The MDS Mentor March 2011 V4 Issue 1
Contents
1. http www mdstraining org upfront ul as Quality Reporting System QRS DADS information site on Texas nursing homes http facilityquality dads state tx us Nursing Home Compare CMS site that compares nursing homes in a given area http www medicare gov NHCompare Include DataSection Questions SearchCriteria as 5 Star Technical Manual Explains data used to create the 5 Star Report http www cms gov CertificationandComplianc 13 FSQRS asp TopOfPage2. not return within 30 days Texas does not require facilities to correct the discharge assessment to discharge return not anticipated This is true if the resident goes to the hospital and then goes toa different nursing facility goes straight home dies etc In other words a discharge return anticipated never needs to be updated to discharge return not anticipated However if facility or corporate policy is to correct a discharge return anticipated to discharge return not anticipated once it is determined the resident will not return Texas does allow it to be completed Last but not least when a resident returns to the facility over 30 days after a discharge return anticipated it is considered a new ad mission and a new OBRA Admission assessment must be completed MDS Modification Secrets When a mistake is discovered in an MDS that has been submitted to CMS a correction is required Chapter 5 of the RAIM3 goes into great detail concerning corrections Modifications are particularly tricky but a few sim ple secrets can help you perform them correctly The least known secret of modifications involves item Z0400 Signatures of Persons Completing the Assess ment or Entry Death Reporting When any section of an MDS is modified or inactivated Z0400 must be signed and dated by facility staff who certify the accuracy of the corrected data The facility staff certifying the cor rected data may be di
3. AI Coor l asi dinators who help all Date SNF benefit exhausts i e the 100th day of the benefit or state MDS RAI coor Date of last day covered as recorded on the effective date from the Generic Notice or dinators with MDS issues Cheryl s ex pertise will now benefit swing bed Date the resident was discharged from the facility see Item A2000 Discharge Date and nursing facilities across the nation The last paid day of Medicare A when payer source changes to another payer regardless if the resident was moved to another bed or not or It is essential when the resident does not exhaust 100 benefit days that MDS coordi nators are aware of any notices provided to a Medicare Part A recipient in the facility Many times facility staff will mention that they were unaware that a Generic Notice listing the last day of Medicare Part A coverage was provided to the resident Next it is crucial to understand that when a payer source changes for example from Medicare to Medicaid that the payment source at midnight is considered the payment source for the entire day The last day of the Medicare Part A stay would have been the day before the payer source changed Finally the day of discharge can be the ARD of a Medicare Part A assessment espe cially when the resident is discharged unexpectedly when none of the earlier rules for setting the end date of the Medicare stay apply and it is a valid date for that type of MDS It is sugge
4. The MDS Mentor is published in March June September and December each year ACRONYMS Assessment Reference Date ARD Care Area Assessment CAA Centers for Medicare and Medicaid Services CMS CMS Long Term Care Facility Resident Assessment Instrument User s Manual Version 3 0 RAIM3 Minimum Data Set MDS Omnibus Budget Reconciliation Act OBRA INSIDE THIS ISSUE 00400D Respira tory Therapy Can a LVN Conduct Respiratory Train ing MDS News in Review Discharge Assess ments in Detail MDS Modification Secrets A2400C and the Medicare MDS Incorrect Resident Information Useful Web Links 1 2 The MDS Mentor Cheryl Shiifer BSN RN RAC CT MDS Clinical Coordinator Andy Alegria MDS Automation Coordinator VOLUME 4 ISSUE OO400D Respiratory Therapy From the RAIMS3 page 0 18 For purposes of the MDS providers should record services for respiratory psycho logical and recreational therapies Item 00400D E and F when the following criteria are met 1 the physician orders the therapy 2 the physician s order includes a statement of frequency duration and scope of treatment 3 the services must be directly and specifically related to an active writ ten treatment plan that is based on an initial evaluation performed by qualified personnel See Glossary in Appendix A for definitions of respi ratory psychological and recrea ti
5. annot develop the curricu lum and training materials independ ently The LVN must demonstrate compe tency in training other LVNs This includes having a system in place to document the competency of the LVN to both provide respiratory therapy services and train other LVNs in res piratory therapy services There must be a system in place to periodically establish continued nursing competence at least annu ally or at some other specified inter val I I 4 w ee ee ee VOLUME 4 ISSUE PAGE 3 MDS News in Review On January 11 2011 CMS released new technical Providers may optionally implement the new cor specifications that will take effect April 1 2011 This rection procedure prior to April 1 2011 CMS will mostly affects MDS software vendors but includes a update chapter 5 of the MDS 3 0 RAI Manual in change to the Modification Inactivation policy Start Spring 2011 to reflect this policy ing April 1 2011 the reason for assessment items as sessment reference date ARD discharge date and en _ try date can no longer be changed with a modification record on MDS 3 0 records Instead these items must be corrected by inactivating the old record and submit ting anew record The April 1 2011 start date refers to the date that the MDS 3 0 correction record is sub mitted not the ARD of the record On March 29th 2011 www QTSO com made jJRAVEN version 1 1 0 available jRAVEN users should update to t
6. fferent from the facility staff who certified prior data Each signature certifying the accu racy of the corrected data is accompanied by the date that the corrected data was collected or confirmed Once Z0400 is appropriately signed and dated for the corrected data the RN Assessment Coordinator can complete item X1100 for the corrected MDS Never change Z0500 unless that is one of the items that you are modifying because the RN did not sign the assessment on the date indicated Z0500 is always the signature and date that the RN signed the original MDS assessment a For example an assessment needs to be modified because A0700 does not contain a necessary to indi cate that Medicaid is pending To modify the assessment follow these steps 1 Complete Section X except for X1100 2 Modify A0700 to contain a 3 To Z0400 add the staff member who completed and is accountable for the completion of Section X 4 To Z0400 add the staff member who completed and is accountable for the change to item A0700 5 The RN Assessment Coordinator signs X1100 Always remember to complete Section X first before modifying the data in the MDS since this will help to avoid the validation error stating that the original MDS cannot be found When an incorrect assessment meets the qualifications for a significant correction of a prior quarterly comprehensive assessment you must com plete a modification of the original incorrect assessmen
7. he newest version if they have not already Discharge Assessments in Detail We understand that the MDS 3 0 discharge assessment has become the bane of existence for many Swing Bed Nursing Facility MDS Coordinators However it is required by CMS and must be completed correctly Based on the questions that the Texas DADS MDS program gets related to discharge assess ments there is still confusion over how and when to perform them Included below are some important details about the often misunderstood discharge assessment A discharge assessment e Must be completed when the resident is discharged from the facility e Must be completed when the resident is admitted to an acute care hospital e Must be completed when the resident has a hospital observation stay greater than 24 hours e Must be completed on a respite resident every time the resident is discharged from the facility RAIM3 page 2 34 For example a discharge assessment would be required if a resident was out of the building for a hospi tal observation stay of 48 hours because this is clearly more than 24 hours but a discharge assessment would not be required when the resident goes on a leave of absence or out on pass If the resident dies while admitted to your swing bed or nursing facility dies at the hospital during a 24 hour observation when not admitted or dies while out on leave of absence then a death in facility tracking record is re quired and a discharge a
8. ing materials 00100D is a payment item and auditors can request that you provide evidence that training was conducted A sign in Sheet is not evidence that training was conducted but it is evidence that staff attended a training session Course scripts or outlines reference materials and handouts are evidence that training was conducted Continued on the next page VOLUME 4 I i i I l l i i N ISSUE PAGE OO400D Respiratory Therapy Continued from page 1 Ensure that there is documentation in the nurse s files that they were trained by staff qualified to provide the training and that they are competent to provide respi ratory therapy services prior to coding any respiratory services on the MDS Compe tency is established by having documenta tion for one example a checklist that is initialed by trainee and trainer after suc cessful return demonstration that shows nurses who were trained were evaluated to ensure they learned and possess the skills to provide respiratory services Finally ensure that the number of days claimed for respiratory therapy in 00400D includes only those days where the resident received at least 15 minutes of set up time and 1 to 1 treatment time of respiratory therapy in one 24 hour day Also only the time a therapist or trained nurse remains with the resident during treatment may be counted Fi nally The time spent on documentation or On initia
9. l evaluation is not in cluded RAIM3 page 0 16 ss ce 2 Can a LVN Conduct Respiratory Training When the title question was asked CMS wrote Itis a facility responsibility to en sure that staff that conduct respiratory therapy follow their state practice act A challenge has been that many facility staff are not familiar with the requirements of their state practice act including the Nurs ing Practice Act available on the Texas Board of Nursing BON website at http www bon state tx us index html However to assist in clarifying this question and to avoid 1245 facilities in Texas contacting the BON all at once DADS staff met with BON staff and devel oped the following clarification congruent with both agencies guidelines The BON does not maintain a compre hensive list of tasks that LVNs may per form Each nurse has a different back ground knowledge and level of compe tence and must use their judgment in de ciding to accept an assignment A LVN who has demonstrated competency in pro viding respiratory therapy services may train other LVNs to provide respiratory therapy using the following guidelines The curriculum used to train other LVNs must be developed and ap proved by a certified respiratory therapist registered nurse or physi cian trained to provide respiratory therapy services A LVN may participate in developing the training curriculum to train other LVNs but c
10. onal therapies 4 the services are required and pro vided by qualified personnel See Glossary in Appendix A for defini tions of respiratory psychological and recreational therapies 5 the services must be reasonable and necessary for treatment of the resi dent s condition CMS recently clarified that scope of treatment item 2 above refers to indi cating the condition or disease being treated by the therapy as a part of the physician s order Some examples that can be used but only if they apply to the reason for the respiratory therapy for the resident are for Asthma or for Chronic Obstructive Pulmonary Dis ease Qualified person nel for delivering respiratory therapy are respiratory therapists or trained nurses following the state nurse practice act Some methods of developing trained nurses are to have them trained by arespiratory therapist or by a RN who was trained by a respiratory thera pist or a by a RN who has ad vanced academic training in respiratory therapy Ensure your training covers the res piratory therapy services offered in your facility and is titled as respiratory therapy training Don t call it nebulizer training there is more to respiratory therapy that just one piece of equip ment When the requirement is for res piratory therapy training that is exactly the title they expect to find in your documentation of the training In addi tion keep all your train
11. ordinator rar z g MDS Automation Coordinator COWIACT amp S 11307 Roszell Street Room 1310 epee P O Box 149030 San Antonio TX 78217 Mail Code 279 4 Phone 210 619 8010 Fax 210 619 8100 Shared Fax Call First Austin TX 78714 9030 Mail Code E 345 Phone 512 438 2396 Fax 512 438 4286 I i i i i i Shared Fax Call First a a a oe on a oe ee es ee ee ee ee es see ee ee es Useful Web Links DADS MDS Web Site Texas MDS site for MDS policy procedures clinical and technical informa tion including The MDS Mentor http www dads state tx us providers MDS Sign up for MDS Resource E mail updates Go to http www dads state tx us click on the E mail updates tab and follow the directions The DADS Texas Minimum Data Set MDS Re sources E mails are the key line of communication for MDS updates and alerts to nursing home and swing bed facilities from the DADS MDS staff Centers for Medicare amp Medicaid Services CMS MDS Web Site for MDS 3 0 MDS 3 0 High lights RAI Manual Item Sets forms related MDS 3 0 materials and a link to MDS 2 0 http www cms gov NursingHomeQualityInits 25 NHOIMDS30 as QIES TECHNICAL SUPPORT OFFICE QTSO MDS 3 0 2 0 jRAVEN RAVEN and AT amp T Client Software information Validation Report Messages Guides Training and DAVE DAVE 2 Tip sheets https www atso com CMS MDS Training Web Site MDS 2 0 computer based training CBT
12. ssessment is NOT performed If the resident dies after your facility has dis charged him or her perform a discharge assessment and NOT a death in facility tracking record For unplanned discharges the facility should complete the discharge assessment to the best of its abili ties The use of the dash is appropriate when the staff are unable to determine the response to an item including the interview items In some cases the facility may have already completed some items of the assessment and should record those responses or may be in the process of completing an assess ment RAIM3 page 2 34 Please note that if the resident interview was dashed because the discharge was unplanned then the staff assessment for that interview must also be dashed You cannot perform the staff assessment if the resident is not available in the building to perform the resident interview Every section of the MDS specifies the look back period for the items in that section Always report data from the entire look back period Even though the resident s status may have changed dramatically just before discharge the entire look back period for each section must still be observed The assessment ref erence date ARD of the discharge assessment is always the date of discharge Continued on page 4 VOLUME 4 ISSUE PAGE 4 Discharge Assessments in Detail Continued from page 3 When a resident is discharge return anticipated and does
13. sted that staff review and keep as a reference the excellent algorithm on page A 26 of the RAIM3 Incorrect Resident Information The Texas DADS MDS program has recently re Medicaid number and date of birth ceived numerous calls related to incorrect resident information Facilities are not receiving Medicare or Medicaid money because the resident s name social security number etc are incorrect Take steps to avoid this issue in the first place and to correct it when it occurs Implement procedures at your facility based on what you learn from the Resident Legal Name arti cle to ensure that correct resident information is col lected during resident admission Confirmation up front can help you avoid the issues that arise from incorrect resident information later If you encoun Please read the article Resident Legal Name on ter resident information inconsistencies during ad page 4 of the September 2010 MDS Mentor available mission or discover an MDS with incorrect resident on the DADS MDS website Wherever you see a ref information then correct the resident information erence to the resident name in the article you should whether that correction needs to be made with Medi also consider social security number Medicare care Medicaid or the MDS itself VOLUME 4 ISSUE PAGE 6 f ele ell elle E ee LT I zZ_ __ 0 Oe Aaa oa _ eae o _ Cheryl Shiffer BSN RN RAC CT JE Andy Alegria MDS Clinical Co
14. t in addition to completing a significant correction You are allowed to submit and modify MDS 2 0 assessments using the MDS 2 0 format up to three years after the ARD of any assessment where the ARD is earlier than October 1 2010 In gratitude we thank Nurses their willingness to serve we find so appealing bringing to us their comfort wisdom compassion and healing Written by Richard G Shuster VOLUME 4 ISSUE PAGE 5 A2400C and the Medicare MDS A difficult task for new MDS coordinators is figuring out the last day of the Medicare stay This is not only important for filling out item A2400C End Date of Most Recent Medicare Stay correctly for a Part A Medicare stay but also important for ensuring that the Assessment Reference Date ARD in item A2300 is always a date when the resident Come celebrate with was still receiving Medicare services and a date allowed by the RAIM3 for that type of Congratulations to assessment DADS MDS RN Cheryl ue Shiffer On February From the coding instructions for A2400C on page A 25 of the RAIM3 10 2011 Cheryl was e Code the date of last day of this Medicare stay if A2400A is coded 1 yes appointed as the e If the Medicare Part A stay is ongoing there will be no end date to report Enter dashes ee o o i the RAI Panel a se to indicate that the stay is ongoing lect croup of eicht e The end of Medicare date is coded as follows whichever occurs first state MDS R
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