between the S80xx items that are not included in the CMS data specs While this seems like a nominal issue it is a substantial hurdle for compliance for both vendors and facilities It means that software must be modified at the eleventh hour to accommodate an alternate set of question wording but this could conceivably extend to questions responses numbering error checking and skip patterns if allowed by CMS on the MDS This is something that was never anticipated and never designed into software applications We would prefer for the State of New York to adhere to the originally published requirements Can CMS assist with standardizing Section S with the state of New York understand that CMS re
4. Incorrect HIPPS RUG Value The submitted value of the HIPPS RUG code does not match the value calculated by the QIES ASAP System The assessment in question had a RUG III score of RAC on the assessment for ZO200A Georgia is a case mix state and Z0200A is used in our CMI calculations The SSB has a CMI of 1 736 while the RAC is a CMI of 1 936 This resident had ST OT PT with minutes 125 amp 4 days 200 amp 4 days and 175 amp 5 days The ADL score under RUG Ill is 15 According to the crosswalk for RUG III this assessment should be an RAC I downloaded the assessment through Casper to check the assessment It has all the information listed herein but with a ZO200A of SSB have questions about what the states can setup so that the Z0200 and Z0250 RUG scores are validated by the ASAP MDS Validation System It would be helpful to know this information so that we can mirror the available RUG setups in our products Page 53 of 100 Answer SSB is correct for the GA RUG III index maximized calculation GA uses CMI set D01 for their calculation In the D01 CMI set RAC has a value of 1 31 and SSB has a value of 1 33 so SSB has a higher index value than RAC and so SSB is returned as the index maximized RUG in the ASAP recalculated Z0200A value Since the indexed values you provided do not match the D01 CMI set index values it appears your software is not using the D01 CMI set The discussion below describes what the ASAP syst
5. 20100820 030 options 20100820 029 options 20100820 009 options Question Please clarify whether to include the V section or not in the NQ assessment for the state of Illinois httos www aqtso 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 Can CMS confirm that Connecticut has authorization to use the NC MDS 3 0 form in place of the NQ and NP I cannot find documentation to that fact but am getting push back from our clients in CT 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 Some other states are currently sending back case mix index reports to the MDS server and storing the reports in the individual facility folders for the facilities to access Will this option be available once the facilities validation reports are moved into the CASPER system A State us
6. 99 These recalculated ID Topic Question Answer specification for a MDS 3 0 producing a RUG III value values are compared to the submitted Medicare RUG IV Also how long will the Final Validation report produce a RUG values in items Z0100 and Z0150 If any of the submitted Ill and RUG IV value items do not equal the recalculated value the ASAP system sends a warning message that includes the item id the submitted value and the recalculated value If the submitted values match the recalculated values then no message is sent RUG III The ASAP system also calculates the Medicare Transition RUG III for all assessments with the exception of records where A0310A 99 and A0310B 99 The ASAP system uses the CMS developed crosswalk software a DLL that translates the data in an MDS 3 0 record into MDS 2 0 format The output from this software is then sent to the existing RUG III grouper to obtain a RUG III classification The software and the specifications that were used to develop the DLL are posted on CMS s MDS 3 0 technical information web page The Medicare Transition RUG III value calculated by the ASAP system will be provided on the Final Validation Report for records submitted with a target date between 10 01 2010 and 10 31 2010 inclusive Providers will see this information displayed in Warning message 1057 Medicare RUG III Transition RUG Calculated A Medicare Transition RUG III was calculated for this assessment
7. 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 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 Topic Question Answer Folder Compression using WinZip Microsoft added one caveat with respect t
8. 1 or Attestation date X1100E when X0100 2 3 ascending 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 For the automatically generated Final Validation Report the ASAP system does the following Record sorting order Assessment records for the facility will be sorted in the order they were processed see above sort order Error detail sorting order Multiple errors from same assessment will be displayed by listing FATAL errors first in the alphabetic order of item names and then listing all WARNINGs in the alphabetic order of item names in errors Values in the item in error field will be used for alphabetical ordering of both FATAL and WARNING error details for any assessment in validation report A single user ID and password will be used to access both the MDS 2 0 and MDS 3 0 submission systems and CASPER Reports The individual user ID and password currently used to access the MDS 2 0 submission system and CASPER Reports will be the user ID and password used to access MDS 3 0 A provider can submit more than one record for the same person in the same zip file Processing Order of records in a single zip file Within an MDS 3 0 zipped file records are sorted using the same sort as MDS 2 0 records were sorted in their submission file The records in the zip file shall be
9. If the system can t find the resident using the information sent in Section X then the modification will be rejected with an error 3745 No Match Found Only printable ASCII characters except apostrophes are accepted in the file name Do not use an apostrophe as a character within file name It is 260 characters including the extension The same character limit applies to names of xml file names This information is in the MDS 3 0 Data Specifications Overview The ASAP system sorts assessments in advance of processing because it is possible to receive original records and corrections to the originals in the same zipped file In order to avoid rejecting the correction we sort before processing We use the same sort order as used in MDS 2 0 20100926 045 L ASAP 20100926 044 L ASAP Question have been getting inquiries from a nursing home saying that they have been receiving conflicting information regarding whether or not facilities will need new passwords for submission of MDS 3 0 documents Can you please clarify whether or not new passwords will be required or if the transition for submission will be the same as it is for the MDS 2 0 Can you submit more than one MDS record for the same person within one zip file Page 92 of 100 Answer The records in the zip file are processed based on the following criteria State code STATE_CD ascending Facility ID FAC_ID ascending Target date TARGET_DATE when X0100
10. 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 Page 69 of 100 Answer indexed maximized Medicare RUG Z0100A group must be a 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 O0400A6 O0400B6 or 00400C6 indicating on going therapy or an end of ther
11. This information can also be located in section 5 of the MDS 3 0 Providers User s Guide which is available on the QTSO website 20101101 025 K If a state wants to use the MCARE rehab parameter for No the ASAP system will not use the MCARE for the RUGS calculating RUGs will the ASAP system recalculate Medicaid rehab parameter in calling Medicaid RUGs RUGs Z0200 and Z0250 using the MCARE rehab option for calling the grouper A state can use whatever rehab parameter they choose to use The discussion below describes what the ASAP system will do If the state wants to do any other type of Medicaid calculation the state must do that in their Medicaid system It will not be done by the ASAP system 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 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 Page 73 of 100 ID 20101101 024 20101101 023 Topic K RUGS K RUGS Question My state is not having me submit Medicaid RUGs in Z0200 nor Z0250 Do need to submit those items in my XML file What versions of the RUG DLLs should we use Page 74 of 100 Answer Medicaid RUG submitted based on the parameters entered by the state into the MDS 3 0 DMS The ASAP system only allows the state to choose the following parameters when having the
12. eight dashes indicate that therapy is ongoing It is correct that the CMS Data Dictionary does not indicate that a skip or dash value is valid for these For any Section S item if a value is submitted that is not listed as a valid value Edit 3808 is triggered and a warning is issued however this warning does not cause rejection of the record If a Section S item has a value sent that is NOT in the list of valid values for that item the value is NOT stored in the database The value in the database for the item is null 20101101 006 Is there a standard as to where Section S items should be There is no order requirement for items on the submitted Page 37 of 100 Topic Question Answer Specs submitted on an xml file Should the items be submitted in XML records The items in the XML file can be submitted alphabetical order or should Section S be after Section Z in any order As long as all the items active on the ISC are submitted the order doesn t matter 20101101 005 E have a couple of minor questions need clarification on All items cited are calculated items All calculated items Specs We have poured over the specifications but need help on are calculated and stored in by the ASAP software when these items please appropriate ORIGINAL_ASSESSMENT_ID Calculated items item type is CALC are NOT submitted in SUBMITTING_USER_ID any XML submission record SUBMISSION_DATE SUBMISSION_COMPLETE_DATE RESIDENT_MATCH_CRITERIA STAT
13. 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 20100114 002 E Could you review the documentation needed for Section M If Both the RAI manual and the data specifications allow for a Specs the wound occurred out of the facility we may not have the dash filled response which would indicate that the date of initial start date etc or do we use the date admitted to the facility And if we do won t that trigger as being in house rather that out of house Is there a utd choice to choose from Thanks the oldest Stage 2 pressure ulcer is unknown Please refer to the Coding Instructions for MO300B in Chapter 3 Section M page M 9 for details on how to code this item Page 52 of 100 ID 20121210 011 20121210 012 Topic F State Options F State Options Question am contacting you in regard to a validation error message The validation report says Z0200A RECALCULATED_Z0200A Z0250A RECALCULATED_Z0250A RAC SSB AAA RAD 3616a WARNING
14. later the provider must complete an MDS 3 0 and submit to the MDS 3 0 system If the ARD is 9 30 10 or earlier then the provider must complete an MDS 2 0 CMS has not determined an end date to MDS 2 0 submissions at this time The MDS 3 0 Correction Policy allows more automated corrections than the MDS 2 0 Correction Policy This Policy is documented in Chapter 5 of the RAI Manual Per Chapter 5 The Modification Request is used to modify most MDS Topic Question Answer gender SSN dob etc that resulted in a new resident ID items The exceptions are being assigned Thus the resident in the prior section of an An Inactivation of the existing record followed inactivation had to be the same resident identified in the AA by submission of a new corrected record is section of the same record required to correct Type of Provider Item A0200 From our understanding the only data could be changed from Type a Assessment A0310 the data that represented a unique assessment facility Entry Date Item A1600 on an Entry tracking resident assessment type amp target date was the target date record A0310F 1 i e a3a a4a or r4 Do these same rules apply for MDS Discharge Date Item A2000 on a 3 0 Discharge Death in Facility record A0310F 10 11 12 Assessment Reference Date Item A2300 on an OBRA or PPS assessment An MDS 3 0 Manual Assessment Correction Deletion Request is required to correct Submission Req
15. modification record is not a new assessment Itis a mechanism to correct data in an existing assessment that has been accepted into the ASAP system A modification cannot have different reasons for assessment RFAs or a different assessment reference date ARD from the original record The RFAs for the existing assessment are entered in the X0600 items and must exactly match the corresponding items in section A Similarly the ARD for the existing assessment is entered in X0700A and must match the ARD item A2300 The RFAs and the ARD cannot be changes since you are correcting data in an existing assessment you are not performing a new assessment All information in the modification record must be based on the existing record ARD not a later date Incorrect data based on the existing ARD are being corrected for that same ARD not a later date Here is an example A nursing home admission assessment A0310A 01 A0310B 99 A0310C 0 A0310D and A0310F 99 with ARD A2300 of 6 1 2011 was accepted in the ASAP system Later it is discovered that the UTI item 12300 was incorrect on that assessment the resident had a UTI as of the existing assessment ARD but item 12300 indicated no UTI To correct the error a modification record is constructed including an exact copy of all info from the existing record The UTI item is then changed and Section X completed with X0100 2 modification The values in the X0600 will be exactly the
16. report We want to have the correct columns and order of columns Answer 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 measure 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 The Facility Characteristics Report has been released 20111110 002 The second digit of the Al code of A seems to say that we Clarification regarding how to bill an End of Therapy Page 1 of 100 20111110 001 A Policy ID Topic Question have to use previous MDS that had the score for the continuation after the OTR There are several questions involved If the EOT date was in the grace period which assessment does it re
17. zip format over the ASAP others in which you will receive MDS 3 0 files in the ZIP existing CMSNet secure network through the link on each format states server Welcome page 20100420 24 L What will CMS do with the MDS data if an element exceeds A fatal error will be issued and the record will be rejected ASAP the maximum allowed as specified in itm_mstr 20100225 092 L Will centers still access the existing state IP addresses to The state welcome page has a new link for submitting MDS ASAP submit the MDS 3 0 and 2 0 assessments Or will a different 3 0 records added to the page with the current links for website or sites be used submitting MDS 2 0 records and obtaining CASPER reports 20100225 060 L The application allows a user to enter a partial date for a If a partial birth date is submitted the submission system ASAP resident s birth date A0900 When calculating the age for a defaults the missing data prior to any date comparison or resident the CMS specs state that if the if only the year is calculation of age entered then the month and day should be defaulted to 07 02 and if only the year and month are entered the day should be defaulted to 15 Edit ID 3573 states that the birth date should not be later than all other dates in the system If a partial date is entered for the birth date should it be defaulted to the same values in Edit 3778 before comparing it to other dates in the system 20100225 058
18. 0 The only RUG version supported are RUG IV Version 1 00 and RUG III Version 5 20 The RUG III information is in the download RUG III Version 5 20 ZIP 1 4MB on the CMS website http www cms gov MDS20SWSpecs 09_RUG lIIVersion520 asp TopOfPage sRugsVersion is a string variable which returns the Logic Version code of the RUG IV classification which was used This version code will be the RUG IV Logic Version 1 00 plus the Model 66 57 or 48 An example version code is 1 0066 This version code is recorded on the MDS at items Z0100B and Z0150B ZO300B is for the facility s use only and is not submitted to CMS Z0150A is the non Therapy Medicare RUG This is documented in the RUG IV documentation location on the CMS website for MDS 3 0 Technical Information http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html You can get more information on Section Z in Chapter 3 of Topic 20100720 027 K RUGS 20100720 026 K RUGS Question Am 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 ma
19. 0 assessment is meant to be an From section Z in the RAI manual Nursing homes may Policy on line assessment Does that mean a printed copy will not use electronic signatures for medical record be required in the chart How will signatures be handled 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 policies 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 Page 15 of 100 ID Topic Question Answer record be maintained electronically most facilities have the option to maintain a resident s record by computer rather than hard copy 20100114 080 A How do you expect the workflow of daily documentation to be CMS has no requirement for this feature Policy affected by the change of MDS 3 0 We are especially concerned with Section E for Behavior 20100114 026 A In CH3 MDS Items X Page X 12 there is a line that reads From section Z in the RAI manual Nursing homes may Policy The entire correction request should be completed and use electronic signatures for medical record signed within 14 days of detecti
20. 02 Quarterly or 03 regular OBRA assessment and as a discharge Note Annual or 04 Significant Change in Status or 05 that the assessment reference date must equal the Significant Correction to prior comprehensive assessment discharge date or the combination is not valid and will or 06 Significant Correction to prior Quarterly assessment be rejected AND A0310F set to 10 Discharge return not anticipated or 11 If an assessment has a reference date on or before the Discharge return anticipated date of a temporary discharge with the resident later Page 7 of 100 20100820 003 A Policy 20100720 039 A Policy Question 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 Will the MDS
21. 1 10 or does it look at SPEC_VRSN_CD to determine which version to apply 20110126 018 H VUT We are using the VUT in an unattended fashion When an This enhancement was implemented in the 09 06 2011 exception happens that is not a normal exception not a fatal release of the VUT Version 1 2 0 warning it pops up a message box and halts processing Could that be changed to write the message to a log file so it doesn t halt processing 20100926 022 H VUT have attached a number of files that we are having issues The XML files you submitted contained some invalid or with When we run then through the VUT we see notification extraneous tags It appears you used itm_db_id from the pop ups with no text a number of times but the files still specs master table for the tag instead of itm_id The process Any feedback is greatly appreciated current version of the VUT displays a pop up message box We are updating the VUT so it will ignore any extra tags similar to the ASAP system 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 can Page 61 of 100 ID Topic Question Answer server to validate assessments be used to validate MDS 3 0 submission files in XML form
22. 20100720 048 20100720 040 20100720 014 options F State options F State options CMS data specs say they may be left blank How will the state Medicaid agency know that a MDS 3 0 record that was received in a previous text file has been inactivated or modified and should have an end date My concern is that some of our case mix states enforce a transmission cut off date for the case mix rate setting reports In this case the modification and inactivation date for an assessment is necessary for the reports The MDS 2 0 data has an ast_beg_ver_dt and an ast_end_ver_dt We receive the entire asmt_hist table with each MDS 2 0 data export and all of the records in this table have a valid end date Once we have this data imported we remove all of the existing records in our existing version of the assessment table that have been inactivated or modified and are now in the asmt_hist table 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
23. 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 20110126 014 E Specs You mentioned you will change processing of the electronic The caller has misunderstood the change Edit 3789 transmission record to hierarchical If you encounter a fatal should have been a hierarchical edit but it was not The error will you stop processing at that point and therefore not new edit 3810 will determine if an assessment is both a return all warnings and error messages PPS and a Comprehensive if it is both the ASAP system will only apply the comprehensive edits not the PPS edits The caller should review both edit 3789 and 3810 in the specs Edit 3810 replaces edit 3789 20110126 015 E Specs In regard to consistency edit 3811 since you re not allowing Those items are used to find the record Even though RFA assessment items entry date assessment reference these items can t be changed beginning April 1 they are date and discharge date to be modified do X0600 and active on the item subset and need to be completed as X0700 need to be submitted because they tell whether we they are used to locate the record to be are modifying the reason for assessment or date modified inactivated CMS will consider whether to revise the ISCs in a later release to remove X0600 and X0700 and hav
24. Correction Policy Provider Instructions Manual dated October 2002 be updated for MDS 3 0 1 RAI Manual 3 0 Page 5 10 says that an incorrect A0200 makes the MDS invalid which suggests that A0200 cannot be changed with a standard modification 2 RAI Manual 3 0 Page 5 12 does not list an incorrect A0200 as one of the reasons for a special manual record correction request Regardless of what the RAI Manual says you tech guys know what the system wants and allows Can A0200 be changed with a modification Or do users have to submit a special manual record correction request Page 8 of 100 Answer 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 chang
25. 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 ID Topic Question Answer 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 Z0150 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 the 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 20111110 009 K RUGs When will the ASAP system begin using version 1 02 of the As both versions are backwards compatible the ASAP RUG IV grouper and version 1 00 4 of the RUG III MDS 30 system will use the new versions immediately following the Mapping specifications September system downtime They will be used for all RUG IV and RUG Ill calls regardless of the target date on the MDS 3 0 assessment After the September 2012 implementation the ASAP system will use version 1 02 for all RUG IV calls both CMS and state sending the appropriate parameters based on the target date of the record and the CMS and st
26. 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 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 X1100C and X1100D attesting individual s title and signature are not submitted items and are therefore never active items on any of the MDS 3 0 item sets Edit 3781 refers to all active items from X1100A through X1100E Since X1100C and X1100D are never active the edit does not apply to them The system error codes are available in Section 5 of the MDS 3 0 Provider s User Guide The guide is posted under the MDS 3 0 link on the QTSO website When the flu vaccination items O0250A C are active on an assessment they should always be answered and they should be answered with regard to the ongoing or most recent flu season The relevant flu seas
27. OBRA assessment not coded as a PPS assessment This allows the second Al digit to be assigned as 0 for any scheduled PPS assessment OR any OBRA assessment not coded as a PPS assessment Note that when the first Al digit is 6 the second Al digit will always be 0 SUMMARY With these two changes 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 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 Ill 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 20100926 035 Topic K RUGs Question 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
28. October 1 2012 Release ZIP 10MB on the CMS Technical website http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html 20121210 006 re ae 1 11 be accepted as a valid value with the implementation of the October 2012 changes Ee 004 20121210 005 E Specs Question am reviewing the changes and noticed that SPEC_VRSN_CD does have a new value for v1 11 0 It just list these as valid values Value Text 1 00 Initial version of data specifications effective 10 1 2010 1 01 First update to data specifications effective 4 1 2011 1 02 Second update to data specifications effective 10 1 2011 1 10 Third update to data specifications effective 4 1 2012 Was the change just missed in the specifications or is the value really staying 1 10 Why does the M0900 say OBRA PPS or DISCHARGE Is the word Discharge a misprint We use the forms provided in the CMS files The wording doesn t affect the MDS but our users are asking what the difference for discharge is I ve looked for some documentation and can t find any We have a question on the following errata item We read this edit is that the edit already existed and that the CMS documentation is just being updated correct QO500B through Q0550B was already NOT allowed to equal and it was just not documented anywhere So when you say However no edit currentl
29. STD flags to No do not process The state also must enter their state s prohibited diagnose codes on the Prohibited ICD 9 page The QIES ASAP system will check the STD and HIV collection flags If the Process HIV and or Process STD flag s for the state is set to No then the submission system will remove any diagnosis code in the submitted assessment XML file that matches a prohibited diagnosis code listed in the state s prohibited ICD table This is the same process as in MDS 2 0 State personnel should note that if they set the Process HIV or Process STD flag to No but fail to specify any prohibited diagnosis codes in the prohibited ICD list then no diagnoses will be removed Topic ID a i 20101101 031 L ASAP L ASAP 20101101 030 20101101 029 L ASAP Question processing and the validation report created A nursing home is getting an MDS formatting error 3591 in 18000 for the value 36 10 My initial guess is that the ASAP system is expecting a leading zero if there are only two digits before the decimal 036 10 but I want to check with you to see if that is correct or if there is another reason that 36 10 is an incorrect format BIMS Background BIMS Edit 3660b If all of the BIMS component items are active and have numeric values AND if four or more of the BIMS component items are equal to 0 which they are then C0500 must equal the sum of the values of the component ite
30. There are classification worksheets for the RUG III 34 and 44 group models at http Awww cms gov MDS20SW Specs 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 and MCAR2 for FY2012 and beyond October 1 2011 until changed Z0100 Z0150 and the transition RUG III For state Medicaid calculations the ASAP system always sets the rehab type to OTHER Z0200A Z0250A 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 An end of therapy OMRA establishes a non therapy RUG for billing days starting with the day after therapy ended A non therapy RUG is therefore necessary for an end of therapy OMRA
31. Values of 3 and are not used in triggering A value of 3 indicates severe cognitive impairment and is not used in triggering because such severe impairment normally precludes successful rehabilitation therapy New York has discontinued collecting all items that they began collecting on October 1 2010 as of March 31 2011 New York will be collecting the 2 items S0160 and S8055 beginning April 1 2011 Please continue to check the New York state website for Section S information WA The exception to collection of all CMS items on the quarterly lists three things not to collect on the quarterly GO900A G0900B Section V items As the Q amp A from Washington describes Section V items are not required on the WA quarterly SD As with Washington SD is collecting all CMS items on the quarterly except the following G0900A 20110126 011 20110126 012 Topic E Specs E Specs Question For the next linked document titled Additional Items Required by States for Nursing Home MDS 3 0 e The information for Washington indicates that all Section V items should be included and the target date for this was 10 01 2010 We have FAQ document from Washington dated 09 01 2010 indicates that Section V and the CAAs will not be required on the quarterly e The information for South Dakota indicates that a full quarterly is required including all Section V items with a target date of 10 01 2010 A
32. a dash should a skip value be placed into the XML for items that should be skipped What value should we place in the XML file for skipped and or unknown items within Section S Answer No personal identification from the record is stored nor returned on the validation report The record will receive a message 3658 No Authority to Collect Data Privacy rights require federal and or state authority to collect MDS data There is no authority to collect the data submitted Data was not accepted 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 particular date fields the data specs can allow either a single dash or a string of eight dashes Whether either or both of these values 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 O0400B5 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
33. and the RUG assigned to Mr P is again RVB Due to an acute illness Mr P is unable to receive therapy services from 10 18 11 through 10 21 11 but is expected to resume therapy on 10 22 11 under the same therapy regimen The facility completes an EOT for Mr P with an ARD of 10 20 11 and reports that the resumption of therapy will occur on 10 22 11 The EOT OMRA assigns Mr P a non therapy RUG of CE2 Mr P is discharged from the facility on 10 28 11 In the case described above assuming no intervening assessments were necessary the facility would bill in the following manner Days 1 14 would be billed under HIPPS code RVB10 Days 15 17 would be billed under HIPPS code RVB20 Days 18 21 would be billed under HIPPS code CE20A Days 22 27 would be billed under HIPPS code RVBOA 20111110 003 Will the printable item sets ever be backward compatible or They are based on the target date of ARD Discharge Date Page 2 of 100 Answer 20110126 002 A Policy It came to our attention that the specs had a change that went out this week Vendors were only made aware of this via the State of Texas Is it possible to send out updates when specs change via QTSO or CMS Updates Will anything be done to verify that the therapy dates are correct when flagging A0310C as an SOT or EOT OMRA For example 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
34. 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 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 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 ID 20121210 017 20121210 018 Topic K RUGs Question version code 1 0266 for Z100B and Z1
35. com ravendownload html RAVEN the healthcare community as of yet If so where can locate this information on the CMS site 20100926 023 l manage a swing bed wing at a hospital have been unable jRAVEN software supports MDS 3 0 for both nursing jJRAVEN to locate any software to complete the MDS 3 0 which is homes and Swing bed facilities is available free of charge effective October 1 2010 Can you please tell me if CMS will It was posted September 15 2010 on the MDS 3 0 be offering a free download as they did in the RAVEN Technical Information link found on the CMS Website software for the MDS 2 0 am unable to locate any http www cms gov NursingHomeQualitylnits 01_ Overview information about this on the CMA website asp TopOfPage The jRAVEN download can also be found on the QTSO website www QTSO com 20100820 049 l Will swing bed providers still be able to use the RAVEN Yes a single install of JRAVEN supports both nursing jRAVEN software If not does CMS have a vendor similar to homes and Swing bed facilities RAVEN Trying to determine transition 20100820 046 l What are the system requirements for jRAVEN jJRAVEN requirements are located on the QTSO website jRAVEN www QTSO com 20100720 017 1 When will RAVEN for MDS 3 0 be available Ta eee Technical Information link found on the CMS Website Page 62 of 100 20100114 033 Will the new version of RAVEN support other file formats jJRAVEN 2
36. 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 makes the logic for billing unusable Page 3 of 100 You should be checking the CMS and QTSO websites for updates The CMS Technical Website begins with a Whats New section There may be tools available to you outside the CMS structure that you may use should you choose However CMS can t guarantee accuracy of these tools 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 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 assess
37. for Z0150A AAAOQ2 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 the Medicare Part A RUG IV group is AAA but doesn t seem to do the same for the NT calculation This is the code from the SAS file that does this Reset Al code to 00 if RUG IV group is AAA default group IF sRugHier AAA THEN sAI_code 00 Page 79 of 100 Answer 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 identification of the reason for the AAA group code The other cases where the HIPPS code contains an AAA classification are AAA w
38. of 100 Answer 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 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 purpose of the ordered therapy items on MDS 2 0 and RUG III was to project therapy usage at the beginning of Medicare stays The concept of projecting therapy usage with the ordered therapy items is not used in RUG IV and has been replaced with the special calculations that can be applied to short sta
39. providers based on RUG IV Facilities in Washington should use the state WA1 and WA2 CMI sets not the F01 and F02 national sets The ASAP system will validate the Medicaid RUG items Z0200 and Z0250 on NC NQ and NP ISCs if the state has set up the options to do the evaluation in the MDS 3 0 ID Topic Question Answer 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 20100114 029 D RAI see a conflicting message on the ADLs After the Rule of 3 ADL score calculation was provided in the SNF PPS Final Manual discussions it says if the activity did not occur 3 or more Rule and in chapter 6 of the RAI manual section 6 6 and times then code supervision However then see a new in the RUG IV SAS code With the MDS 3 0 code 7 if the code 7 to be used when the a
40. remains for Medicare PPS FY2011 with changes in therapy minutes and extensive services will CMS then adjust the rates and Case Mix index to be budget neutral as planned for RUG IV implementation Does this change mean that the MPAF Quarterly would change therapy minutes and both pre admission and post admission extensive services The MDS 3 0 PPS Quarterly item subset will not change That item subset contains all the items necessary for RUG Ill and RUG IV 20111110 014 L ASAP_ How is the 92 days being calculated is it from the ARD field The timing of OBRA assessments is from ARD to ARD Page 90 of 100 ID Topic 20111110 015 L ASAP 20101220 017 L ASAP 20101220 018 L ASAP What characters will be accepted in the file name 20101220 019 L ASAP 20101220 020 L ASAP Question or ZO500 field We are receiving late assessments We also have set are dates ahead so we should never be late This has just started in the last couple of months Never has happened before We are set at 85 days and 360 Also we have spoken with our vendor who said that it s a state issue Until late September our software did not trigger CAT20 automatically based on Q0600 allowing users to submit any value and there were no rejections because of that All of a sudden our clients started getting rejections when they submitted Q0600 1 and CAT20 0 and opposite Has something has been changed in the ASAP system and t
41. safeguard their MDS 2 0 information Is this jJRAVEN has a backup utility for the provider to use to back required for MDS 3 0 up their database Other vendor software should also have a method of backing up the data 20100926 003 A We have had several clients inquire as to when to begin Providers should be recording the mode of therapy Policy documenting Concurrent Therapy Minutes beginning at the latest 9 25 10 in order to code the MDS 3 0 accurately in early October If the provider does not For example an MDS 3 0 assessment with an ARD of record according to the modes then they will not be able to 10 1 2010 would look back 7 days to Sept 25 Normally complete item 00400 during that time providers would be providing therapy to residents in either individual or group mode by doing so the therapy that would be included on the 10 1 2010 MDS 3 0 would be listed as either all individual and or group which could overstate the individual therapy since concurrent was not recorded even if it had been provided Providers are wondering if this is allowable or if they should be documenting individual and concurrent therapy beginning on Sept 25 for those assessments performed in October that will look back into the latter part of Sept 20100926 002 A When a facility sends in a combined assessment If a record had A0310A 01 02 03 04 05 06 anda Policy discharge A0310F 10 11 it would qualify both as a A0310A set to 01 Admission or
42. specified in MDS 3 0 In 2 0 there was a question about Ordered Therapies and that is what was used to determine what Rehab Type was passed in 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 How would this effect the RUG III calculation this should mean that the RehabType passed into it is always Other correct 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 ELSE IF A0310A A0310B AND OR A0310B 07 THEN DO sRUGHier_NT AAA AND Page 84 of 100 Answer classification for RUG IV mirrors the 34 group classification for RUG III
43. target date of the modification record must match the date in item X0700 see Edit 3811 Note that beginning on May 19 2013 when version 1 12 is implemented this edit will no longer apply This means that for modifications submitted on or after 5 19 2013 you will be able to change the target date so that the target date of the modified record is different from the target date of the original record In any event the version of the data specs that applies to a record whether it is a new modified or inactivated record is always controlled by the record s target date regardless of when it is submitted This means that the record s target date is used to determine which version of the data specs applies and which set of edits will be used to check the record Please refer to the item values for the control item SPEC_VRSN_CD for a list of the effective dates for each version of the data specs A similar table is shown near the beginning of the data specs overview document that accompanies the data specs Yes the assessments will be accepted with 1 11 in the value for SPEC_VRSN_CD as the edit on the SPEC_VRSN_CD is only requires that the submitted value be in the list of valid values in the Data Specifications The value of 1 11 was added in the MDS 3 0 Data Specifications Errata V1 11 0 for the October 1 2012 Release The download for this document is directly below the download for the MDS 2 0 Submission Specs for V1 11 0 for the
44. target dates Hence if submitted in the same record and both dates are not skipped they must be equal Specs field from the MDS 2 0 header record Specs MDS 2 0 prior section so that MDS 3 0 section A contains X0100 add modify inactivate and to identify the record to Page 48 of 100 Topic Question the new data for the assessment and section X is only used to identify the assessment for which to modify or inactivate Answer be modified inactivated X0100 2 3 and the reasons for this modification inactivation The information in Section A on a modification record X0100 2 is the new information 20100225 050 20100225 030 20100225 029 20100225 027 Why does the isc_val database table include entries for the The isc_val table includes all possible combinations of the 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 am requesting clarification on edit 3573 as of the 01 11 2010 specs have a couple of issues regarding the recent updates to this edit One of the updates involved the additional constraint on rule 2 which states if a2300 is active My issues are The verbiage under group A Group A items are listed below Each active item in this list that contains a valid date to me already impl
45. 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 20100926 040 K The RUG III mapping specs do not include a translation from The MDS 2 0 item I1cc Traumatic Brain Injury is not used RUGs MDS 2 0 licc Traumatic Brain Injury to MDS 3 0 15500 by the RUG III grouper It is therefore not necessary to Traumatic Brain Injury Is there a reason this no longer is include a translation between 15500 and l1cc in the RUG III used in RUG III calculation mapping specs 20100926 039 If facilities performs an OMRA start of therapy PPS for a The requirement is that a start of therapy OMRA must Page 76 of 100 20100926 038 Topic K RUGs Question 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 a non 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 ES83 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 s
46. 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 because 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 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 We understand your concern that software vendors are under pressure to provide products for the MDS 3 0 release CMS is advising states that they have to timely notify their vendors on not only Section S items but any and all of the configurable items in an assessment e g RUG specifications prohibited HIV STD codes and additional items on their quarterly or PPS assessments
47. to for MDS 3 0 submissions Pressing the MDS 3 0 link on this page leads the upload page included by the questioner The QIES Assessment Submission and Processing ASAP System MDS 3 0 Provider User s Guide is available on the QTSO website www qtso com This guide provides detailed information on the submission process including screen shots of the MDS 3 0 Submission Page Your current user ID and password will still be valid for MDS 3 0 submissions There is not an HTML page that can be given out The system uses Java applications not plain HTML pages to generate JSP pages ID 20100720 044 20100720 043 20100720 038 20100420 Ad Hoc15 20100420 Ad Hoc14 Topic L ASAP L ASAP Question Will it be a problem for our facilities to have Windows 7 Operating Systems and use IE 8 to submit the MDS 3 0 EDS files to CMS Can you tell me if you will support IE8 using IE7 compatibility mode Can you tell me if there are any upgrade enhancements to the applications that will be implemented along with the new MDS 3 0 submission process We have heard in previous calls that validation feedback for MDS 3 0 submissions will only be provided in PDF format with no plans to provide alternatives PDF format is notorious for being difficult to extract underlying content so providers are facing a real risk of losing the ability to process validation reports in bulk which can be done with the more accessible ASCII text b
48. website by South Dakota with FAQ makes no mention of a full quarterly being required As a general question should we be relying on CMS for the information regarding state requirements concerning Section S and optional questions for NQ and NP or is it best that we perform our own research into the state requirements 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 Page 30 of 100 Answer G0900B Section V items CMS posts the data specifications for the MDS including section S CMS can t respond to State specific questions If you have questions you should contact the specific State s 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 enti
49. what you answer A0410 If it concerns the facility why an MDS is not transmitted either create a policy regarding HMO MDS or simply print copy the HMO MDS and store w the medical record then delete the HMO MDS from the history Based on the comments above it seems that other organization have interpreted that the SUB REQ field does NOT drive the submission process and that we are not required to submit the Insurance MDS s that would have a SUB REQ 3 Can someone from CMS please clarify if the SUB REQ field should be tied to the EDT transmission process or if the two processes stand alone With the clarification that MDS Assessment Reasons cannot be modified we would like to discuss the following process that some states require and what should be done after the April 2011 have been made kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk SOME STATES REQUIRE A MODIFICATION CORRECTION REQUEST OF THE DISCHARGE ASSESSMENT FROM RETURN ANTICIPATED TO RETURN NOT ANTICIPATED IN CERTAIN SITUATIONS If the facility completed a Discharge Assessment Return Anticipated A0310F 11 because the resident was expected to return to the facility within 30 days and the facility learns later that the resident will not be returning to the facility another Discharge Assessment is not necessary However the state may require a modification from return anticipated to return not anticipated The State RAI Coordinator can be con
50. 0 of 100 Answer 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 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 combina
51. 0100926 026 20100926 025 20121210 015 K RUGs 20121210 016 K RUGs Does the RUGS DLL version code v1 02 1 replace the RUGS The Medicare RUG IV logic version continues to be 1 02 Page 63 of 100 Question Will vendors and or providers be able to submit XML files to the CMS QIES ASAP system on October 1 that have the test flag indicator set to yes or will the system only accept files that the flag set to indicated a production file 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 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 http www cms gov NursingHomeQualitylnits 01_ Overview asp TopOfPage The jRAVEN download can also be found on the QTSO website www QTSO com The application will provide the user the ability to export zipped XML files and the capability to export files as standard fixed text files The ASAP system should not be used as a test system for submissions Facilities and vendors should use the VUT to validate records to be submitted There is not a test system
52. 0A 01 03 04 05 These values are properly specified under all other circumstances The expanded version of Edit 3833a will allow the specs to cover all circumstances As stated in the errata document this expanded version of this edit will not be implemented until the next major update of ASAP scheduled for the October 2013 release Therefore the expanded edit is voluntary at this time although we urge vendors to implement it if possible currently says If QO400A 0 and A0310A 01 03 04 05 then if Q0490 is active it must equal However no edit currently indicates the allowable values for items Q0500B Q0550A and Q0550B if Q0400A 0 and A0310A 01 03 04 05 To fix this edit 3833a should be changed to say a If Q0400A 0 and A0310A 01 03 04 05 then both of the following rules apply a1 If Q0490 is active it must equal a2 All active items from Q0500B through Q0550B must not equal Answer al If Q0490 is active it must equal a2 All active items from Q0500B through Q0550B must not equal Note It will not be possible to fix this issue in ASAP until the system s next major release In the meantime software vendors are urged to make to their data entry submission software 20121210 007 E Specs have a question and was wondering if you could provide me The ASAP system checks the record to determine whether with some in
53. 10 11 12 then all active items from 00450A through 00450B must equal But then Edit 3815 states If XO900E 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 A0310F 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 X0900E 1 then 00450A must equal 1 This means that when XO900E is 1 00450A should also be 1 Now what would happen if XO900E is 1 and the value in 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 Page 27 of 100 Answer 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 ori
54. 100720 047 20100720 037 20100720 015 20100720 009 Topic 20100820 006 E If A0310A is 05 or 06 will it be a fatal error if A2200 is less No there is no edit that compares A2200 with October 1 Specs than 10 1 2010 2010 E Specs E Specs E Specs E Specs E Specs Question I am not able to locate the CAT20_test_v2 txt in order to test CAT20 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 Will there be a batch upload capability Do you have any specs for the xml schema s documented yet saw the sample xml documents but am looking for the xSd s A question has come up about the first MDS 3 0 OBRA assessment s due date For example an OBRA quarterly is completed on 9 1 2010 but has an ARD of 8 29 2010 MDS 2 0 would set the due date of the next quarterly based on the completion date of 9 1 2010 With MDS 3 0 changing the due date calculation from the completion date to the ARD of the Page 42 of 100 Answer c If C0600 then all active items from C0700 through C1000 must equal d If CO600 and C0100 0 then all active items from C0700 through C1000 must not equal The CAT Specification Package V1 00 3 does contain the wrong CAT 20 test data file The file CAT20_test_v1 txt is contained in the V1 00 3 packa
55. 2 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 Page 66 of 100 Answer This record had 0 4 4 8 days so it qualifies for the RM_ group Perhaps it is that the other RUG issues are similar in that they do Not have the required five days in one discipline 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 Error 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
56. 310C does not indicate an end of therapy Because this scenario does not make sense the record would be rejected ID 20110803 004 20110803 005 Topic E Specs E Specs Question Can you help me out with edit 3811 which seems to prevent a user from modifying an existing assessment If XO100 2 modification record the following rules apply a XO600A must equal A0310A X0600B must equal A0310B X0600C must equal A0310C X0600D must equal A0310D XO600F must equal A0310F f If XO6OOF 99 then XO700A must equal A2300 g If XO6OOF 10 11 12 then XO700B must equal A2000 h If XO600F 01 then X0700C must equal A1600 Notes Previous versions of the data specs allowed modification records to change the values of a previous record s reason for assessment items assessment reference date discharge date or entry date Beginning with V1 01 of the data specs these items can no longer be changed with a modification record Instead these items must be corrected by inactivating the old record and submitting a new record b c d e We have noticed an inconsistency within different documents located on the CMS website for the CAA triggering logic used in the 05 ADL Functional Rehabilitation Potential Care Area The RAI manual Chapter 4 pages 22 24 states that the C1000 values are 0 2 however other documents within the CMS website s Technical Information page state that the Page 28 of 100 Answer A
57. 5 The yearly and quarterly timing rules apply only to nursing home assessments These rules are not applied to swing bed assessments 6 If asubmitted assessment fails either the yearly or quarterly timing rules warnings will be issued but the record will be accepted unless it has other fatal errors The timing rules are not fatal edits MDS 2 0 Format MDS 3 0 Assessment Data Table Field Specific Name ation Section MDS 3 0 Data Specificatio ns Item ID ASSESSME NT_ID ASSESSME Calc NT_INTERN AL_ID FACILITY_IN Calc TERNAL ID FACILITY_P ROVIDER_IN Topic Question RES _CHG_TIMESTAMP RES _MATCH_CRITERIA QILIS_ VALID RESIDENT_INTERNAL_ID ORIG_ASMT_INT_ID AST_BEG_VER_DT AST_END_VER_DT AST_MOD_IND AST_CORR_VER Page 44 of 100 Answer TERNAL_ID SUBMISSIO N_SEQ_NU MBER SUBMISSIO N_ID AA8A use A0310A A031 0F AA8B use A0310A A031 0F EFFECTIVE _DATE EFFECTIVE _ DATE always blank not calculated TARGET_DA TE TARGET_DA TE CREATED_ DATE not in MDS 3 0 UPDATED_ DATE not in MDS 3 0 RES _CHG_T IMESTAMP not available on state extract file RES_MATC H_CRITERIA Number 2 RESIDENT _ MATCH_CRI TERIA QI_IS_VALID not in MDS 3 0 RESIDENT_ NTERNAL_ D Number 10 RESIDENT_ NTERNAL_ D ORIG_ASMT _INT_ID Number ORIGINAL_A SSESSMEN ID Topic
58. 50B 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 In another case we calculated RUCOA and it was recalculated to RMBOA The example assessment is in the RAI manual 2 49 3 10 2011 Would either of you be able to help me with this problem We are pulling the previous RUG IV therapy classification level into Z0100 Does the QIES ASAP System look at the previous RUG IV therapy classification level when showing this warning Page 64 of 100 Answer 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 the indexed maximized method not the hierarchical method of RUG calculation Since CMS uses index maximizing you should reference the payment rates for e
59. AP system does not display the RUG Ill for insurance purposes The specifications for HIPPS code and Medicare short stay assessments have been available for several months on the CMS website They are also included in Chapter 6 of the RAI manual The DLL calculating the HIPPS code and Medicare short stay is available in the RUG IV grouper package The DLL can be called from a variety of languages Visual Basic C and Java The RUG IV grouper package also included SAS and C modules for calculating the HIPPS code and the Medicare short stay indicator Topic Question Answer TOTAA 004 Can additional lines be added in Z0400 for staff signatures Yes additional signature lines may be added Policy 20101101 001 A If any resident had therapy in the past but now is either off Update Policy Medicare or is on Medicare and skilled for nursing issues The MDS states the following in the instructions for coding only does the facility complete the start and end dates of all therapy start and end dates therapy received Record the date the most recent therapy regimen since the most recent entry started and record the date the most recent therapy regimen since the most recent entry ended enter dashes if therapy is ongoing Provider should follow the instructions on the MDS 20100926 004 A In 2003 CMS required nursing homes to backup their local Yes Nursing Homes should back up their local databases Policy database to
60. ASAP system recalculate Medicaid RUGs 1 Choose RUG IV version 1 00 model 66 57 or 48 or RUG IIl version 5 20 model 53 44 or 34 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 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 The Medicaid RUGs items Z0200A Z0200B Z0250A and 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 The most current versions should be used The RUG documentation and DLLs are posted on the MDS 3 0 Technical website As of 10 26 2010 the RUG IV Files lin
61. DS 3 0 ASAP System Records with earlier target dates should be MDS 2 0 records submitted to the state MDS 2 0 system The target date is defined as the dates cited in the prior sentence so yes the target date is evaluated against the 10 01 2010 date to determine whether to submit to MDS 3 0 or MDS 2 0 The RAI Manual is correct C0100 can be 0 or as it is part of an earlier larger skip pattern in B0100 Comatose If B0100 1 skip to GO110 Therefore it can be ID Topic 20100420 Ad Hoc08 D RAI Manual 20100225 078 D RAI Itis implied but not stated in RAI chapter 5 Is it true that an Manual Inactivation cannot be Inactivated 20100225 076 D RAI Manual 20100225 071 D RAI Manual 20100225 037 D RAI Manual Question This does not seem logical as there are skip patterns revolved around answering C0100 Thus C0100 should have a value shouldn t be blank in order for the user to appropriately complete the BIM C0200 to C0600 or be required to complete the staff assessment starting on C0700 Can this tip be removed from the RAI Manual With MDS 2 0 a list was provided with actual item and response numbers for the items that triggered a significant change Will we receive a list for MDS 3 0 Page 2 45 Under Section 2 11 Combining OBRA Assessments and Medicare Assessments there is a paragraph that says The OMRA item sets are all unique item sets and are never completed when comb
62. E_EXTRACT_FILE_ID CMI_SET_FOR_RECALC_Z0100A CALCULATED_ITEMS FILLER1 20101101 004 E Are there additional fields that will be submitted on an xml file The items designated as calculated described in the MDS Specs after Section Z The sample xml files do not show any fields 3 0 Data Specifications in the Detailed Data specs report after Section Z Examples of additional fields are are calculated by the ASAP system They are not RECALCULATED_Z0100B submitted in an XML submission record RECALCULATED_Z0100C RECALCULATED_Z0150A return not anticipated be submitted with all different types of assessment codes Q5 On this table isc_val why isn t an example of a re entry l listed How will a re entry be submitted to CMS A0310A 99 Not OBRA required 20100926 014 E Q1 What is the acronym ISC A1 Item subset code The ISC is based upon the reasons Specs Q2 What is the isc_mstr table a key of The types of for assessment A0310A B C D and F and indicates the assessments that can be submitted to CMS type of record and the items that are active on the record Q3 Is the isc_val table a reflection of the actual assessments A2 Yes this is a list of the valid ISCs that can be submitted Example 1 isc_id_key 2 has an A3 A record with an invalid combination of reasons for isc_id indicating which means Invalid ISC RFA assessment will produce a fatal error and like any record combination not allowed Is this type of assess
63. 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 20100820 025 20100820 023 Topic K RUGS K RUGS Question nRugHier_NT 72 sRUGMax_NT AAA nRUGMax_NT 72 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 My understanding was we have to be calculating RUG IV for 10 1 2010 spoke with the Stat of GA this afternoon and they tell me GA will be continuing with RUG III Can you provide any help and guidance on this Based on the information have read and you seem to confirm it It appears we can transmit RUG IV regardless of state and the QIES MDS 3 0 ASAP System will convert the submission for the relative state which means we only need be concerned with calculating RUG IV Or do we need to calculate both Are there RUG test files Page 85 of 100 Answer therapy ended forward Version 1 00 6 of the RUG IV grouper the last public version inappropriately 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 n
64. L For a particular ISC there are required fields If an XML Missing fields required to identify the facility such as state ASAP assessment has required fields missing what type of erroris code fac_id type of provider A0200 type of record will thrown Is it an edit or is it another type of error receive specific edit error numbers Missing clinical fields will receive a different error number In each case the missing field will be identified in the error information 20100225 057 L In MDS 2 0 there were fatal file errors Other than the zip The MDS 3 0 submission system defers some file editing to ASAP files xml assessment data and the max file size limitations after the file has been submitted There are only three 3 will there be any other fatal file errors or file edits fatal file errors that will be returned immediately upon submission These three errors are 1 the file size limitation has been exceeded 2 the file path entered is Page 97 of 100 ID Topic 20100225 055 What resident matching algorithm will be used ASAP 20100225 017 L ASAP 20101101 032 How can a submitter find out if the submission has completed The MDS 3 0 File Submission system allows the submitted Page 98 of 100 Question Colorado does not allow for the processing and or storage of STD HIV data this is currently blocked by a setting in the DMS we have the DMS validation set to not process HIV and to not process STD There ar
65. MDS30Technic allnformation htm 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 Many users that have configured their MDS 3 software to use the MDS3 to MDS2 converter and RUG III grouper DLLs for item Z0200 are submitting BC1 as a grouper result A common software logic is 1 A 3690 byte fixed length format string for the assessment is generated for the purpose of passing it to the RUG IV DLL and the MDS3 to MDS2 converter DLL 2 The RUG IV DLL reported a correct grouper value The MDS3 to MDS2 converter DLL generated a corresponding 1814 byte MDS 2 fixed length string for the assessment without error 3 The RUG III grouper function in rug520 dll accepted the 1814 byte string generated in 4 but reported BC1 for the grouper value NOTE While the iError parameter for the RUG III DLL returned a 0 no errors the overall function returned a 1 which indicates one or more of the RUG items was out of range The MDS3 to MDS2 converter DLL does not perform range checking of the input values The fields in the 3690 byte fixed length format string containing the MDS 3 0 values were not formatted per the MDS 3 0 Data Specifications Overview pages 17 19 and so two fields P7 and P8 were reported as out of range for containing the values 2 and 1 rather than 02 and 01 respectively Review of the MDS 2 0 specs
66. ML object names 20100720 051 L ASAP 20100720 049 L ASAP 20100720 045 L ASAP Page 95 of 100 Answer will be a pdf report and will be located in the user s My Inbox when it has completed running The QIES Assessment Submission and Processing ASAP System MDS 3 0 Provider User s Guide is posted on the QTSO website https www qtso com under the MDS 3 0 link on the left side The SB Provider Internal Number referred to in the SB shared folder ID is the MDS 3 0 submission FAC_ID field located in the control section of the MDS 3 0 Data Specifications position 37 52 in the flat file It is the same fac id used by the Swing Bed providers to identify and submit their SB MDS 2 0 records For SB MDS 2 0 the fac_id item is submitted in the Header Record in positions 30 45 Each submission receives a unique MDS 3 0 Submission ID No other MDS 3 0 submission file will receive that same Submission ID Please remember that each facility provider with records in this submission file will receive their own facility Final Validation Report in their shared VR folder Each of these facility Final Validation Reports will have the same Submission ID Records from multiple states and both NH and SB provider types may be included in the same submission file The questioner is correct that all submissions are submitted to the same page The MDS 3 0 Welcome page is the page that all state welcome pages and the NACD SB welcome page link
67. O310F 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 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 ssion date A2000 discharge date should be less than or equal to s Since can have an NC record where A0310A 1 and A0310F 10 for example which rule applies a or d 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 Report These reports will give you a description of the changes 20100114 051 E Edit 3752 also does not reference all the required items it Edit 3752 states that the CAA values should be consistent Specs needs to complete this check Only the items which contain with the items used to compute the CAAs but it does not the CAA trigger calculations are provided in the rltn_itm_txt list the component items Similarly edit 3616 states that and rltn_itms tables These tables should also relate the the RUGs values should be consistent with the items used items which are used to perform the CAA calculations to compute RUGs but does not list the component items Because of t
68. Question Answer TID AST_BEG_V use ER_DT SUBMISSIO N_ DATE AST_END V use ER_DT SUBMISSIO N_DATE of the next modification or inactivation for this assessment AST_MOD_I Char 1 use A0050 ND AST_CORR_ Number 2 use X0800 VER 20100420 Ad Is A2400 Medicare start of stay a required field that has to The answer to both questions is yes It is a required on all Hoc11 be entered Will that date whatever the date is be entered types of assessments except on an inactivation Yes for each assessment until such time as the stay ends continue to enter it during the course of the stay You indicate the start and end date of most recent Medicare coverage stay 20100420 Ad My question regards answer 00013 from the January 14 In the data specs there is a layout for a flat file which will Hoc09 conference It stated the calculated items will be populated be used by CMS to produce extract files for the states in files received from CMS What files is this statement The layout for Section S has just been added to version talking about 1 00 2 of the data specs which will be posted in the near future On the layout there are calculated fields The ASAP system will recalculate some items are recalculated without storing the recalculated value in the database An example of such an item is the recalculated PHQ D0300 D0600 If the assessment does not have the correct calculated PHQ score the ASAP system iss
69. Validation Report and Submitter Final Validation ways the automatically generated text file report or by the Report If the text only format will not be provided via facility user running a facility Final Validation report CASPER where will it be provided 1 The automatically generated Facility Final Validation Reports are text files not PDF files The Final Validation Reports will be located in CASPER in the facility s final validation report shared folder titled NH st fac_id VR where st is the 2 character state code of the state of the facility and the fac_id is the facility id of the facility This is the same fac_id that is used to submit MDS 2 0 records and MDS 3 0 records It is located in the control section as item FAC_ID The access to the Facility Final Validation Reports is very similar to accessing the MDS provider Five Star reports only in a different shared folder in CASPER Accessing the MDS 3 0 Facility Final Validation Report is different than the way it was done in the MDS 2 0 system A sample file can be found on the MDS 3 0 Technical website http www cms gov NursingHomeQualityInits 30_NHQIMD S30Technicallnformation asp T opOfPage Click on MDS 3 0 Sample Item Sets and XMLs V1 00 2 07 26 2010 Click on the file 07082010143808 txt 2 If a generated Facility Final Validation report is no longer available in the shared folder as it has exceeded the report retention period and been deleted gt 60 days the facility
70. Y2012 entered or does the software calculate the adjusted minutes Medicare classification MCARE or MCAR2 If the first then calculate the RUG score sRehabType is set to OTHER used for Medicaid in some states and other payers then group time is not divided by If the adjusted minutes are used to calculate the RUG score 4 and the 25 group limitation is not applied when we tested our software updates using the CMS dll we are not getting the correct score It s too high Is there an The DLL code was reviewed and no problems were error in the calculation for the updates effective October 1 observed Records 14 and 15 in the test data file 2011 Mcar2_rehab_Test_v1 txt both have only 15 minutes of group time and the total adjusted time for Medicare in this case sRehabType MCAR2 is 0 for both records Page 70 of 100 ID Topic 20101220 014 K RUGs 20101220 015 K RUGs Question What are the parameters for calculating the Medicare RUG HIPPS value on an MDS 3 0 assessment from a swing bed When my MDS 3 software uses the RUG Version Converter and RUG III DLLs to get a grouper value keep getting BC1 for every assessment while the ASAP gets a correct value Why Page 71 of 100 Answer RUG IV Specifications and DLL Package V1 02 0 is located on the CMS MDS 3 0 Technical website http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualityInits NHQI
71. ach 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 The details for this assessment are ADL calculation G0110A 4 G0110B 2 GO1110 1 2 G0110H 0 Total ADL 8 for RUG calculation Rehabilitation calculation Topic Question Page 65 of 100 Answer O0400A are all zero minutes 00400B1 273 O0400B2 0 00400B3 0 00400B4 4 00400C1 277 00400C2 0 00400C3 0 00400C4 4 Total Therapy minutes 550 Total occupational therapy days 4 Total physical therapy days 4 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 Total Therapy minutes of 500 minutes or more and At l
72. age 2 This is called back staging MDS 3 0 does not allow back staging Once an ulcer reaches stage 3 for example it is always considered a stage 3 pressure ulcer even if it later improves or goes away entirely Consider M0300C1 and M0300C2 as examples M0300C1 asks for the current number of stage 3 pressure ulcers M0300C2 asks the assessor to indicate how many OF THESE pressure ulcers were present when the resident entered the facility Thus the ulcers included in M0300C2 Topic Question Answer assessor is required to put a 1 in MO300B1 a 0 in will always be a subset of those that are included in MO0300B2 a 0 in MO300C1 and a 1 in MO300C2 M0300C1 This means that the count in MO300C2 must Edit 3663 will fail the submission because the 1 in always be less than or equal to the count in M0300C1 M0300C2 is greater than the 0 in MO300C1 Your example of a stage 3 ulcer improving and becoming a stage 2 ulcer could happen on MDS 2 0 because of back ID m staging but is not allowed on MDS 3 0 20100720 004 Thank you for the Power Points Is there a way that can get The Power Point slides on MDS 3 0 training issues were Policy the password so can edit the slides have only been able re posted back without password protection to open them as a read only file A 20100720 002 A In the state copy field of DMS would it be possible to input As long as the Medicaid Agency has a DUA an
73. answer at all If four or more of the items are equal to zero because of reason 1 the resident gave incorrect answers then C0500 should contain the simple sum of the items If four of more of the items are equal to zero because of reason 2 because of nonsensical answers and or refusal then C0500 should contain 99 MDS software cannot distinguish these two cases from the pattern of responses Similarly the ASAP system cannot determine this either which is why Edit 3660 is written so that the summary score in C0500 may contain either the sum of the responses or a 99 if four or more of the component items are equal to zero The best solution for software developers is probably to provide the user with the calculated sum but to allow them to override this with a 99 if four or more of the responses are equal to zero Only the interviewer will be able to determine whether the sum or the 99 is the correct response The printable item subsets and the defined items are have the dates in the format mm dd yyyy The MDS 3 0 Data Specifications require that the dates ID Topic 20100926 046 L ASAP 20101101 034 M Browser Question What happens when extra items XML tags are sent in the XML submission file Providers have been prevented from uploading their MDS 3 0 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 an
74. apply For an inactivation the only field in the Group A and Group B lists of dates that is active is X1100E so the only edit that will run is that X1100E correction attestation date lt current date where the MDS 3 0 Assessment Submission and Processing System uses the submission date as the current date of the assessment for this edit CMS has decided to leave this edit unchanged Vendors are free to enforce a more restrictive edit on this item if they wish 20100225 022 Topic E Specs Question 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 allowed 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 This is for Section V question V0200 In sub question A there are 20 numbered lines Each has a pair of checkboxes and a textbox in which data is to be entered Appendix F of the RAI Manual the matrix of full fields only accounts for the two checkboxes on each line not the data in the textbox Likewise in the submission specs Detailed specs Section Page 5
75. apter 6 The Z0300 fields are for the use of the facilities The items are not submitted to CMS and so are not listed in the detailed specifications Similarly ZO400A L the signatures are on the printed items sets but are not in the data specs and are not submitted to CMS in the submission record 20100114 036 K Will both RUG III and RUG IV systems need to be The QIES MDS 3 0 ASAP System will support RUG IV RUGS maintained for a period of time once RUG IV is in place Version 1 00 for both Medicare and Medicaid and RUG III 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 20100114 035 K Is implementation of RUG IV payment system still planned RUG IV payment began October 2010 RUGS for October 2010 or has it been delayed to October 2011 If itis delayed until October 2011 what is the interim plan for RUG III payment system under the MDS 3 0 umbrella 20100114 020 K How will this affect RAI chapter releases dealing with RUGs For use in state Medicaid systems the current version of RUGS Will RUG III be modified to handle the change in concurrent RUG III Version 5 20 will remain the same using total minutes or will this change simply modify the total minutes passed to RUG III Likewise if Extensive service look back is changed will all the RUG III extensive services be retained for RUG III calculations If RUG III
76. apy 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 r Topic Question Answer Lie updated with the errata from version 1 01 1 allowing A0310C to equal 3 for a short stay To avoid this confusion the logic change was made in V1 01 1 that A0310C must only equal 1 to qualify for short stay ba 10803 007 K aad The current changes in V1 01 RUG IV specifications will not If the rule is finalized the ASAP system will be using the affect the State RUG IV calculation results as the changes new version 1 01 for re calculating ZO200A and Z0250A are applied to sRehabType MCAR2 and States do not use however as you note that part of the code has not the federally defined Assessment Indicator where other changed State RUG calculations are always done with major v1 01 changes occurred So really state RUG sRehabType OTHER This change will not affect the results are not affected by updated RUG IV v1 01 calculation state RUG IV calculation results for the RUG IV group It changes The version code returned by the grouper is will affect the RUG IV version code returned by the
77. art 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 The cited crosswalk has been withdrawn by CMS CMS is not providing an MDS 2 0 to MDS 3 0 crosswalk of all items The crosswalking of items is a judgment decision and depends on the purpose of the crosswalk The only crosswalk supported by CMS is the RUG III MDS 3 0 Mapping Specs currently posted on the CMS Technical web page The way pressure ulcers are staged on MDS 2 0 will be different in MDS 3 0 On MDS 2 0 if a stage 3 pressure ulcer improves it can be re staged as a st
78. as stated in the question On an NP being completed within the 14 day lookback period O100A1 01001 would be assessed individually and only checked code value 1 if the treatment occurred Topic 20101101 013 E Specs 20101101 012 E Specs 20101101 011 E Specs Question For the Item Set NT for Entry and Death in the Facility Records what fields are required The item set posted by CMS includes Item Z0400 which is the signature with attestation however the Submission Specifications on the CMS website list Section Z as inactive for version 1 00 3 What should be included on the NT assessment Where should be looking to see what items are included with each Item Set A0310E Is this assessment the first assessment OBRA PPS or Discharge since the most recent admission This is a new concept and is important since the item controls whether certain clinical items are addressed or not on the current assessment A special transition rule applies to the first assessment under MDS 3 0 for each resident The first MDS 3 0 assessment should have A0310E coded as 1 Yes indicating that this is the first MDS 3 0 assessment whether or not there was a prior MDS 2 0 assessment before 10 01 2010 Is the above applicable to entry tracking records Answer sets for Question A0410 Background The verbiage from the data submission specifications for all three possible answers leads the user to Page 35 of 100 A
79. as also brought up on the MDS Central forum with the following explanation being used to describe how to process HMO MDS s that do not require transmission If an HMO requires a RUG score based on an MDS assessment following the PPS schedule create an MDS assessment and complete as you would if it were an actual MDS PPS to attain a correct RUG score Since these assessments are NOT reimbursable under the SNF PPS they do not need to be submitted but retained in the facility s files for HMO review If you do submit it will still be accepted The issue arises if the last MDS HMO submitted was a 14 Page 4 of 100 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 not 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 sub
80. ase formats of the MDS 2 0 When will sample validation reports be available to assess this risk and the viability of extracting the content What conditions precludes validation feedback in xml or some other machine interpretable content as a supplement to the human readable PDF How will validation reports for multi state multi facility submissions be delivered to the constituent providers Page 96 of 100 Answer CMS currently does not support Windows 7 or IE 8 for MDS file transmissions The submission system does not contain any technology that is browser dependent so users should not have any problems if they try to submit with a Windows 7 or IE8 combination however if a user has issues while submitting under Windows 7 IE 8 support will not be provided by CMS Many of the state entities have started converting machines to Windows 7 and IE 8 and they have reported software problems with other software MDS 2 0 DMS ASPEN CMS has not done much testing with IE 8 and will not support it at this point If you upgrade to IE 8 and use the IE 7 compatibility mode CMS position for now is use at your own risk MDS 3 0 is a totally new and separate system from MDS 2 0 so it has all new manuals and documentation These new user manuals were posted in August with the August downtime The current MDS 2 0 user manuals are correct for the MDS 2 0 system We have already updated and posted the revised MDS 2 0 error message manual to includ
81. at 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 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 Assessment Instruments NursingHomeQualityInits 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 20100720 022 H VUT Do you have the actual code that performs the VScan We CMS will not be providing source code for the VUT would like to start with whatever code pseudo code there is Historically we did not provide source code for the MDS 2 0 validation DLLs of the past either uses XML files for input and output 20100926 024 l Is there a free MDS 3 0 download from CMS similar to the There is only one CMS MDS 3 0 assessment tool It is jRAVEN Raven Software with the 2 0 have been told Yes that jJRAVEN which is used for both swing beds and nursing there would be have been on the CMS site for the past two homes It can be downloaded from weeks and am unable to locate Is this download available to httos www qtso
82. ate requirements The version values for RUG IV version 1 02 are returned in the B items Z0100B ZO200B Z0250B 1 0266 RUG IV 66 groups 1 0257 RUG IV 57 groups 1 0248 RUG IV 48 groups 20111110 010 K RUGs For the October 1 2012 release am not finding anywhere Here are locations of documentation concerning index in the documentation on the RUG information where it says Page 67 of 100 20111110 011 Topic K RUGs Question how to set the sRehabType when using the RUG dll s Is the following a correct assumption for setting these values i If the ARD Date is greater than or equal to 10 1 2011 and it is a Medicare assessment then sRehabType MCAR2 7 If the ARD Date is less than or equal to 9 30 2011 and itis a Medicare assessment then the sRehabType MCARE i 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 Page 68 of 100 Answer maximizing 1 There is an Index Maximizing section in Chapter 6 of the RAI Users Manual 2 There is discussion of index max
83. ate RUG groups will the system compute the Medicaid RUGs Answer Chapter 6 of the RAI manual is correct in labeling the RUG IV Extensive Services groups as ES1 ES2 and ES3 These groups are incorrectly labeled as SE1 SE2 and SE3 in three places in the RUG IV V1 00 8 grouper documentation as follows In Table 5 1 of RUGIV grouper overview V1 00 8 20100817 PDF In Table 2 of RUGIV DLL user doc V1 00 8 20100817 pdf In Table 2 of RUGIV SAS user doc V1 00 8 20100817 pdf The correct group labels are ES1 ES2 and ES3 An errata to RUG IV V1 00 8 was posted indicating the errors in the three documents Whether the ASAP system recalculates the Medicaid RUG values depends on the requirements of the state If the state requests the ASAP system to calculate Medicaid RUGs then the ASAP system will recalculate the Medicaid RUG values and send warnings when the submitted value does not match the recalculated value States may request the ASAP system to recalculate the Medicaid RUG Z0200 and or Z0250 items The ASAP system only calculates standard RUG III V5 20 and RUG IV V 1 00 calculations The state may require providers to submit values in Z0200 and or Z0250 items without requesting the ASAP system to recalculate these values In this case the ASAP system stores the values submitted but does not do any recalculation States that use non standard RUG calculations will not use the ASAP system to do any recalculation 20100926 032 Th
84. ation website http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic a OTE 00820 022 RUGS 20100820 021 K RUGS K 20100820 020 RUGS 20100820 019 K RUGS Leston o o o ooo Is there S SE r code on the CMS site for this conversion Will MDS 3 0 data be backwards compatible that is can MDS 3 0 data be used for RUGS III The programmer assigned to this project has run into some errors with the RUG Version Converter that CMS has on their website The programmer needs the code to connect with the DLL to convert the MDS3 0 data to MDS2 0 data When the Demo RUG Version Converter for NET is accessed it is giving an error when an attempt to open it for testing occurs The error says the project file is invalid The following attachment is a copy of the first error It basically reads that a section lt lt MDS 3 0 CALCULATOR ERROR 1 doc gt gt The programmer then went to the solution file to find the solution to this error edit and received a second error Attached in this second attachment lt lt MDS 3 0 CALCULATOR ERROR 2 doc gt gt This error basically reads that the programmer needs a newer version of Visual Studio to open this file So we need to know in which version of Visual Studio did CMS create this demonstration program When checked the properties of the files on the ZIP file it did not give this informatio
85. be rejected Moreover in the jRaven software V section is not included for the state of Illinois Page 54 of 100 Answer 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 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 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 The Additional Items Required by States that is a link published on the Vendor Section of the QTSO website httos www qtso com vendormds html is correct Illinois collects all CMS defined items EXCEPT for GO900A GO900B and also except for all Section V items All Section V items are within this exception list so are not collected In the future for state specific issues questions please contact the state directly Topic 20110126 016 F State Options ID 20101220 013 F State Options 20101101 016 F State Options
86. bmitted file and not edited and not stored No personal identification from the record is stored nor returned on the validation report The record will receive a message 3658 No Authority to Collect Data Privacy rights require federal and or state authority to collect MDS data There is no authority to collect the data submitted Data was not accepted A0410 1 These records do not fall under any law to transmit so should NOT be submitted to the ASAP system Records with A0410 1 are usually completed for some other purpose i e insurance requirement lf a record with A0410 1 is submitted it will be cleared out from the submitted file and not edited and not stored ID Topic 20101101 010 E Specs 20101101 007 E Specs Question How are dates supposed to be submitted when they are unknown or ongoing Nursing facilities in Pennsylvania are instructed by the State to skip S9080C Recipient number and S9080D MA NF Effective Date if the resident is not MA for MA Case Mix S9080A 0 No The CMS Data Dictionary does not indicate that a skip or dash value is valid for these items Pennsylvania is instructing vendors to allow a dash for these items as well as for S0120 ZIP Code of Prior Primary Residence and S0123 County Code of Prior Primary Residence if unknown My questions are If our software allows the user to enter a dash for Pennsylvania s Section S items will the record be rejected Instead of
87. ctivity occurs only 1 or 2 times activity only occurred once or twice and code 8 if the These conflicts to me Also if you code a 7 in the score by activity did not occur at all In calculating the ADL score a frequency how does that affect the total ADL score code of 7 is counted as 0 along with 1 independent 2 supervision and 8 activity did not occur 20100114 028 D RAI How is the total ADL score calculated found a RUG IV ADL score calculation was provided in the SNF PPS Final Manual version of this but it was not an official document so want to Rule in chapter 6 of the RAI manual section 6 6 and in be sure the RUG IV SAS code which are all available 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 anursing home Since this is a non standard use of the create a hybrid RUG III calculation code for the state 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
88. cument contains which items each state has been approved by CMS to collect Another document contains the states which were approved by CMS to collect additional items on their quarterly NQ and or PPS NP assessments Yes contact state agencies We did include item text for Section S items in the new version 1 00 2 of the data specs Topic Question Answer CMS has been reminding state agencies they need communicate with vendors about Section S 20100926 019 G 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 S state program which would receive the Section S data then data in the record including Section S create a RUGs IIl reimbursement rate for Medicaid residents How exactly does this work 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
89. d record RAI Manual Chapter 2 Pages 35 36 September 2010 We have received information that the following states require a modification of the Discharge Assessment from return anticipated to return not anticipated in the circumstance indicated above Florida North Dakota South Dakota Not allowing modifications for ARD or reason for assessment assume a rejection would occur if the user attempted to modify an assessment for changes here also assume that inactivations would now be used for these kinds of changes Will the RAI manual be updated to show these changes Beginning April 1 we are to do inactivations when changing the target date or assessment type Is it recommended that facilities begin doing that now We vendor have a central database and we must use automated scripting what are you suggesting we do to replace that CMS received a vendor question on the display of RUG III values for an assessment CMS received a question regarding HIPPS codes for an assessment Page 6 of 100 Answer Yes An inactivation is required when the provider must correct reason for assessment or a target date 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 The RUG III group will be displayed on validation reports for assessments with a target date from October 1 through November 1 2010 The AS
90. d the state Policy the path of a server that does not exist within the state opens the appropriate connections for the copy utility it is agency For example is it possible to bypass a separate permissible to copy the data straight to the Medicaid state agency server and copy the data straight to our Agency their contracted data custodian A Medicaid agency their contracted data custodian They have a current DUA in place 20100420 Ad If we ran out of room to list all the individuals who contributed This should not be any different than how it is handled in Hoc24 Policy answers to an assessment do you expect vendors to track MDS 2 0 We don t have a process for you to audit each that on the side and provide it if a surveyor wants that person completing items in the assessment information Do you expect software vendors to audit who actually answered every question in the assessment 20100420 Ad A have a question regarding signatures in the Z0400 series Whoever completes any item on the assessment has to Hoc23 Policy Does every section require that each person answering a attest to the accuracy of how he she responded If one single question in the assessment actually need to be listed clinician only answers one item his her signature should in the Z0400 series of signatures or just the people who are be there signing off on the entire section itself 20100420 Ad A Will CMS offer any guidance in printing rules Is there any CMS ha
91. d upload again The users are using IE 7 and their TLS 1 0 is on Page 100 of 100 Answer must be formatted in the XML file as yyyymmdd The provider s vendor software should be converting the dates to the required format prior to creating the XML submission file Please contact the vendor as it is a vendor issue Extra items that are sent in an XML file but are not active on that ISC will be ignored They are not edited not stored and will not be in the state assessment extract file for that record No errors messages are sent about any ignored field To correct the issue IE settings should be changed as 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
92. der submitted in files with different user IDs then there is a possibility of receiving sequencing warning messages from the submission system 20100225 084 A What is the definition of the start of a therapy regimen Is it Evaluation date Policy the Initial Eval Re eval date or the date that the 1st therapy treatment was given 20100225 083 A What do we do regarding Insurance companies who require Private insurance companies may require providers to Policy a Medicare assessment How is the RFA coded May the follow the SNF PPS assessment schedule Item Z0300 user perform a PPS assessment for private pay insurance allows providers to obtain a payment code for private insurance for this purpose These RUG values Z0300A and Z0300B are not submitted items on a record Private insurance companies determine their own reimbursement method which may not be RUG IV 66 Providers should inform their vendor what their individual needs are Item Page 12 of 100 20100225 094 A Is there a regulation that assessments must be submitted in Records submitted in the same file are sorted by target Policy order Example The resident is discharged for 1 day The date prior to processing Records submitted in separate Entry record is submitted on the Entry Date 14 The files on the same day are processed in order of submission Discharge Assessment is submitted later the same day OR date and time If 2 records have the same target date and submitted 7 days a
93. der and then either replace the entire period or from ARD date onwards 2 An extension to the above question Start of Therapy OMRA will affect the payment period starting from the earliest of the ST OT PT start dates till the end of coverage while Swing bed will follow SCSA logic How will we determine the start date as of when the new RUG score will impact the payment period 3 Similarly while combining Start of therapy OMRA with SCSA assessments How should we code A0310B How will this impact the PPS payment period Page 19 of 100 Answer relevant to these questions All of the questions refer to unscheduled assessments used for PPS see Chapter 6 Table 3 Scheduled PPS assessments establish the RUG payment group for the standard payment periods Unscheduled assessments used for PPS can only revise the RUG group for part of a payment period already established by a scheduled PPS assessment A start of therapy OMRA is an unscheduled assessment that will revise the standard period payment group from the earliest start of therapy date SLP OT or PT to the end of the standard payment period It does not affect the RUG group from the start of the standard payment period to the earliest start of therapy date Those earlier days are not billable unless a scheduled assessment has already been performed If the scheduled assessment has not been performed before the unscheduled assessment then the unscheduled and scheduled assess
94. der to submit the assessment and have it pass submission validation But this code is not valid for states that choose to use the RUG IV grouper it is defaulting the State RUG score to AAA We have run into test cases using the draft version of the E01 E02 CMI sets handed out at the Las Vegas CMS MDS 3 0 training where the calculated Medicare RUG is a Rehab based score but the default RUG IV CMI sets F01 F02 F03 do not calculated a rehab based RUG so the score is being defaulted to AAA Case RUG 66 Model using F03 CMI Set Section 001002 E 1 and F 1 O0400A1 500 O0400A4 5 ADL 5 The Medicare Score is a RVL Medicare Non Therapy ES3 When the RUG IV is using the default CMI Set F03 Nursing Only no Rehab taken into account in the CMI set the correct score is ES3 which trumps any Rehab based score This is true of the F01 and F02 sets as well ES3 trumps any Rehab based score So if a State is using the RUG IV 66 or 57 or 48 groupers they will get a default AAA by the RUG IV logic being applied Page 82 of 100 Answer Test flat file strings containing the required RUGs items are available with the MDS 3 0 to MDS 2 0 RUGs conversion DLL and documentation contained in the RUGIII files amp RUG IV file download This is available for download at http www cms gov nursinghomequailityinits 30_nhqimds30 technicalinformation asp website Please note that these test files only contain the RUGs items and will not pass all
95. determined that the values were out of range because they were missing leading zeros Vendors that are experiencing a BC1 issue and are using the converter and RUG III DLLs are strongly encouraged to check their software to verify that the MDS 3 3690 byte rope SEE 016 K 20101101 028 Aus pee 027 RUGS eston o o o ooo Where do find the a version code to submit in Z0100B Z0200B and Z0250B We have clients who are not getting the short stay assessment with a Rehab RUG using Index maximizing However if we use Special Medicare we are getting the short stay designation and the proper Rehab RUG score If Index maximizing is the proper grouper why are we not getting the proper RUG and short stay designation What is the difference between the special Medicare and Index maximizing We are using the new dll as provided by CMS It is my ste bah he RUD and ne RUG vate ssepiot that the Final Validation reports will give both the RUG III and the RUG IV value for ste bah he RUD and ne RUG vate ssepiot assessments Can you please provide the criteria Page 72 of 100 Answer The RUG version code required in the submission record is 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 sy
96. e DMS will allow the state to set up a Medicaid RUG If you are using RUG III version 5 12 and the BO1 CMI set Page 80 of 100 ID Topic Question Answer RUGs 20100926 030 calculation The DMS Webex display did not include the RUG version of B01 and B02 will these versions be available in the DMS 3 0 If not what version in the 5 20 is equivalent to the 5 12 BO1 34 group 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 81 of 100 for MDS 2 0 the equivalent MDS 3 0 settings are RUG III version 5 20 34 groups and the D01 CMI set The RUG IV documentation located on the CMS technical website http www cms gov nursinghomequailityinits 30_nhgqimds30 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 th
97. e OBRA assessments Will there be a grace period on the due date of the first MDS 3 0 OBRA assessments or will software developers need to readjust the first MDS 3 0 OBRA schedule due dates based on the ARD of the last MDS 2 0 OBRA assessments For these MDS 2 0 fields can you please indicate whether these fields are still present in MDS 3 0 and where they are located ASSESSMENT_INTERNAL_ID FACILITY_INTERNAL_ID SUBMISSION_SEQ_NUMBER AA8A AA8B EFFECTIVE DATE TARGET_DATE CREATED_DATE UPDATED_DATE Page 43 of 100 Answer 3 Yearly timing rule applies if the submitted MDS 3 0 record is a comprehensive assessment a If the most recent prior comprehensive assessment is an MDS 3 0 then the ARD of the new MDS 3 0 assessment must be within 366 days of the ARD of the prior assessment b If the most recent prior comprehensive assessment is an MDS 2 0 then the ARD of the new MDS 3 0 assessment must be within 366 days of the VB2 date of the prior assessment 4 Quarterly timing rule applies if the submitted MDS 3 0 record is a quarterly or comprehensive a If the most recent prior quarterly or comprehensive assessment is an MDS 3 0 then the ARD of the new MDS 3 0 assessment must be within 92 days of the ARD of the prior assessment b If the most recent prior quarterly or comprehensive assessment is an MDS 2 0 then the ARD of the new MDS 3 0 assessment must be within 92 days of the R2B date of the prior assessment
98. e 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 RUG IV MDS_RUG_CLSFCTN_TYPE_CD INDEX Z0200A or Z0250B sRugMax Z0200B or Z0250B sRugsVersion If MWDS_RUG_CLSFCTN_TYPE_CD Z0200A or Z0250A sRugHier Z0200B or Z0250B sRugsVersion RUG III If MDS_RUG_CLSFCTN_TYPE_CD Z0200A or Z0250A cRugMax Z0200B or Z0250B cRugVersion If MDS_RUG_CLSFCTN_TYPE_CD Z0200A or Z0250A cRugHier HIER INDEX HIER a 00926 028 20100926 027 a RUGS RUGS Question can we obtain a sample of a RUGIV fixed format MDS 3 0 string that will successfully convert to a MDS 2 0 format string via the converter dil that will also be compatible with the rug520 and rug512 grouper libraries There is a qualification if the assessment is coded as a Start of Therapy assessment A0310C 1 or 3 that is providing an issue when the grouper is used to calculate a State Medicaid Score RUG IV Pseudo Code has an adjustment in RUG group for a start of therapy OMRA A0310C 1 or 3 By defaulting the RUG calculation to the default AAA score if there is not a rehab based score works fine if you are only looking at the Medicare RUGs Calculation The process is sound as the facility would need to remove the Start of Therapy reason in or
99. e be required must equal Why is this field active on any record type other than an NC since it s only completed on an admission assessment All other active ISC s will be submitted as blanks all the time correct 20100225 068 E NQ Skip Patterns Because H0200A is inactive on a quarterly any edits that Specs Question e H0200C is skipped if HO200A 0 HO200A is involve HO200A do not apply to quarterlies Therefore edit inactive on a quarterly Do we assume that the skip pattern is 3537 would not apply and any of the valid values listed not active and HO200C should be answered including could be submitted Similarly because O0400D1 is inactive on quarterlies NQ Edit Checks edits involving O0400D1 would not apply on quarterlies On a NQ 00400D1 is inactive and 00400D2 is active Do we assume that we can ignore consistency rules concerning these two fields if one is inactive 20100225 062 E Edit id 3573 in the Group A Rules there is an entry If the discharge record is combined with another Specs A2300 assessment reference date A2000 discharge assessment that requires an ARD to be entered then the date that don t fully understand What logic does the discharge date A2000 must be the same date as the ARD stand for in this case Does the mean that the ARD A2300 Two assessments may not be combined into one should be the same as the Discharge date record if they have two different
100. e configurable ICD 9 options too Answer invalid no file path and 3 an internal submission system error has occurred system problem The ASAP system will be updated to not allow upload of any files without the extension of zip All other errors are generated after file acceptance when the file is processed Errors similar to the MDS 2 0 fatal file errors that may occur on the submitted zip file after submission and acceptance of the file are unable to unzip the file and no files contained in zip file Errors that will occur at the individual XML file are file is not well formed XML unable to determine what facility this file belongs to due to missing invalid field user is not authorized to submit for this facility no authorization to collect information invalid subreq invalid test production flag invalid ISC There may be other errors added as the system is completed The same resident matching algorithm as is used for MDS 2 0 OASIS MDS Swing Bed 2 0 and IRF PAI assessment collection As in MDS 2 0 states will have the capability to set state specific options in the MDS 3 0 DMS Data Management System tool For MDS 3 0 states will need to access the MDS 3 0 DMS tool prior to October 1 2010 to set their preferences These preferences include the flags that govern the collection of STD and HIV data Each state prohibiting collection of STD and or HIV data will need to set their Process HIV and or Process
101. e data specs can allow either a single dash or a string of eight dashes Whether either or both of these values 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 O0400B5 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 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 O0400B6 eight dashes indicate that therapy is ongoing The use of slashes e g would not be allowed ID Topic E Specs 20101101 015 20101101 014 E Specs Question On the NQ and NP forms 00400D2 days of respiratory therapy and O0400E2 days of psychological therapy are both active The CMS specifications include this skip pattern a If 00400D1 0001 9999 then if 00400D2 is active it must 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 O00400E1 0000 then if 00400E2 is active it must equal
102. e in status assessment is due after return and the existing OBRA assessment schedule continues Each submitted record is assigned a unique ASSESSMENT _ID value The MDS 3 0 correction Policy has been updated and is located in Chapter 5 of the MDS 3 0 RAI Manual posted on the CMS MDS 3 0 website at http www cms gov NursingHomeQualitylnits 45_NHQIMD S30TrainingMaterials asp TopOfPage Summary answer 1 True A0200 cannot be changed using a modification request 2 Users must submit a special manual request to their state agency to delete the records with the incorrect A0200 and fac_id Then users must submit the records as originals using the correct A0200 and fac_id Notes 1 If the A0200 item was incorrect for the fac_id submitted on the original record then the system will not be able to determine the provider of the record The record would receive fatal error 3693a and not be accepted If the Topic 20100720 035 A Policy Question 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 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 feed only the current assessment Can you provide some c
103. e the ASAP system use the corresponding items in Section A Until a change removing the items from the ISC occurs the items must be submitted as per the manual and data specification or the modification inactivation record will be rejected as the record to be modified inactivated would not be found 20101220 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 008 E have an assessment that was rejected with the fatal error The values submitted for the end of therapy date items Specs 3804 Could you please provide information as to why the 00400B6 and 00400C6 are incorrect assessment was rejected lt 00400B6 gt lt 00400B6 gt lt 00400C6 gt lt 00400C6 gt The submitted values are a single dash indicating not Page 31 of 100 Topic ID 20101220 009 20101220 010 E Specs E Specs 20101220 011 E Specs Question If the tags for an item are sent in but no value is included or the value is all spaces what error will occur The error message description just noted invalid state code value submitted in STATE CD is invalid Is invalid just determined by the wrong state origination or something else What characters can be used in the name item Page 32 of 100 Answer assessed lt O0400B6 gt lt O0400B6 gt and lt O0400C6 gt lt 00400C6 gt This s
104. e the new fatal error message 408 Invalid Target Date The target date of this assessment is equal to or greater than 10 01 2010 and may not be submitted to the MDS 2 0 system This was the only change to the MDS 2 0 system The automatically generated Facility Final Validation Report is a text file If a submission comes in with 10 records for four providers each of the four providers will receive their own Facility Final Validation report with their own records they will not receive any information about data submitted for another provider facility The validation reports will be automatically generated and inserted into each facility shared VR folder in CASPER at the time the submission is processed If the submitter individual who logged in needs a complete report a Submitter Validation report will be available containing all records in the submission for that individual submitter The Submitter Validation report will only be available to the user who did the submission log in id used to submit the file not to other individuals in the facilities providers 20100420 Ad If you go to the state welcome page to submit the file there is It matters for MDS 2 0 but not for MDS 3 0 Hoc13 an option for MDS 2 0 or 3 0 If you are doing multiple states does it matter which state welcome page you go to submit the file 20100420 31 L What are all the communication channels i e FTP or We will only receive MDS 3 0 file in the
105. east 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 The RM_ medium RUG group criteria is Total Therapy minutes of 150 or more and At least 5 days of any combination of the three disciplines 00400A4 plus 00400B4 plus 00400C4 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 number 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 A2400C End date of most recent Medicare stay 05 14 1
106. econd 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 members 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 77 of 100 Answer 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 contained 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
107. ed inactivations cannot be modified or inactivated If an accepted inactivation was done in error then a new assessment must be submitted The OMRA item sets do not contain all the needed items for payment quality and care planning If an OMRA is combined with another type of assessment that includes a larger set of items the larger set of items must be completed For example if a provider wanted to combine a Start of Therapy OMRA with an OBRA admission assessment the provider must complete the comprehensive item set that is required for an OBRA admission assessment If a Start of Therapy OMRA is combined with a Discharge then the Discharge item set must be completed When a discharge assessment is performed whether or not combined with another assessment the ARD is the discharge date In this case the ARD will necessarily be a partial day This is the only case where an ARD does not cover the whole day until 11 59 pm CMS will take this under consideration 20100926 007 D RAI 1 While combining Swing Bed Clinical Change Assessment Please consult Chapter 6 of the RAI Manual for information Page 18 of 100 ID Topic Manual Question and Start of Therapy OMRA A0310B value is coded as 07 Unscheduled assessment used for PPS How will the resultant RUG code from the combined assessment impact the PPS period Should we check the ARD date of the combined assessment and see which PPS payment period it falls un
108. em the record will be rejected The provider would not be able to bill Medicare when applicable for that assessment until it is accepted into the ASAP system We are not aware of the ramifications impact on Medicaid payment for a record being rejected 20121210 010 20111110 004 20111110 007 specs the skip pattern for Q0600 was removed Caret is therefore not a valid value for assessments with target dates on or after April 1 2012 What are the ramifications to our clients if their software is not updated until later this year On a discharge assessment section O If there are no minutes in the look back can enter a zero for the days For the dates PT OT ST is blank a valid answer Or must enter a dash Appendix C contains a listing of all the items that have been added and deleted Appendix E contains a listing of changes to items active April 1 2012 Will CMS provide an ISC grid like that in Appendix E that contains all the changes to each ISC with v1 10 1 including new questions deleted questions and items that have changed ISC assignment In previous releases of item set PDF documents there were field misnaming errors in terms of data tags applied to PDF fields that required hand adjustment to allow automatic 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
109. em will do If the state wants to do any other type of Medicaid calculation the state must do that in their Medicaid system It will not be done by the ASAP system 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 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 20121210 013 Topic F State Options Question We are software vendors in the state of Illinois We have a question regarding items collected for NQ ISC for the state of Illinois As per the Additional items required document published by the CMS it is required to include all V section elements in the NQ assessment When one of our clients checked with the state coordinator then have indicated that there is no need to submit V sections in NQ Following are my questions 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
110. en 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 The State of New York in direct contradiction of published CMS requirements for Section S has changed the wording on question S0520 and is mandating that facilities and vendors use NY state specific wording on software and forms The NY documentation states The MDS 2 0 Question S5 has been temporarily assigned to MDS 3 0 Item 0520 This assignment will change on April 1 2011 The Page 59 of 100 Answer and or PPS NP record s 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 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
111. entry am working on developing training for my staff during the transition process do you have a sample copy of the Final Validation report one that contains both the RUG III and RUG IV codes This will be very helpful in helping identify where these will show up on the report Section N on the NQ set doesn t have a Z None of the Above Is this an oversight It has the None of the Above on the NC set Page 39 of 100 Answer A0310F 01 Entry Record A1600 date of entry A1700 2 reentry Following the implementation of the QIES ASAP MDS 3 0 system a RUG III value will be provided on the Final Validation Report for records submitted with a target date between 10 01 2010 and 10 31 2010 inclusive with the exception of records where A0310A 99 and A0310B 99 Providers will see this information displayed in Warning message 1057 Medicare RUG III Transition RUG Calculated A Medicare Transition RUG III was calculated for this assessment This information can also be located in Section 5 of the MDS 3 0 Providers User s Guide which is available on the QTSO website www gtso com mds30 html This manual would be helpful for training 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 i
112. es 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 Page 55 of 100 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 website will be 07 08 or 09 depending upon the number of groups Connecticut is not collecting additional item on the NQ nor NP assessment They had been approved to collect the item and then decided not to collect them 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 At this time some states distribute reports to their facilities by putting the
113. ether the assessment should be considered MDS 3 0 vs MDS 2 0 We are getting feedback from our clients about a validation issue when C0100 is blank that they can go directly to C0700 and start entering data Please refer to the bottom of 29 and top of page 30 from the attached Users Guide Tip This is a skip pattern If C0100 is O or blank then skip to C0700 Short term Memory Ok or the next active item Page 17 of 100 Answer with an entry date of 10 1 10 or later and death in facility records with a discharge date of 10 1 10 or later will be MDS 3 0 A MDS 3 0 with a target date earlier than 10 1 10 will not be accepted into the QIES MDS 3 0 ASAP System Records with earlier target dates should be MDS 2 0 records submitted to the state MDS 2 0 system Yes your understanding is correct MDS 3 0 records must be submitted to the MDS 3 0 submission system and MDS 2 0 records must be submitted to the MDS 2 0 submission system The files for each system must follow the Data Specifications for the appropriate submission system Modifications and inactivations will be handled as they are today The provider will need to submit any 2 0 records to the 2 0 system Assessments with an ARD of 10 1 10 or later entry records with an entry date of 10 1 10 or later and death in facility records with a discharge date of 10 1 10 or later will be MDS 3 0 A MDS 3 0 with a target date earlier than 10 1 10 will not be accepted into the QIES M
114. fer to Based on the RAI manual it refers to the 30 day assessment but days 61 and 62 would have already been covered by the 60 day assessment Is there corrected wording for that What is the scenario that should be used in this case Answer OMRA reporting Resumption Answer In cases where a facility completes an End of Therapy EOT OMRA reporting a Resumption of Therapy EOT R the facility should bill the days covered by that assessment in the following manner The Al code chosen for this assessment will have a second character of A B or C as these are the only second characters related to an EOT OMRA reporting resumption The first character of the Al code will be chosen based on if this assessment is combined with a scheduled PPS assessment or completed as a stand alone assessment This Al code is then attached to the three character non therapy RUG code to form the five character HIPPS code determined by the information coded on the assessment for those days when the resident did not receive therapy and would be attached to the three character therapy RUG code found on the most recent PPS assessment used for payment which included a therapy RUG beginning the day that therapy resumes Consider the following example A resident Mr P is admitted on 10 01 11 The ARD of the 5 day assessment for Mr P is set for 10 07 11 Day 7 and the RUG assigned to Mr P is RVB The ARD of the 14 day assessment is set for 10 14 11 Day 14
115. fter the Entry record Since both were are submitted in the same file or in separate files with the submitted within the required submission period is there an earlier one submitted prior to the later one or if they are ID 20100225 082 20100225 064 20100225 056 20100225 070 A Question What is the consistency rule for the Start of Therapy date Must it be on or after the admission date a Resident was receiving therapy and was discharged to the hospital for 24 hours Does the original SOT date continue or is there a new SOT date for the reentry into the facility b Resident was transferred from Nursing Facility A to a sister facility B Does the original SOT date continue What form options will each state have for completing a quarterly assessment The NQ or NC The NQ and NP appear to be identical True If so then there would be no advantage to a state using the NP form ID 00012d didn t see a response to the portion of the question dealing with corrections If you have a record that was accepted into the MDS 2 0 State database with an ARD before 10 1 2010 but the error was discovered after 10 01 2010 how will we correct that record Using the MDS 2 0 system or the MDS 3 0 system How long will the MDS 2 0 system be up for MDS 2 0 correction purposes In MDS 2 0 a modification request could not be done if o There was achange in rec_type i e aa8a or aa8b o Or there wa
116. gards Section S as a state matter and that they have no responsibility to share Section S information with anyone because that is a state requirement The problem is that evidently some states feel they have no responsibility to share this information or are unable to share it at this time Answer CMS has approved New York s request to use item S0520 as a stand in item for their state required Medicaid item from October 1 2010 through March 31 2011 As stated in the New York documentation MDS 2 0 Question S5 has been temporarily assigned to MDS 3 0 Item S0520 New York s needed items will be added by CMS in the April 2011 release The valid values for S0520 are the same valid values with different descriptions as the MDS 2 0 Question S5 The use of this stand in item will allow submitted values to pass the ASAP system edits be stored by the ASAP system and be passed on to the state of New York for use in their Medicaid system As announced on the April 20 2010 Vendor call CMS is advising states that they have to notify their vendors on not only Section S items but any and all of the configurable items in an assessment e g RUG specifications prohibited HIV STD codes and additional items on their quarterly or PPS assessments We will again remind States that they need to communicate with vendors about Section S Note CMS has published two documents on the QTSO website at https www gtso com vendormds html One do
117. ge but the file CAT20_test_v2 txt should have been included The file CAT20_test_v1 txt has test data appropriate to an old definition for CAT 20 triggering The CAT20_test_v2 txt is available in the V1 00 3 package A brief document describing this change has been added to the package 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 For MDS 3 0 submissions multiple XML records can be zipped together into a single zip file so long as the zip file is less than 5 megabytes Even if only a single XML assessment is to be submitted it must be zipped into a compressed zip file The information on creating a zip file is located in the MDS 3 0 Data Specifications overview CMS is not supplying XSD s for the XML files only the MDS 3 0 Data Specifications You can get more information on the data specifications and XML schemas on http www cms gov NursingHomeQualitylnits 30_NHQIMD S30Technicallnformation asp TopOfPage 1 If the ARD is on or before 9 30 2010 then an MDS 2 0 must be completed 2 If the ARD is on or after 10 1 2010 then an MDS 3 0 must be completed 20100720 008 Topic E Specs Question previous assessment there could be small window of overdu
118. ginal EOT assessment is being modified by entering appropriate information in 00450A and O0450B Under this scenario XOQ00E 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 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 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 A0
119. grouper changed for all calls as this is a new version of the RUG IV grouper 20110803 008 K RUGs For the states that use RUG IV in Z0200 and or Z0250 and After the September 18 2011 implementation of the ASAP have set up the RUG IV score validate in the ASAP System the ASAP system will use version 1 01 for all RUG IV calls we will need to know the correct RUG IV version that is being both CMS and state sending the appropriate parameters validated in ZO200B and Z0250B As of Assessment ARD of based on the target date of the record and the CMS and 10 1 2011 what is the ASAP System expected State state requirements The version values for RUG IV version Z0200B Z0250B RUG IV version 1 01 are your selection b 1 0166 1 0157 1 0148 20110803 009 K RUGs Will PPS assessments with a target date 8 22 2011 to 9 18 2011 that were already submitted and processed have their Validations Reports regenerated in order to display the transition FY2012 RUG 20110804 010 K RUGs When the software calculates a rehab RUG score where only The group time is only divided by 4 if the rehabilitation type group minutes are entered parameter sRehabType indicates classification for FY2012 Medicare sRehabType MCAR2 The 25 The facility enters the minutes unadjusted for group therapy group time limit is only applied if the rehabilitation type Does the software calculate the RUG based on the minutes sRehabType indicates either FY2011 or F
120. he CAT20 started to be validated Our question is should CAT20 be triggered based on Q0600 that means it is covered by ASAP validation process or it can be submitted as any allowed value If the first or last name are too long for the maximum length of the field will we get the 3793 format error or a message that you can t find a match for that name Someone mentioned a character limit on name of the zip file In what order are records on the final validation reports sorted They are not in xml order alpha order ISC order or date order Page 91 of 100 Answer Z0500 is not used for timing of assessments Please refer to Chapter 2 of the RAI Manual posted on the CMS website http Awww cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits MDS30RAIManual ht ml This is described in the chart on pages 2 15 and 2 16 discussed in 02 on pages 2 19 2 20 for Annual assessments and in 05 on pages 2 30 and 2 31 for Quarterly assessments The fatal edit for CAT 20 went into effect in the ASAP system on 9 22 2011 with the new release for October 2011 A comprehensive assessment will be rejected if the values of Q0600 and CAT20 are inconsistent If Q0600 1 then CAT 20 must be 1 if Q0600 does not 1 then CAT 20 must be 0 This edit will be enforced for all assessments submitted after the 9 22 2011 QIES system downtime If the name is too long the system will issue format error 1003
121. he Medicare End of Stay Date A2400C minus the most recent entry date A1600 must be less than or equal to 7 20100114 031 E The data specifications for MDS 3 0 indicate that the file The submission file must be XML The flat file format will Specs format flat ASCII with cms extension will remain be ASCII for calling the grouper DLLs and will be the file unchanged Is this correct and will other file formats e g produced by CMS XML be supported 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 Z0500A is on the form but not in the specs not 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 Z0500B is the last associated with the state or CMS side of the submission We
122. he 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 available items that are not in Section V added 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 accommodate the specific state s quarterly additional items CMS does not create state specific printable item subsets 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 Topic Question Can you please explain how the states can make these items required or that providers must complete the items if the Answer
123. he large number of items involved we did not feel that these lists would be particularly helpful in the data submission specifications The items involved in these calculations have been listed in the CAT and RUGs specifications 20100114 049 E Can you address the connection of the A0310 fields to the The overview document that accompanies the data Specs Item Matrix How do they correspond with the types of submission specifications explains this connection refer to Page 51 of 100 ID Topic Question Answer assessments on the Data Submission Specifications the Item Subset Codes section Briefly we provide two examples NC NQ NP NS NSD NO NOD ND NT SP ways of determining the ISC from the RFA items First SS SSD SO SOD SD ST you can use the lookup table in the isc_val table in the data dictionary or the corresponding CSV file Second you can use the logic provided in Appendix B of the overview document 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 t
124. hecked only under the following Page 26 of 100 Question As of 04 01 2012 00400A4 00400A5 O0400A6 00400B4 00400B5 00400B6 00400C4 00400C5 and 00400C6 have been added to the MDS 3 0 ND type of assessment This means we can now have days with no minutes The skip patterns do not say that is allowed would like to confirm our interpretation of the AO600B formatting based on the Data Submission Specifications For AO600B Resident Medicare railroad insurance number can the character positions 10 12 be alphabetic numeric or blank Below is our understanding based on the Data Specifications along with the Edit IDs Please verify whether our understanding is correct for the formatting of positions 10 12 I have rephrased the Edit IDs as to eliminate any ambiguity on our part Also beyond the correct field formatting of AO600B for MDS 3 0 submissions are there any supplemental documents to assist users with ensuring that they enter a correct number in AO600B beyond the RAI Manual Field max length 12 Edit ID 3569 If the first character is numeric then character positions 1 9 must be numeric and character positions 10 12 must be alphabetic numeric or blank Edit ID 3570 If the first character is alphabetic then character positions 1 2 OR 3 must be alphabetic AND if positions 2 or 3 are not alphabetic then they must be numeric character positions 4 12 should be alphanumeric or blank Answer Based on skip pat
125. ies that a2300 must be active am also assuming that a0900 must be active as well given the verbiage in my point above however rule 1 does not explicitly state this So which is accurate There is no mention of whether the logic in rule 3 using a0310f should run if a0310f is active Edit 3573 will run for an XX ISC and a0310f will not be active 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 These characters are listed below What middle initial would be a number or one of the special characters o 0 9 a z A Z OGOOGOGOOGOGOOGOO b Gig Page 49 of 100 for the modification They are informational only and are not included in the MDS 3 0 submission system edits or messages The date relation edits are only applied to date fields that are active on the ISC This is an edit which compares dates within a single record for consistency Only dates that are active are edited If a date is not active such as A2300 on an ISC of NT then that date is not edited for that ISC The same is true for the other dates A0900 birth date is only edited on ISC s where the birth date is active If the birth date is not active as on an ISC XX Inactivation then the birth date is not edited For the issue in the third bullet since A031 0F is not active on and XX ISC inactivation then edit 3 will not
126. imizing 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 or other SOT the 20110803 006 Topic K RUGs Question index maximization in this
127. 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 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 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 ID 20100820 043 20100820 027 Topic K RUGS 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
128. ingHomeQualitylnits NHQIMDS30Technic allnformation htmlicontains all public documentation for MDS 3 0 The link at the bottom of the page for the most current MDS 3 0 Submission Specs would be most useful There are several zipped files that contain item descriptions field lengths data types as well as all the edits for each field The information is written in a variety of formats that you might find useful There are pdf files CSV files mdb files and text files You will see that the same information is in a variety of formats hopefully to accommodate your particular preference in digesting the information hope this answers your question I ve added you to the vendor list as well Periodically there are vendor conference calls where vendors have submitted questions for us to answer as they do their development The questions and answers from our two calls for MDS 3 0 can be found on the public web site www qtso com under the Vendors link The current version of the MDS 3 0 Data Submission Specifications are posted on the CMS website at http Awww cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualityInits NHQIMDS30Technic allnformation html The intent is that if FO300 0 then F0400 through FO700 must be skipped equal to and FO800 must be completed not equal to The edits are correct in the MDS 3 0 Submission Specifications which are available on Topic Question A
129. ining with other assessments For example a Start of Therapy OMRA item set is completed only when an assessment is conducted to capture the start of therapy and assign a RUG IV therapy group In addition a Start of Therapy OMRA and Discharge item set is only completed when the facility staff chooses to complete an assessment to reflect the start of therapy and discharge from facility What does this mean Chapter 2 page 8 If a provider combines an OBRA or PPS assessment with a discharge assessment the ARD A2300 and discharge date A2000 must match per the RAI Manual However if the resident is discharged at 9 a m the provider obviously cannot observe beyond that time Doesn t that contradict the above definition of an ARD covering the whole day until 11 59p m Could there be a single page somewhere on CMS for Case Mix contacts by state like there is for the RAI Coordinators by state Believe it or not asking RAI Coordinators what their specifications are for case mix in their state does not always get an answer Answer As in 2 0 with 3 0 we give examples of what a significant change in status may be The list in Chapter 2 is not an all inclusive list This should not be considered to be the only circumstances when a change in status needs to be completed The decision needs to be based on the individual s status The decision is the inter disciplinary team s judgment There is no triggering Yes Accept
130. ional NQ and NP Items from the Vendor Call Agenda for January 26 2011 Within the first document titled State Section S Items Effective April 1 2011 e I m alittle confused about New York We understood before that the field S0520 was going to be used temporarily and replaced with another field April 1 The document for the agenda indicates that there are two new fields and the 6 that were required for October 1 2010 are all gone was expecting only S0520 would be removed looked on the New York website and could not find any information about the change for April 1 Page 29 of 100 Answer values of 0 3 This possible range of values is documented in the technical specifications for software developers in MDS 3 0 CAT Test Data Documentation Table 2 MDS 3 0 Items in the CAT Test Data Files Excel MDS 3 0 CAT Specifications document Items used This is all technical information for developers giving general characteristics of items used Note that the technical documentation also provides the item length and in some cases the location of the item in the MDS 3 0 standard fixed format record The possible range of values does not indicate the values used in triggering The actual use of C1000 in triggering CAA 5 is given in Chapter 4 and in the Triggering Conditions and Pseudocode SAS sections of the MDS 3 0 CAT Specifications document The C1000 values involved in triggering are 0 1 and 2
131. ith a blank Al code when a grouper parameter is in error 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 rehab 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 20100926 034 Topic 20100926 033 K RUGs Question 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 Chapter 6 Medicare SNF PPS refers to Category III Extensive Services RUG IV 66 Group as RUG IV Classes of ES but one of my staff believes they are really SE which is what see in Quality He thought that ES in the manual was a typo Do you know if it is SE or ES If we are a case mix state and have values in DMS for state primary and altern
132. k contains version 1 00 9 and the RUG III Files link contains RUG III converted specifications and DLL dated 10 22 2010 Please check this site frequently for updates Topic ID 20101101 022 K RUGS 20101101 020 K RUGS 20101101 019 K RUGS 20101101 018 K RUGS 20101101 017 K RUGS Question In a Skilled Nursing Facility if a resident is on Medicare and is within their 100 days and they are transferred to and admitted to a hospital upon return from the hospital without a new qualifying stay do they continue their 100 days Or are the days at the hospital counted towards their 100 days For example the resident is transferred to the hospital on day 5 comes back 5 days later Are they then technically on day 6 at the SNF or Day 10 see a reference to a Swing Bed Hospital but what about a regular hospital The distinction for rural and urban is urban over 10 000 Can you confirm that SNF s are supposed to bill RUG IV as of 10 1 2010 on our Medicare Claims That is and has been my understanding at least until further notice from CMS Washington State is a Case Mix state with their own computation formulas for case mix weights Washington does not distinguish between Urban and Rural Washington has set up WA1 for the primary 57 Grouper and WA2 for the alternate 48 Grouper Nursing Homes and Vendors want to know what to put in their systems Would they use F02 and F01 to identify 57 and 48 or WA1 a
133. king record or a death in facility tracking record It is only coded 1 for an OBRA PPS or discharge assessment With the transition to MDS 3 0 A0310E is coded 1 on the first MDS 3 0 OBRA PPS or discharge assessment If the first MDS 3 0 record is an entry this record will be coded 0 on A0310E When the first MDS 3 0 OBRA PPS or discharge assessment subsequently occurs that record will be coded with A0310E 1 per the special transition rule After that the coding of A0310E follows the normal rules Providers need to identify the submission requirement for each record The specifications list the 3 possible values Topic Question not choose answer 1 A0410 Submission requirement 3707 Fatal Consistency a If AO200 2 if the provider is a swing bed provider then A0410 submission requirement must equal 3 it cannot equal 1 2 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 However when reviewing the coding instructions from the RAI manual regarding this question it says that there are times when users should code the question as a 1 Code 1 neither Federal nor State required submission if the MDS record is for a resident on a unit that is neither Medicare nor Medicaid certified and the State does not have authority to collect MDS information for residents on this unit Question Can yo
134. larity on this point Do we ignore that portion of the logic or do we need to find the previous assessments Page 9 of 100 Answer original record is not accepted a modification record will not be accepted and should not be sent in 2 A modification cannot be used to change the provider the record belongs to The provider cannot be changed using automated corrections If the provider on the original record does not match the provider on the modification record then they get error 1058 Unable to Modify Data The submitted value for the FAC_ID or Submission Requirement A0410 item in the corrected record does not match the values previously submitted for the matching record The Facility ID and Submission Required items cannot be changed with a modification request A manual deletion request must be submitted by the state to the QIES Help Desk to delete the records assigned to the wrong provider New original records should then be submitted to the correct provider 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 Re
135. ll be We are still working out the details of Policy MDS 3 0 when that will happen because of software release schedule 20100114 055 A Can you mention the dates that will drive the decision on There is no AB1 date There is an entry date in A1600 that Policy 10 1 2010 regarding which assessment should be completed has to be completed on every record and it is the most MDS 2 0 or MDS 3 0 The Ab1 date and the A3a date are recent admission or re entry date However this date has on the admission assessment Which date takes priority nothing to do with the requirement for when an assessment should be an MDS 2 0 or MDS 3 0 assessment The decision about whether to complete and submit an MDS 2 0 or MDS 3 0 assessment is completely based on the ARD A2300 20100114 044 A What is the significance of requiring an entire MDS It gives us more information at discharge amp assists with Policy assessment done at discharge rather than the current both quality measurement amp survey programs process of just a discharge tracking form Will this translate into any additional logic required for processing a discharge 20100114 040 A If a printed copy is still required what will need to be printed Print the active items for whatever ISC the assessment is Policy will skipped sections need to be printed including items that are part of a skip pattern You are not required to print inactive items 20100114 039 A We have heard that the 3
136. ly speak to Page 23 of 100 Topic 20121210 008 20121210 009 Question this issue so was wondering if perhaps you can provide some insight Are these types of codes not allowed When ICD 10 is implemented we have questions regarding ICD 10 use in MDS am aware that 18000 is already designed to allow for ICD 10 values Will an additional indicator item calculated field or control field be added to indicate whether 18000 is coded as ICD 9 or ICD 10 In other words will something be added to the state extract file that will indicate whether 18000 is coded with ICD 9 or ICD 10 How does CMS plan to identify which ICD code was submitted ICD 9 vs ICD 10 in 18000 Has ICD version detection been developed based on the first character the number of total characters or some other means of 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 to share so others might use ICD version detection in their own coding The most recent MDS 3 0 Errata lists an issue with QO600 04 26 201 2 The value list for item Q0600 includes a caret even though Q0600 can t be skipped In previous versions of the specs for assessments with target dates prior to April 1 2012 item Q0600 could be skipped so caret was a valid value However beginning with V1 10 1 of the data Caret is nota valid value for item QO0600 for V1 10 1 of the data submission s
137. m into the facility directory on the CMS owned state server At this time States have been told that they can continue to use these folders to distribute the state created reports to their facilities This can occur so long as the MDS 2 0 system is available for submission CMS has not made a decision on what will happen after MDS 2 0 is discontinued The subdirectory name is strpts 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 20100820 005 Topic F State options Question the specific state Quarterly Assessment If so how can get a copy Could you please advise vendors of the options for question A1300A D Per the MDS 3 0 data specs v1 00 3 A1300A D items are active on all ISCs except XX 4 A1300A D items are not state optional on any ISC Each may be completed with a text value or can be left blank We vendors are hearing from more than one state that they require or that providers must complete the A1300A D items on all assessment types ISCs and that vendors should comply with the state requirement They also are indicating that these questions are state optional Page 56 of 100 Answer 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 t
138. m 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 20100225 041 Topic K RUGS Question 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 The items used in the RUG III calculations T1b Ordered Therapies Tic Ordered Therapies estimated days until day 15 Tid Ordered therapies estimated minutes until day 15 According to the mapping specs these do not have an MDS 3 0 item to support the data but there is no explanation of how a user vendor will capture this information in order to perform the required calculations Will these items be part of the Section S items that states who need to collect the data to support their RUG model will be able to select for inclusion Page 89
139. ment 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 20110126 003 Part 1 20110126 003 Part 2 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 required 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 CONFLICT BETWEEN DEFINITION amp MDS OPTIONS Recently this topic w
140. ment an error with a fatal error will be rejected by the ASAP system that gets kicked back to the facility for correction or is it A4 When determining the ISC the two discharge types accepted Example 2 isc_id_key 225 has an isc_id A0310F 10 return anticipated and A0310F 11 return indicating NC which means Nursing home comprehensive not anticipated are treated identically If you look at the assessment This assessment indicates an Admission ISC_VAL table you will see that both of these types of A0310A with a Discharge return not anticipated A0310F assessment will produce a D discharge in the ISC code would expect to see a discharge be submitted with either the A5 Scenario 1 This is the correct re entry reasons for A0310A set to 99 or be blank Why would an admission assessment for a nursing home re entry tracking record assessment be marked along with a discharge which has an ISC NT or a swing bed re entry tracking Q4 Will the two discharge types return anticipated and record which has an ISC ST Page 38 of 100 20100926 013 20100926 012 Topic E Specs E Specs Question Scenario 1 A0310A 99 Not OBRA required A0310F 01 Entry Record A1600 date of entry A1700 2 reentry Scenario 2 A0310A blank A0310F 01 Entry Record A1600 date of entry A1700 2 reentry Scenario 3 A0310A 01 Admission A0310F 01 Entry Record A1600 date of entry A1700 2 re
141. ments should be combined and rules about late scheduled assessments after the allowable assessment window may apply A nursing home significant change or swing clinical change assessment is an unscheduled assessment that will revise the standard period payment group from the assessment ARD to the end of the standard payment period It does not affect the RUG group from the start of the standard payment period to the assessment ARD Those earlier days are not billable unless a scheduled assessment has already been performed If the scheduled assessment has not been performed before the unscheduled assessment then the unscheduled and scheduled assessments should be combined and rules about late scheduled assessments after the allowable assessment window may apply If a start of therapy OMRA is combined with a nursing home significant change or swing bed clinical change then the RUG group will be revised as of the earliest start of therapy date 20121210 002 E Specs have a quick question on inactivations unfortunately the When you submit either an inactivation or a modification RAI manual doesn t really specify this or can t seem to find record the target date in item X0700 must match the target 20121210 003 Topic E Specs Question it We were wondering for inactivation item sets what the target date was Is it the ARD of the original assessment or does it have its own ARD Reason we ask is because we re trying t
142. mitted 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 responsible or capable of meeting all the possible needs of all providers and payers for non OBRA and non SNF PPS requirements CMS would not be able to validate all possible payer source codes possibly edits Vendors are permitted and encouraged to add questions items that are not part of the CMS item set are not included in the submitted file in order to meet provider needs How these needs are met are between the provider and the vendor i e a business arrangement CMS can suggest how these needs might be met but we can t require that these non OBRA and non SNF PPS needs be met 20110126 004 Topic A Policy Question day e g then the resident converts to a traditional Medicare the real 5 day PPS MDS submitted will get a sequential error although non fatal What do you put in the A0410 field Complete the HMO MDS exactly as if it were a PPS MDS Since this MDS is not submitted and simply used as a tool for payment by the HMO it doesn t matter
143. ms OR it must equal 99 Question Can you please advise us on how software vendors are to determine which score it should equal since it can be either 99 or the sum of the fields This would force users to hand score the BIMS We have started receiving Final Validation Reports but are getting all of our MDS assessments rejected with a fatal error stating that the ZO500B date must be in year month date format This is NOT what is listed on the MDS What should Page 99 of 100 Answer to query and view the status of submission files the submitter successfully uploaded to the National Submission Database Section 3 of the MDS 3 0 Providers User s Guide pages 3 27 through 3 29 under the header SUBMISSION STATUS describes this functionality The User s Guide is located on www QTSO com under MDS 3 0 11800 asks for other diagnosis codes ICD codes with only 2 digits prior to the decimal point are procedure codes not diagnosis codes 36 10 is not a valid diagnosis code Either this is a procedure code which is not submitted in 11800 or it is an incorrect diagnosis code A correct diagnosis code similar to this is 036 10 submit as 4036 10 however that is not the value sent in to the ASAP system The value sent failed the edit Each of the BIMS component items can have a score of zero for either of two reasons 1 because the resident responded with an incorrect answer or 2 because they answered with a nonsensical answer or refused to
144. n 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 MDS 3 0 we are trying to make it a little easier on ourselves Page 86 of 100 Answer 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 RUG III may be determined based on MDS 3 0 Visual Studio 2008 was used for the NET demo 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 12 version code Topic ID K 20100720 053 20100720 033 20100720 032 K RUGS RUGS Question Will the recalculated value for Z0100A be returned for all assessments or o
145. nd WA2 Could you explain the ASAP setups for the state with regards to validation of the state RUGs Are the state options to validate or not validate or is there an option to validate if data Page 75 of 100 Answer The Medicare Part A SNF benefit period limit of 100 days refers to covered days ina SNF Days outside of the SNF do not count The count resumes when SNF coverage resumes in a SNF If the resident was discharged to a hospital after 5 covered days returns to the SNF 5 days later and Part A coverage resumes then the count resumes at 6 days To distinguish between rural and urban you must use 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 The following OMB website gives the very latest information on any changes to the CBSAs http Awww whitehouse gov omb bulletins default CMS tries to be very diligent about keeping up with the OMB definitions and a facility should be able to go to the FY 11 SNF wage index table A and look to see if their county is included in a CBSA If so they are urban If not they ll receive the rural rates and rural statewide average wage index Here s a link for the FY 11 SNF Notice http edocket access qpo gov 201 0 pdt 2010 17628 pdf As of October 1 2010 CMS has begun to reimburse SNF
146. nd whose A0310A and A0310B values are not equal to 99 Providers can submit on weekends Submissions should be processed within 24 hours If your submission has not been processed within 24 hours please call the QTSO help desk The number of submissions received and waiting to be processed will affect how quickly a submission is processed Submissions are processed in the order received Providers may try different submission times off hours such as nights and weekends if desired The system is available all days all hours except for the QIES down times system downtime 2nd Saturday of the month QIES downtime 3rd Sunday of the month At these down times providers will not be able to submit files These are the same down times as for the MDS 2 0 submission Topic Question Answer ID EE A ND o E 20100820 036 L Will any MDS 3 0 documents validation reports QI QM The MDS 2 0 final validation reports will continue to be ASAP provider reports etc be published to the state site facility stored in the current state site facility folders when MDS folders where the MDS 2 0 final validation reports are found 2 0 records are submitted The scheduled reports for MDS currently 2 0 have been discontinued The QI QM reports are in CASPER not in any state site facility folders 20100820 0385 L Which file format s will be provided via CASPER for the NH The facility Final Validation report can be obtained in two ASAP Final
147. ng an error in an MDS documentation including the MDS when permitted to do National Repository record A hard copy of this request so by state and local law and when authorized by the including the signature of the attesting facility staff must be nursing home s policy Nursing homes must have written attached to the modified or inactivated MDS record and policies in place that meet any and all state and federal retained in the resident s record regardless of whether the privacy and security requirements to ensure proper security facility maintains a paper or an electronic clinical record measures to protect the use of an electronic signature by system a This requirement does not exist anywhere else anyone other than the person to whom the electronic in the RAI manual so why would only the signature belongs Although the use of electronic correction inactivations need to be printed and put in the signatures for the MDS does not require that the entire resident s record It was felt that the government and long record be maintained electronically most facilities have the term care industry were trying to move to electronic systems option to maintain a resident s record by computer rather This requirement seems to force us back to the paper than hard copy process b If a hard copy of this request needs to be put in the chart do the staff signing X1100D need to physically sign the hard copy of the MDS record or does the electronic signature c
148. nly for all PPS assessments or for only the PPS assessments where the recalculated value does not match the Z0100A submitted value What values belong in the following RUG version code fields on section Z Z0100B Z0150B ZO200B Z0250B Z0300B The Medicare calculated RUG rate and HIPPS code belongs in field Z0100A while the Medicaid RUG rate and HIPPS code belongs in Z0200A We are unclear as to the population of Z0150A Z0250A and Z0300A Do they use a RUG calculation algorithm different from what is detailed in chapter 6 of the RAI manual Are there separate groups of RUG indices Page 87 of 100 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 The recalculated value for Z0100A will be calculated for all assessments except for assessments where A0310A and A0310B both are equal to 99 The recalculated value for Z0100A is only returned if it does not match the Z0100A submitted value this includes if blank is submitted It is returned when the values do not match on all assessments that have Z0100A recalculated The RUG version code field depends of the version of the RUG Calculated in the corresponding Z field RUG IV version codes are documented in the RUG documentation cited above RUG III version codes are the same ones that you are currently calculating for MDS 2
149. 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 The Al code definition in Chapter 6 July 2010 version has two statements that are being changed The changes are CHANGE 1 On page 6 8 the assessment type description for a value of 6 for the first Al digit is OBRA assessment used for PPS not combined with any PPS assessment when Part A eligibility is unknown at time of assessment This statement is being changed to OBRA assessment not coded as a PPS assessment This allows the first digit of the Al code to be assigned as 6 to all OBRA assessments not also coded as a PPS Topic 20100926 037 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 Page 78 of 100 Answer assessment This applies to all assessments with A0310A 01 06 and A0310B 99 CHANGE 2 On page 6 9 the assessment type description for a value of 0 for the second Al digit is Scheduled PPS assessment not replaced by or combined with an unscheduled PPS assessment or an OBRA assessment used for PPS This statement is being changed to Either a scheduled PPS assessment not replaced by or combined with an unscheduled PPS assessment OR an
150. nswer Soe eee FO800Z must be answered the MDS 3 0 Technical Information page on the CMS website 20100225 085 E What is the FAC_ID Assigned facility provider submission The fac_id is the same fac_id as for MDS 2 0 Itis the Specs ID and how is it obtained Is this the same value as the state assigned facility identifier MDS 2 0 FAC_ID 20100225 080 E Since the Inactivation has active items for sections A and X No There will not be an Item subset for an inactivation Specs only can we expect an Item Subset document that includes Inactivation records only have control items and Section X only those 2 sections items active There are no active Section A items for an inactivation 20100225 069 E Question A1500 Resident Evaluated by PASARR data specs Itis true that some items in Section A are skipped for some Specs indicate it s active on types of records However because most Section A items NC NQ NP NSD NOD ND SP SSD SOD SD ISC s and are required for every type of record except inactivations inactive on NS NO NT SS SO ST XX record types Since we made a design decision to make all Section A items edit 3777 indicates active for all of these types of records and to use skip logic a If A0310A 01 then if A1500 is active it must not equal to exclude individual items when necessary This decision decreased the number of printable item sets and ISCs that b If A0310A 02 03 04 05 06 99 then if A1500 is active it would otherwis
151. nswer 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 0100J1 The values in the items 00100A1 00100J1 are coded per the 1 00 3 data specifications The data submission specifications V1 00 3 contain a table called ITM_MSTR both in the Access database and as a CSV file which indicates which items are active for each item subset code However keep in mind that this table includes only those items that are submitted to the ASAP system There are a few additional items on the printable item sets that must be completed even though they aren t submitted This includes Z0400 the signature items These signature items must be completed on an NT record which is why they re included on the NT printable item set To summarize The data submission specifications are the correct source to determine which items must be submitted for each item subset code The printable items sets are the correct source for determining which items must be completed for each item subset i e the printable item sets include all submitted items plus a few non submitted items The item A0310E is never coded as 1 for an entry trac
152. nt MDS 3 0 data specs overview v1 00 3 06 01 2010 pdf Towards the bottom of the page the document says the following The relational edits that are included in the data specifications apply only to items that are active for a 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 O00400D2 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 w
153. nual 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 Page 88 of 100 Answer the MDS 3 0 Manual and the Instructor Guide for the items located on the CMS website for MDS 3 0 Training Material http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits MDS30RAIManual ht mi Z0250A is the alternate state Medicaid calculation States can choose to have 2 RUG scores calculated Z0200A and Z0250A You need to find out from the state if they are using Z0250 and if so what version of the RUG should be calculated for Z0250 Z0300 is not submitted to the ASAP system It was added as aconvenience for the facility CMS does not support Z0300 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 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 fro
154. o determine what the item set version of an inactivation should be The scenario is Assume an assessment was submitted with a 9 28 12 ARD However on 10 2 12 it was then inactivated What should the ARD of that 10 2 12 assessment be 10 2 or 9 28 And also if it s the latter does that mean that the item set version of the inactivation should be the same as the original I understand that the item set version number has not changed for the 10 1 cross over This is a hypothetical situation that will eventually be a scenario in the future We have the same question for modifications want to verify that our assessments with a Target Date on or after October 1 2012 will be accepted without error We programmed our submission file as instructed below with SPEC_VRSN_CD 1 11 when the Target Date 10 01 2012 However in the overview of the Submission Specifications v1 12 on page 1 bullet 1 it is noted that the fix for issue 01 from the last errata document will be incorporated in the V1 12 0 update did run my test assessments through the VUT tool and received results without an warning error for the SPEC_VRSN_CD but the information in the v1 12 overview document has me concerned So will SPEC_VRSN_CD Page 20 of 100 Answer date of the original record so that the ASAP system can find the record that you are trying to inactivate or modify see Edit 3745 Under the currently active data specifications v1 11 the
155. o 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 20100420 28 When will ZIP sample files be available We have no plans on publishing a sample zip file Specs 20100420 25 Specs 20100420 19 E Specs 20100420 17 E Specs 20100420 07 E Specs Will CMS work on changing the format of XML to allow multiple assessments per XML file I m looking for a document that contains a title and brief description of each required field for the Long Term Care MDS guidelines I d like to verify that an application we sell will meet the MDS guidelines and be able to map fields from our application to your data submission guidelines Also know the data specs have been updated do you plan to update the data dictionary as well Will that be updated on a given schedule or just as you have time If question F0300 is 0 all active items from FO400A F0700 are to be blank as per the 3533 edit Looking at edit 3534 there is no handling F0700 being a blank value Is it safe to assume that if FO300 0 and F0700 blank that FO800A Page 47 of 100 Not at this time We will accept a zip file with multiple XML files from multiple vendors from multiple states The website http www cms gov Medicare Quality Initiatives Patient Assessment Instruments Nurs
156. of the MDS 3 0 Data Specifications for submission files CMS policy is that a Start of Therapy OMRA assessment is only valid if it produces a Medicare index maximized RUG IV classification of Rehabilitation Plus Extensive or Rehabilitation in item ZO100A Start of Therapy OMRAs that produce a lower RUG IV classification in Z0100A are considered to have a fatal error and are rejected by the CMS MDS 3 0 system Such records like all other rejected records are not in the CMS MDS 3 0 database and will not be available to the states for Medicaid rate calculations CMS has no plans to change this policy and no revisions to the RUG IV grouper are necessary ID Topic 20100820 047 K RUGS Question Will CMS be updating the RUG IV grouper and associated DLLs to have a variable added to it so this logic can be bypassed if the States deem it necessary 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 83 of 100 Answer 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 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
157. on should be determined using the ARD for the assessment In the 20100820 010 Topic E Specs Question Coding Instructions for 00250A Did the Resident Receive the Influenza Vaccine in This Facility for This Year s Influenza Season Code 0 no if the resident did NOT receive the influenza vaccine in this facility during this year s Influenza season Proceed to If Influenza vaccine not received state reason 002500 Code 1 yes if the resident did receive the influenza vaccine in this facility during this year s Influenza season Continue to Date Vaccine Received 00250B Example Mrs J received the influenza vaccine in the facility during this year s Influenza season on January 7 2010 Coding 00250A would be coded 1 yes 00250B would be coded 01 07 2010 and O00250C would be skipped We need to know if this coding is based on the ARD of the assessment Does the ARD have to be within the date range for the influenza season For example if flu season is 10 01 2010 to 05 15 2011 and the ARD is set as 05 20 2011 does this get answered since the ARD is outside of the flu season or does this always get answered based on the most recent flu season information We found a problem with the logic for edit 3527 sub edit a Currently it states that IF C0100 0 then all active items from C0200 through C0600 must equal This causes C0600 to be skipped when C0100 is skipped which triggers the skips f
158. on 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 The QIES MDS 3 0 ASAP System will support both RUG IV for Medicare and RUG III 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 ASAP system will recalculate the state RUG values only if the state requests the ASAP system to do so and the state uses one of the 2 supported groupers above The vendor needs to always submit RUG IV for the Medicare RUG items Z0100 and Z0150 If GA is using RUG III and having the ASAP system recalculate the state RUG values Z0200 and or Z0250 then the vendor should be submitting the appropriate RUG III in the appropriate item s per GA GA should be notifying their vendors of their RUG Version ie RUG III Version 5 20 RUG model 34 44 or 53 for RUG III version 5 20 to be used for the state calculation s If a RUG item is active on the ISC but not submitted the assessment will be rejected as missing the item If the item is submitted as a blank or the value does not match the recalculated value the assessment will get a warning message RUG test files are available in the RUGIII files amp RUGIV files download on the CMS MDS 3 0 Technical Inform
159. or CO600 as well The logic for 3527 sub edit a should be If C0100 0 then all active items from C0200 through C0500 must equal This way C0600 is not skipped incorrectly Page 41 of 100 Answer example given in the question if the ARD was 5 20 2011 the items should be answered with regard to the flu 2010 2011 flu season Please note that in the recently posted errata document for the MDS 3 0 data submission specifications dated 7 20 2010 issue 11 explains that Edit 3762 is being suspended until further notice This edit governs item 00250B the flu vaccination date The purpose of the edit is to make sure that the vaccination date falls within the proper flu season but this edit will not be applied by the ASAP system when the system starts up in October The edit may be reinstated at a later time however The specs are correct C0600 in this circumstance is skipped correctly The filling out of the staff assessment when C0600 is blank is covered under 3528d CMS did not want to have the assessor complete the staff interview gateway question C0600 when they already knew based on C0100 that they did not complete the resident interview so the staff must complete C0700 C1000 3528 Consistency Fatal a If C0600 0 then all active items from C0700 through C1000 must equal b If C0600 1 then all active items from C0700 through C1000 must not equal ID 20100720 054 20
160. or 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 44600 44 lt item_value gt Answer Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html When a record is submitted and it does not meet the data specifications format the record will be rejected The VUT also checks the format and will issue a fatal error just as the ASAP system does In addition the VUT compares the ICD 9 to the official list posted on the CMS web site at http www cms gov Medicare Coding ICD9ProviderDiagno sticCodes codes html If the record contains an ICD 9 that is not listed a warning is issued All the codes you listed as not on the official list For example 600 is not an official ICD 9 but 600 00 is At this time the ASAP doesn t compare the ICD 9 to the Official list posted on the CMs site Regardless of the checks CMS has in place for ICD 9 codes it is the provider s responsibility to ensure they are using proper ICD 9 codes whether it be for the MDs or a claim or other document lt results gt lt results gt can t find documentation anywhere that specifical
161. over the requirement 20100114 025 A There are questions in section A that have changed A1800 Requirements for claims regarding entered from and Policy amp A2100 which will impact the UBs Has this been discharge status have not changed identified and will requirements for the billing side be released and if so when 20100225 001 20100820 002 B 672 802 672 802 Was the SOM ever updated to include a new version and crosswalk for these forms Looking through the CMS site manuals have been unable to locate an updated version of these forms see no reference to report Form 672 Census amp Conditions Appendix PP amp Forms 672 802 amp 805 of the SOM will be released as an advanced copy through a S amp C letter with accompanying training materials on August 27 2010 with full implementation in the actual SOM amp CMS forms site on October 1 2010 SOM Appendix P changes were released through an S amp C letter S amp C 10 27 NH with accompanying training materials on July 30 2010 Chapter 4 revisions to the SOM which are related to Section S implementation amp RAI designation by the state will be completed in September The revision to Appendix P of the SOM that includes the 672 802 is in the process of clearance Summary or 802 QI Matrix B 20100820 040 Will CMS allow providers to transmit either MDS 2 0 or MDS Assessments with an ARD of 10 1 10 or later entry records Page 16 of 100
162. pecifications for assessments with target dates on or after April 1 2012 Caret will therefore be removed from the list of valid values for QO600 Page 24 of 100 Answer The formatting of ICD 9 and ICD 10 do differ ICD 10 requirement will be based on target date of the assessment Prior to the implementation of ICD 10 today s world the specifications require the ICD 9 format and thus the ASAP edit checks any codes entered in 18000 meet the ICD 9 format described in the Data Specifications When ICD 10 is in place the Data Specifications will be updated for the ICD 10 release to describe the ICD 10 format expected The ASAP edit will check the code to ensure it meets ICD 10 format From a CMS perspective for MDS 3 0 the ICD 10 implementation will be based on target date of the assessment A2300 As the expected ICD code ICD 9 or ICD 10 is based on target date not submission date after the ICD 10 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 It is not relevant when the provider s software is updated The provider must enter a valid code into this item As long as the provider enters a valid code there will be no issues If the provider skips for this it
163. processed based on 20100926 043 L ASAP 20100926 042 L ASAP Question Will the Final Validation report warning 1057 show the entire RUG III and RUG IV HIPPS code or just the RUG was wondering if submissions done either on Saturday or Sunday would be appropriate If so will there be a 48 hour wait to get the MDS 3 0 validated I ve been hearing that facilities should not submit on Thursday afternoons through Friday afternoon because of the large number of facilities submitting and validations could be held up for as long as 48 hours Page 93 of 100 Answer the following criteria Sort records by state code Facility ID Target date for new data records X0100 1 or X1100E Attestation date for correction records X0100 2 or 3 If two records have the same target date or X1100E for correction X0100 2 or 3 then records where A0310F 01 Entry record are processed first records where A0310F 10 11 and 12 discharge records are processed last and all other records are processed in between If two corrected records have the same attestation date then sort the records in ascending order by correction number If multiple records for the same resident are to be transmitted at the same time they should be included ina single zip file Yes the RUG III code will be provided with Warning message 1057 on the Final Validation report for assessments with target dates 10 01 2010 11 01 2010 a
164. r 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 ID 20100720 01 1 20100720 010 20100926 018 20100926 017 20100926 016 20100926 015 options options options F State options F State options F State options Question Z0250 is active on the NC NQ and NP subsets but is inactive on the remaining subsets Do the states have a way to make the remaining subsets except XX guess active Do the states have a way to set up this field so that the Blank not available or unknown is not a value option so that a value is required Warning Edit 3616 says If the item is active and contains a value the value should be consistent with all of the MDS items used in the RUGs classification i e the RUGs calculation should be correct This suggests that even for the NC NQ and NP if it doesn t contain a
165. s active on the NC and not active on the NQ the NQ does 20100820 012 Topic 20100926 01 1 Specs E 20100926 009 E Specs 20100820 031 E Specs E Specs Question The tracking forms Entry and Death in Facility do not have an A2300 or a Z0500B date required on the form will the CMS system calculate either a target date or an effective date for either of these forms Has a decision been made regarding Edit ID 3781 Are X1100C and X1100C required as is implied in the edit ID If X1100C and X1100D are required when X0100 1 2 is the Item Type text printed 2 documents that show examples of the validation reports They list some warning numbers 1054 1055 1056 that have not been able to locate Can you give me some direction on where to find the specifications for those We are working to create a rule to auto populate this section of the MDS from our Immunizations module The current instructions for this for manual coding are Page 40 of 100 Answer 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 quarterly 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
166. s a change in resident information e g name Page 13 of 100 Answer A0310B is for Medicare Part A assessments If an assessment is required for private insurance A0310B would be coded 99 A0310C would be coded 0 A0310E coded 0 and A0310F coded 99 As with MDS 2 0 therapy services may only be coded on the MDS 3 0 since admission into the facility or since returning to the facility The States must at a minimum use the quarterly item set for their quarterly and the PPS item set for PPS assessments From a Federal perspective the quarterly and PPS items sets are identical However States may add items from the comprehensive item set to quarterly and PPS assessments and different items can be added to each type When a combined assessment is completed then any items that are contained in either item set must be submitted Thus if a State added items to the quarterly but did not add items to the PPS assessment then if a combined quarterly PPS assessment was submitted it must contain all of the items on the State s quarterly If a provider inactivates or modifies an MDS 2 0 record then the provider would submit this info through the MDS 2 0 system However when a provider determines a significant correction to a prior record must be completed the provider would complete the assessment according to the ARD for the significant correction record If the ARD of the significant correction to prior assessment is 10 1 10 or
167. s no requirements for printed documentation Hoc18 Policy concern by CMS whether or not sections break in the same When surveyors go out and want to see documentation at place if the same fonts are used or if an entire section is not a facility CMS has no particular formatting requirements in printed when it is not actually part of that particular that environment We simply have the requirement that the assessment data has to be available It is not our call to take on the role of dictating what printed copy should look like 20100420 Ad A If a significant change in status assessment is noted prior to A significant change in status will be the same as 2 0 In Hoc07 Policy a 90 day scheduled assessment how is the subsequent your example a quarterly will be due next after the schedule affected For example on a 60 day assessment if significant change in status and the significant change a significant change is triggered when would the next assessment resets when the annual is due That has not scheduled assessment take place changed from MDS 2 0 to MDS 3 0 What has changed is that the next assessment is based on the ARD in MDS 3 0 not on the completion of the assessment 20100420 Ad A Some nurses asked if validation reports will be in electronic Whenever CMS puts documentation out for public use it Hoc04 Policy format or just printed has to be 508 compliant accessible to individuals with disabilities and the PDF format is the mos
168. same as the corresponding A0310 items The value in X0700A will be exactly the same as A2300 If a provider determines that an assessment that has been accepted into the ASAP system has an incorrect RFA and or ARD then the provider must inactivate that record and complete and submit a new one There are no errors in Chapter 4 of the technical documentation Item C1000 cognitive skills for daily decision making is used in the triggering logic for CAA 5 ADL Functional Rehabilitation Potential This item has a possible range of 20110126 009 Topic E Specs Question C1000 values are 0 3 Could you please confirm the correct C1000 values that should be used within the triggering logic for the ADL Functional Rehabilitation Potential Care Area is it C1000 gt 0 AND C1000 lt 2 or C1000 gt 0 AND C1000 lt 3 e RAI Manual starting on page 4 22 v1 03 states 0 2 e Located on the CMS website MDS 3 0 Technical Information page Downloads is MDS 3 0 CATs Specifications V1 00 3 08 27 2010 ZIP 376 KB which contains the following documents MDS 3 0 CAT Test Data Documentation Table 2 states 0 3 MDS 3 0 Items in the CAT Test Data Files Excel states 0 3 MDS 3 0 CAT Specifications document Items used table states 0 3 and Triggering Conditions section states 0 2 have taken a little time to review the two linked documents found under the section State Required Section S and Addit
169. 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 Page 57 of 100 Accepted modifications and inactivation requests will be sent in the state assessment extract flat file The Medicaid agency can tell whether it is a correction or an inactivation by querying the A0050 Type of Record Item A record is effective equivalent to the MDS 2 0 ast_beg_ver_dt on the submission date The record is no longer effective equivalent to the MDS 2 0 ast_end_ver_dt on the submission date of the subsequent accepted correction or inactivation request The assessment end version date is not stored on the record The subsequent version of the record or the inactivation request must be queried to determine the end date of the prior one 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 prio
170. sight on ICD 9 codes A facility has brought up the ICD 9 code submitted meets the format requirement the fact that some of the ICD 9 codes that we allow in our Please refer to the technical specifications for the required 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 Awww cms gov Medicare Quality Initiatives Patient Assessment Page 22 of 100 Question generic codes are not acceptable for 18000 600 Hyperplasia Of Prostate 707 0 Pressure Ulcer 733 0 Osteoporosis 585 Chronic Kidney Disease Ckd 724 0 Spinal Stenosis Other Than Cervical 786 Symptoms Involving Respiratory System And Other Chest Symptoms They claim that they have received validation errors when submitting the MDS to CMS 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 ICD9cm site http icd9cm chrisendres com index php action chil d amp recordid 5909 and confirmed that the codes listed above are valid ICD9 codes When imported a test file into jRaven didn t receive any validation errors stating that these codes were not allowed also tried using the VUT tool from QTSO https www gtso com vendormds html and did not receive a FATAL err
171. situation for a Short Stay or an SOT MDS 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 V1 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 the special Medicare short stay calculation If the Modification is created on or after
172. stem 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 ZO200A 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 Z0200B or Z0250B is 1 0066 for the 66 group model 1 0057 for the 57 group model and 1 0048 for the 48 group model A specific RUG IV configuration includes ALL of the following settings 1 Model 66 group 57 group OR 48 group 2 Classification method index maximizing OR Hierarchical 3 Rehabilitation type Medicare OR Other 4 If index maximizing a CMI set must be set there are different rural and urban sets for Medicare The proper grouper for FY2011 Medicare must have Model 66 groups Classification method index maximizing Rehabilitation type MCARE Medicare AND the E01 rural or E02 urban CMI set The special Medicare short stay provisions is only in effect when Rehabilitation type Medicare RUG IV The ASAP system calculates the Medicare RUG IV values for all assessments with the exception of records where A0310A 99 and A0310B
173. t universal 508 Page 11 of 100 Topic Question Answer compliant document validation reports will be PDF format Post Meeting Note The automatically generated Facility Final Validation Report FVR that is placed in the facility s shared folder will be a text file similar to the MDS 2 0 Final Validation Report When a CASPER user runs the CASPER Submitter Final Validation Report or Facility Final Validation Report it will appear in the user s Inbox as a pdf report 20100420 35 A Can you please tell us where to get specific information Information on the MDS3 0 Quality Measure can be found Policy regarding quality measures for MDS 3 0 on the CMS website http Awww cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIQualityMeasur es html 20100420 29 A Is there an MDS 3 0 sample data set that can be used for No Polic statistical analysis 20100420 18 A would like to clarify something related to the use of the MDS You would not be infringing on any copyrights by using our Policy 3 0 forms We would like to use the MDS 3 0 PDF forms as PDF version of the form 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 issue with their being submitted out of or
174. tMDS 3 0 Vendor Questions and Answers 1 13 Consolidated December 10 2012 Topic A Policy ID 20121210 001 Question 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 didn 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 www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits 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 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 Will CMS release the planned formatting of the facility profile
175. tacted for clarification if your state Page 5 of 100 Answer A vendor may develop a separate set of specifications to meet these needs and allow the provider to choose which specifications to use for the resident The vendor could add to the CMS specifications but then would need to develop items that are not part of the information submitted to CMS when the assessment is required by CMS For example additional items that may meet some of the provider needs are payer source payment system which may be a RUG III RUG IV other case mix methodology etc assessment type frequency for example a payer may require assessments to be completed every 45 days The A0410 field should not be changed since this item is specific to the unit the resident is on Changing A0410 leaves the provider vulnerable for not submitting assessments that are required for OBRA and or SNF PPS CMS does not require that the sub req item be automatically tied to the transmission file If a state needs to know when a resident doesn t return to a facility they may not require a provider to submit an additional MDS record This negatively impacts the CMS quality measures A state may collect the needed information in section S through the modification process or must collect this information outside the MDS 20110126 005 A Policy 20101220 001 A Policy 20101220 002 A Policy 20101220 003 A Policy Question requires a modifie
176. tates that end dates for OT and PT are unknown The submitted end date for speech O0400A6 was skipped value since there were no speech minutes O0400A1 through O0400A3 There are no known end dates for therapy and the assessment does not qualify as a special Medicare short stay assessment which requires at least one therapy having an end date on the Medicare stay end date A2400C or therapy is ongoing on the assessment reference date value 8 dashes Rehabilitation classification is based on total minutes of therapy not average minutes of therapy The total minutes of therapy are less than those required for a therapy group and there are no restorative nursing services so the resident does not classify in a rehab group and the error 3804 occurs because the submitted assessment is a start of therapy OMRA A0310C 1 and a rehab extensive or rehab group does not result This situation can be fixed by submitting O0400B6 and 00400C6 with 8 dashes instead of 1 dash If there is no value or the value is all spaces not caret but 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 The ASAP system will automatically upper case all letters State cd will be read when submitted as upper lower or mixed case e g TX tx or Tx Error 1008 will trigger if the submitted value is spaces null or not valid i e not a valid
177. tern edits and item set manual instructions you cannot have days without minutes The item set specifically states record the number of days this therapy was administered for at least 15 minutes a day in the last 7 days Thus there will be no days zero if there are not enough minutes to account for a day For the ND item set individual concurrent and group minutes are not listed thus there is not a skip pattern when the sum 0 Your interpretation of edit 3569 appears to be correct However your interpretation of edit 3570 would allow values which do not conform to the data specs Your interpretation says that if the first character is alphabetic then character positions 4 12 should be alphanumeric or blank Note that the original edit in the data specs says that if the first character is alphabetic then there must be 1 2 or 3 alphabetic characters followed by 6 or 9 numbers For example according to the data specs the following codes would be acceptable A123456 A123456789 AB123456 AB123456789 ABC123456 ABC123456789 Your interpretation would allow these codes as well However your interpretation does not specify the number of numeric digits which must follow the alpha portion Therefore your edit would allow the following codes which do not conform with the data specs ABC1 AB123 A12345 20110803 003 Topic E Specs Question Edit 3812 b states If A0310C 0 1 4 or AO310F 01
178. 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 Page 25 of 100 Answer Edits 3557 3558 and 3559 address this issue consistency fatal skip pattern Please refer to the error message chapter of the Provider Users Manual as well as 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 CMS will not make any changes to Appendix E The information is available if you wish to create your own a combined table You would only need to add rows for the deleted items to the table CMS is required to meet 508 requirements which allows the item sets to be read and navigated by assistive technology Our software meets the requirements for 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 ID Topic PO 20111110 008 20110803 001 20110803 002 have a question about editing 00450A Item XO900E should be c
179. ties 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 checklist 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 ID Topic Question Answer that assessment follow the old pre April 1 2011 Section Data specs version summary that has been posted on S specifications Or should it follow the new post April 1 the MDS 3 0 technical information web page for details 2011 Section S specifications about version control Will software vendors need to support both versions of Only warnings are issued for section S items when item is section S for a state that has made changes For example missing or the response is missing or invalid if on April 5th the facility needs to correct an MDS from March
180. tion is in the field called isc_id If this field contains dashes the combination of RFA values is not allowed Instead of 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 The text field in each question in items VO200A01 V0200A20 is not submitted to CMS ID Topic Question Answer ee es V there is no specification for how that data would be submitted 20100225 015 E Edit 3789 states In your example where a discharge is combined with a Specs RULES FOR NEW RECORDS WHERE X0100 1 comprehensive assessment both rules would apply a If A0310A is equal to 01 03 04 05 this is a Each of these rules is applied independently 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 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 A
181. to be calculated by the ASAP system 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 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 document Additional Items Required by States for 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 their Quarterly NQ or PPS NP assessments CMS does not create state specific printable item subsets For October 1 2010 the states asking for additional items on their quarterly do not want the Section V items This is a change to the items on the state s OBRA quarterly NQ Topic ID G 20100820 016 Section S 20100820 015 G Section S 20100820 007 G Section S Question name would be confusing 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 th
182. turn assessment for a Medicare stay If a Start of Therapy OMRA is performed and the 5 Day or 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 20100720 016 A Policy 20100720 006 A Policy Question A draft version of an MDS 2 0 vs 3 0 crosswalk was published in August 2008 was wondering if there is an updated version of that document available have been running our outputs through the VUT to compare its results to our validator We still have a fundamental disagreement with Part B of edits 3662 through 3667 Part B always states that the number of pressure ulcers present at admission must be less than or equal to the number present now This requirement does not allow for the resident to be getting better i e have fewer ulcers now than they did at admission Consider the simple scenario of a resident arriving from another facility with one Stage 3 ulcer and at the time of assessment not just an admission assessment it could be a year later it has improved to become a Stage 2 The Page 10 of 100 Answer c All requirements for both the St
183. two character state code The valid state codes are listed in the data submission specs for the STATE_CD item For example submitting XY will cause Error 1008 The ASAP system supports ASCII encoding only 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 Topic 20101220 012 E Specs Question What is the correct format for the electronic file for ongoing dates or My record is rejected when submit or in A2400 Page 33 of 100 Answer 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 The numeric characters 0 through 9 The letters A through Z and a through z The character The following special characters at sign single quote forward slash plus sign i underscore e Embedded spaces spaces surrounded by any of the characters listed above For example LEGAL TEXT would be allowed Depending upon the particular date item th
184. u please clarify how to answer this question For example should users always choose answer 2 to 3 Page 36 of 100 Answer A0410 3 CMS only has System of Record SOR authority to access those records with a submission requirement value 3 A record with A0410 3 will be edited by the ASAP system and if no fatal errors occur will accept the record and store it in the ASAP system CMS will have access to the record A0410 2 Some states have a law that allows them to collect MDS assessments on licensed only beds The authority is the submission requirement value 2 CMS cannot access these records only the state can access these records States with these laws must set a parameter in the ASAP system indicating that they have a law that allows them to collect When the ASAP system receives a record with an A0410 2 the ASAP system checks to see if the state of the record has set their authority to collect submission requirement 2 records indicator to Y If the state has set their indicator to Y then the record will be edited by the ASAP system and if no fatal errors occur will accept the record and store it in the ASAP system The state will have access to the record CMS will NOT have access to the record Records with a submission requirement 2 should only be transmitted for states with a law to transmit Records with a submission requirement 2 in states with their indicator set to N will be cleared out from the su
185. ues a fatal error so the record is rejected If the recalculated PHQ value equals the submitted value then there is no need to store it as they are the same Another calculated field the ASAP system stores is the urban rural flag which is looked up for use in calculating the RUG HIPPS group 20100420 38 E If FO300 0 then all active items from FO400A through The only way that F0300 will equal skipped will be if Specs FO700 must equal For similar sections Section C BO100 1 if the resident is comatose This case is Page 45 of 100 4 Topic ae 00420 37 er 20100420 33 an Question Pe eee eel E the rule also includes Just want to clarify if this Pe teen be eel E A or just 0 Where can find a listing of the items that are included on the different MDS assessment types like Discharge Assessment Quarterly Assessment PPS only assessment etc Is there a specific program that we need to use to create the zip submission file Page 46 of 100 Answer handled by Edit 3609 Go to http www cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html 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 item names There is an
186. uirement Item A0410 State assigned facility submission ID FAC_ID _ Production test code PRODN_TEST_CD 20100225 053 A We see that the MDS form has copyright information at the The copyright needs to appear on all versions of the MDS Policy bottom of some section pages For example Section D has 3 0 either on screen or on paper 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 20100225 049 A How does the Care Area Assessment impact the Care Area The MDS 3 0 ASAP software uses the information sent in Policy Assessment triggers see that CMS came out with the care the assessment to determine whether a trigger occurs or area assessment but did not change anything with the Care not From there a care area assessment is warranted if an Area Assessment triggers There is a lot more to the area triggers Detailed information is available in chapter 4 assessment than there is to the triggers Se ee oy the MDS 3 0 RAI Manual Will the government prange an XML Collection Schema for Policy Microsoft SQL Server 20100225 039 A CATs Worksheets Appendix C of the RAI Manual has this information eee Boy Will CAT worksheets be developed If so what is timeline for aoa vendor specs 20100225 012 A For most of the interviews the initial question to determine There will be no linkage for edits bet
187. user may request the report through the CASPER system in the MDS 3 0 NH Final Validation or MDS 3 0 SB Final Validation report categories They will enter the submission ID and run the report The requested report Page 94 of 100 Question Topic Section 4 page 4 of the MDS 3 0 Provider User s Guide says the Final Validation Reports for Swing Beds will be located in CASPER reports with a folder ID of SB Provider Internal Number VR What number is the Provider Internal Number specifically Is it equivalent to the Nursing Facility ID FAC_ID 20100820 034 ASAP 20100820 033 20100820 032 ae When the Submission Confirmation message is presented after a provider uploads a file is the Submission ID a unique field that will never be used to identify another submission Can Nursing Facility and Swing Bed assessments be included in the same zip file CMS State Site Will we be logging into the same location Will the process screens change for logging in Is there any supporting documentation that we can receive Any specification documentation on the submission process would be greatly appreciated Corporate Vendor Account Will anything change with this account Will the current ID and password still be valid or will we require a new account Might it be possible for CMS to provide a copy of the HTML that will be used for the login submission and validation web pages so we can at least see the new process flow and HT
188. value there won t even be a warning A1300A is active on all subsets but the XX and it has item values of Text or Blank not available or unknown Do the states have a way to set up this field so that the Blank not available or unknown is not a value option We vendors are hearing from more than one state that they require or that providers must complete the A1300A D items on all assessment types ISCs and that vendors should comply with the state requirement Is it possible to get a copy of your state optional info as we 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 Since the footer of each the Item Subset MDS3 0_Comp is MDS 3 0 Nursing Home Comprehensive NC it does not appear that we can use that set for a Quarterly as the form Page 58 of 100 Answer No states can only add items to the NQ and NP ISCs They cannot add non section S items to any other ISC 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
189. ween items involving Policy whether the resident interview can take place involves B0700 whether the resident can be understood If they are rarely never understood the interview is skipped and a staff assessment is generally completed Since field B0700 Makes Self Understood refers to a resident being understood and answer 3 Rarely Never Understood will there be a link Page 14 of 100 Topic Question Answer ID e f between this question and the initial interview question s For example if B0700 3 then C0100 0 etc 20100225 005 A If a correction needs to be submitted for an MDS assessment There is no time limit for a correction An assessment is that CMS has already accepted is there a time limit on not in compliance until it is accepted so the 14 day submitting such correction i e only have X months to window is the time frame 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 20100114 058 A In MDS 2 0 we had RAP worksheets Will there be similar There is no mandatory worksheet that needs to be Policy worksheets associated with CATS in 3 0 completed for MDS 3 0 There is a set of tools that you will see when Appendix C is posted that can be used voluntarily by nursing homes 20100114 057 A Will the QIS specifications be adjusted for the changes in Yes they wi
190. y indicates the allowable values for items QO500B Q0550A and Q0550B if Q0400A 0 and A0310A 01 03 04 05 it just means that you are now clarifying this 04 07 10 NOTE This 2012 issue and its resolution replaces issue 02 above Edit 3833a changed to say then both of the following rules apply Page 21 of 100 Edit 3833a should be a If QO400A 0 and A0310A 01 03 04 05 Answer A new entry for SPEC_VRSN_CD should have been added for version 1 11 0 of the data specs The value list for SPEC_VRSN_CD should include the following entry 1 11 Fourth update to data specifications effective 10 1 2012 You should therefore submit SPEC_VRSN_CD 1 11 for all assessments with a target date on or after 10 01 2012 We will add this issue to an errata document No changes are being made to the printable item sets for October 2012 so there are no new entries for ITM_SET_VRSN_CD The wording for M0900 was changed in Version 1 10 4 Effective 04 01 2012 You can download the MDS 3 0 Item Subsets from the MDS 3 0 Technical Information page on the CMS web site http Awww cms gov Medicare Quality Initiatives Patient Assessment Instruments NursingHomeQualitylnits NHQIMDS30Technic allnformation html This is an expansion of an existing edit not a new edit As currently written in v1 11 0 the data specs do not specify the allowable values for items Q0500B Q0550A and Q0550B if Q0400A 0 and A031
191. ys Because this concept is not used for RUG IV the ordered therapy items were not added to MDS 3 0 Ordered therapy therefore cannot be used to make RUG III calculations from MDS 3 0 ID 20100225 035 20100225 024 Topic RUGS K K RUGS Question Chapter 3 Section Z Assessment Administration Nov 2009 pdf Page Z 1 makes reference to a HIPPS code link as can be seen below e The HIPPS code is a Skilled Nursing Facility SNF Part A billing code and is composed of a three position code representing the RUG category label plus a two position assessment type indicator For information on HIPPS access http www cms hhs gov ProspMedicareFeeSvcPmtG en 0O2_HIPPS CODES asp TopOfPage As avendor are we to continue using the existing Definition and Uses of HIPPS Codes 3 17 2008 Version 4 document that we ve been using for MDS 2 0 or will there be updated HIPPS code document provided specifically for MDS 3 0 Just to confirm assume that since Z0300 fields for Insurance Billing are not in the data specs that CMS is not collecting that information and therefore does not care how they are used Answer The HIPPS codes have been completely revised for MDS 3 0 and RUG IV The HIPPS Code Master List referenced below will be updated in the future as needed Chapter 6 of the RAI manual discusses the new HIPPs codes for MDS 3 0 RUG IV A vendor should be able to determine the HIPPS code from the information in Ch

MDS 3.0 Vendor Q & A Consolidated 11-2-2010

Contents

Download Pdf Manuals

Related Search

Related Contents

MDS 3.0 Vendor Q &amp; A Consolidated 11-2-2010

Contents

Download Pdf Manuals

Related Search

Related Contents

MDS 3.0 Vendor Q & A Consolidated 11-2-2010