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The MDS Mentor INSIDETHISISSUE: 1 ItemA0100:CommonCodingChallenges 2‐4 Z0400andZ0500SignatureGuidance CherylShiffer,BSN,RN,RAC-CT MDSClinicalCoordinator 4 TMFAnnouncesVideoSeriesonQuality Measures BrianJohnson QIES&MDSAutomationCoordinator 5 MDSNewsinReview 6 ContactUs 6 UsefulWebLinks V O L L U U M M E E V O 7 7, , I IS SS SUUE E 1 I * TheMDSMentor ispublishedin March,June,Sep‐ tember,andDecember eachyear. ACRONYMS: AssessmentReferenceDate (ARD) CentersforMedicare& MedicaidServices(CMS) CMSLong‐TermCareFacili‐ tyResidentAssessment InstrumentUser’sManual Version3.0(RAIM3) InterdisciplinaryTeam (IDT) MedicaidEligibilityService AuthorizationVeri ication (MESAV) MinimumDataSet(MDS) OmnibusBudgetReconcili‐ ationAct(OBRA) ProspectivePaymentSys‐ tem(PPS) RegisteredNurse(RN) ResourceUtilizationGroup (RUG) SkilledNursingFacility/ NursingFacility(SNF/NF) M AJ RU CN HE 22 00 11 44 2 0 1 2 D E C E M B E R Item A0100: Common Coding Challenges Judgingbyareviewofthequestions SNF/NFandSwingBedstaffhaveasked aboutSectionA:Identi icationInformation,theitemgeneratingthemost amountofinquiriesinTexasisA0100. ThecodinginstructionsfrompageA-3 oftheRAIM3instructstaffto“•Enterthe nursinghomeprovidernumbers: A.NationalProviderIdenti ier(NPI) B.CMSCerti iedNumber(CCN) C.StateProviderNumber(optional)” FacilitystaffneedstonotetheState ProviderNumberisanoptional ield, meaningthatitisnotfederallyrequired. However,statesmayrequiretheitemand provideinstructions,asTexasdidinProviderLetter2010-19,ProviderRequirementsforMDS3.0,excerptedbelow: “ItemA0100C:StateProviderNumber: InTexas,theStateProviderNumber matchestheFacilityID/VendorNumber andwillbefourorsixdigits.IftheFacility IDendswithV01,excludeV01fromthe StateProviderNumber.SampleFacility IDs/StateProviderNumbersinclude 4611,0242,101371and000128. TheMDSStateProviderNumberisnot tobeconfusedwiththe9-digitMedicaid ContractNumber.InTexasMedicaid& HealthcarePartnership’s(TMHP)MESAV, the9-digitMedicaidContractNumberis calledthe"StateProviderNumber,"but thatisNOTthesamenumberthatisenteredintoMDSassessments.“ Whatactionshouldstafftakeifthe StateProviderNumberiswrong?Once theerrorisfound,ifyoursoftwareisset uptoenterthenumberautomatically, staffmustnotifyeitherthesoftware vendorand/orthebusinessof iceand havethemcorrecttheA0100Cvaluefor thefacility’spro ile.IftheA0100Cvalue isinputmanuallyoneveryMDS,then staffcanensurefutureassessmentsare correctsimplyby indingandentering thecorrectnumber. InTexas,thecorrectStateProvider NumbermatchestheMDSFacilityID. Therefore,staffcanverifythecorrect numberbyrunninganyCASPERreport andusingthe‘FindbyName’(insteadof ‘AddFacilityID’)option.Thecurrent MDSFacilityIDwillappearatthetopof almostallreports. Alsoparamount,frompageA-3ofthe manual,is“•Nursinghomesmusthave aNationalProviderNumber(NPI)anda CMSCerti iedNumber(CCN).“Facility staffneedstoensuretheseitemsare accurateoneachMDSpriortotransmission.The10-digitNPIisnumericand alwaysinputintoA0100A.TheCCNis onlyapplicabletocerti iedhomeswho participateinMedicareand/orMedicaid andisinputinitemA0100B.ForMedicaidonlyhomes,the6-spaceCCNisalphanumericand,inTexas,beginswitha “45”.IfMedicare(withorwithoutMedicaid),the6-digitCCNisnumericand beginswitha“6”.Onlyifthenursing facilityoranentirewingislicensed-only (e.g.,notcerti ied)isA0100Bleftblank. VOLUME 7, ISSUE 1 PAGE 2 Z04000 and Z0500 Signature Guidance We started this issue addressing the correct coding of an item in Section A. Now let’sjumptocoveringthecorrectcodingofa couple of items in Section Z, items Z0400 andZ0500,whichalsoappliestobothSNF/ NFandtoSwingBedfacilities. Item Z0400: Signatures of Persons Completing the Assessment or Entry/Death Reporting is the place where any person who was responsible for and determined the coding of any item on the MDS 3.0 record signs for the accuracy and truthfulness of thatinformation. American musician Pete Seeger once asked,“Doyouknowthedifferencebetween education and experience?” He then answered that education was what you get “whenyoureadthe ineprint;experienceis what you get when you don't.” Z0400 consistsofanAttestationStatementthatneeds tobereadandunderstoodeverytimeaperson gets ready to sign for the accuracy of anyitemsontheMDS.AsnotedonpageZ-6 of the RAIM3, “Each person completing a sectionorportionofasectionoftheMDSis requiredto signtheAttestationStatement.” One of many important assertions included in the Attestation Statement is to ensure stafflearnsthey“maybepersonallysubject to or may subject my organization to substantialcriminal,civiland/oradministrative penalties for submitting false information.” A screen shot of item Z0400 from the MDS itemsetisonpageZ-6oftheRAIM3,includingthecompletewordingoftheAttestation Statement. In addition, page Z-7 of the RAIM3 emphasizes: “Read the Attestation Statement carefully. You are certifying that theinformationyouenteredontheMDS,to thebestofyourknowledge,mostaccurately re lects the resident’s status. Penalties may beappliedforsubmittingfalseinformation.” notes, “Two or more staff members can complete items within the same section of the MDS.” So, when staff ills in item Z0400,anystaffmemberwhocodedentire sections or any portion of any section of the MDS “should identify which item(s) he/she completed within that section(pageZ-7).” Anotherpointmadeunderthecoding instructionsfrompageZ-7oftheRAIM3 is:“IfastaffmembercannotsignZ0400 onthesamedaythatheorshecompletedasectionorportionofasection,when thestaffmembersigns,usethedatethe item originally was completed.” Consider the following scenario: A staff member is assigned to complete the mood interviewinSectionD.Thestaffmember is aware of the requirement that interviews must be conducted in the lookback period, but CMS prefers, as noted onpageD-4oftheRAIM3,staffconducts this interview on “preferably the day beforeordayoftheARD.”Therefore,the staff member conducts the interview of theresidentontheARD,whichhappens tobeaFriday,andgathersalltheinformation and determines the correct coding of the mood interview items. The staff member then departs on a threedayweekendandreturnsonthefollowing Tuesday to encode the Section D interview items on the MDS in the facility software. Try to answer the following question: Based on the scenario above, what completion date is used for the moodinterviewitems? If you answered that it would be the date the items were originally completed, which was the ARD (the previous Friday),youwouldbecorrect.Staffonly inputthedateMDSdatawasencodedas the date completed when the items are For item Z0400, the coding instructions completed and encoded on the same from page Z-7 of the RAIM3 requires “All day. Otherwise, staff uses the date the staff who completed any part of the MDS itemsoriginallywerecompleted,which must enter their signatures, titles, sections {Continuedonthenextpage.} or portion(s) of section(s) they completed, and the date completed.” As the RAIM3 “Lo! where the rosy -bosomedHours, Fair Venus' train, appear, Disclose the longexpecting lowers, And wake the purpleyear! The Attic warbler poursherthroat, Responsive to the cuckoo'snote, The untaught harmonyofspring: While whispering pleasureasthey ly, Cool zephyrs through the clear bluesky Their gathered fragrance ling…” - Thomas Grey, “OdeontheSpring”, 1742 VOLUME 7, ISSUE 1 PAGE 3 Z04000 and Z0500 Signature Guidance {Continuedfromthepreviouspage.} was the date the data was gathered and thecodingwasdetermined. SectionZTip: CurrentlyZ0500is notanactiveitem, andthereforeisnot included,inthe NT/STTracking Recordcompleted whenaresident entersordiesina SNF/NForaswing bedfacility. In addition, there is another scenario thatcanbeeasilyconceivedfromthecodinginstructionsforitemZ0400.Thisscenario is that only one staff member can completeanentiresectionoftheMDSand still need to sign two or more times for thatsamesectioninitemZ0400.Ascoveredonthe previouspage,staffcompleting any items on the MDS “must enter theirsignatures,titles,sectionsorportion (s) of section(s) they completed, and the date completed.” Because it is possible itemswithinasectionwerecompletedon different dates, the same staff member mayhavetosignmultipletimestore lect accuratedatesofcompletionforeachsub -setofitems. Consider an additional situation, this time regarding Section C. What completiondatewouldbeusedifthestaffmember who conducted the interview in Section C on the ARD was also the staff memberresponsibleforcodingtherestof the active items in Section C and determined coding for those items three days aftertheARD? The answer is the staff member would indicatetheycompletedthementalstatus interview items on the ARD and then make another entry that they completed therestoftheitemsinthesectiononthe date on the calendar for three days followingtheARD. areportionsoftheMDSthatmaybeveriied with the medical record and/or resident/staff/family interview as appropriate.Forthesesections,thepersonsigning the attestation must review the information to assure accuracy and sign for thoseportionsonthedatethereviewwas conducted.Forsectionsrequiringresident interviews,thepersonsigningtheattestation for completion of that section should interviewtheresidenttoensuretheaccuracy of information and sign on the date this veri ication occurred.” This is one of therareoccasionswhenthesignaturedate for the accuracy of the interviews may be after the ARD. The other rare occasion when interviews may be conducted up to two days after the ARD is when it is a stand-aloneunscheduledMedicareMDS. However,inbothcases,asinmostother cases, the RN Assessment Coordinator (RNAC)signatureanddateforcompletion oftheMDSinitemZ0500wouldbeeither onthesamedatebutafterthetimeorafter thedateall activeitems ontheMDS were attested as accurate in Z0400. It is extremelyimportantthatthedateinZ0500B isnotbackdatedandindicatesthedatethe RN actually signed Z0500A. Furthermore, itisequallyimportantthatthepersoncertifyingtheMDSiscompleteisanRN. Also noteworthy, it is not always an error when Z0400 contains a date after Z0500.WastheMDSmodi ied?Ifso,the coderorcodersmustsignanddateforthe accuracy of Section X and the changed MDSitems.However,unlesstheRNsignaOne more potential issue emerges tureatZ0500Aand/orthedateatZ0500B when a staff member completes and en- aremodi ied,theRNcompletionsignature codes items on the MDS, but then is not and date at Z0500 remains unchanged on availabletosignitemZ0400fortheaccu- amodi iedrecord. racy of those items. The instructions on Under what circumstances can an LVN howtohandlethissituationareonpageZ input a date into Z0500B when the MDS -7 of the RAIM3: “If an individual who hasnotyetbeensignedbytheRNascomcompleted a portion of the MDS is not plete in Z0500A? The answer is there are available to sign it (e.g., in situations in NOcircumstanceswhenanLVNcaninput which a staff member is no longer em- a date in Z0500B when the MDS has not ployed by the facility and left MDS sec- beensignedinZ0500AbyaRN.Asnoted tionscompletedbutnotsignedfor),there VOLUME 7, ISSUE 1 PAGE Z04000 and Z0500 Signature Guidance {Continuedfromthepreviouspage.} onpageZ-8oftheRAIM3,“ForZ0500B,use theactualdatethattheMDSwascompleted, reviewed,andsignedascompletebytheRN assessmentcoordinator.”Whatifthefacility softwareautomaticallyinputstheelectronic signatureanddateofthepersonwholocks SectionZintoZ0500AandBrespectively whencertifyingtheSectioniscomplete? Wellthatmeansthepersonwholocksand notesSectionZiscompletemustbethe RNAC.Whatifthefacilitysoftwarerequires thatSectionZbelockedandthedateinput intoitemZ0500BpriortotheRN’ssignature inZ0500Ainordertobeabletoprintthe MDStobesignedbyfacilitystaffwhenelectronicsignaturesarenotinuse?Thenthis isanexampleofsoftwarethatisunusable forMDS3.0.Staffneedstodownloadand useJRAVEN,CMSfreeMDSsoftware. Finally,therearethreeZ0500-related issuesrequiringtheinactivationofanMDS: 1. TheMDSwastransmittedpriortothe RNACsignatureinZ0500A.TheMDS mayNOTbemodi iedtoaddtheRNsignatureanddate.TheMDSthatwas transmittedwasanincomplete,noncompliantandinvalidMDS.AllMDSthat itthiscriteriamustbeinactivated. 2. TheMDSwastransmittedafterthe RNACsignedtheMDSascomplete,but sectionsorportionsofsectionson theMDSwerenotactuallycompleted.TheMDSmayNOTbemodi ied toaddthemissingitems.TheMDS thatwastransmittedwasanincomplete,non-compliantandinvalid MDS.AllMDSthatmeetthiscriteria mustbeinactivated. 3. TheMDSwastransmittedafterit wassignedascompletebyanyone otherthantheRNAC(s)authorized bythefacilitytosignZ0500.Inthis case,eitherthepersonwhosigned wasnotanRNorthepersonwasan RNthatwasnotauthorizedbythe facilitytosignZ0500.FrompageZ-8 oftheRAIM3,“Federalregulation requirestheRNassessmentcoordinatortosignandtherebycertifythat theassessmentiscomplete.“ Afacilitymayhavemorethanone RNAC.OnceanMDShasbeeninactivated,theoriginalARDandcompletion datesmustNOTbereused.AnewMDS createdafterany“windows”closedrequiresthatanARDbesetfortoday’s dateoradateinthefuture,butonly whentheresidentstillresidesinthefacility.Also,ifthenewMDScontainsa Medicarereasonforassessment,theresidentmuststillbeonPartA. 4 The Purple Cow I never saw a Purple Cow, I never hope to see one; But I can tell you, anyhow, I'd rather see than be one. By: Gele Burgess (1866‐1951) TMF Announces Video Series on Quality Measures TMFHealthQualityInstitute,ourTexas QualityImprovementOrganization,is thrilledtoannounceaneweducationalvideoseriesonQualityMeasures. HereisthelinktotheTMFwebsite: http://texasqio.tmf.org/Home.aspx Jointhewebsitebycreatingyouraccount. JointheNursingHomeNetwork(just hittheorangeJoinThisNetworkbut‐ ton)whichislistedasHealthcareAcquiredConditionsinNursingHomes}. Manageyournoti ications–totellTMF howoftenyouwantanemailupdateon what’snewtothewebsite.Checkthe box.Nowyouhavefullaccesstothe website! Toviewthe irstpostinginthevideo series,QualityMeasureAnalysisandImprovement,clickthefollowinglink: http://texasqio.tmf.org/ Networks/ HealthcareAcquiredConditionsinNursingHomes/ QMVideoSeries.aspx Checkbackoftentoviewadditional postingsintheseries. OdetoMDSCoders TheRAIManualis notapurplebook, andtobepurpledoes notaspire, ButIcantellyou anyhow, Readitorretire! VOLUME 7, ISSUE 1 PAGE 5 MDS News in Review Badnewsisn't wine.Itdoesn't improvewith age. ColinPowell Ifyoudon't changeyourbeliefs,yourlife willbelikethis forever.Isthat goodnews? W.Somerset Maugham Newsiswhat somebodysomewherewantsto suppress;allthe restisadvertising. LordNorthcliffe Nothingin ine printisever goodnews. AndyRooney 1) ChangestoSTAR+PLUSMedicaid ManagedCareforNursingFacility Residents:Toallowmoretimeto addressstakeholderconcerns,the TexasHealthandHumanServices Commission(HHSC)haspostponed movingnursingfacilityresidentsinto STAR+PLUSMedicaidmanagedcare toMarch1,2015.HHSCwillcontinueworkingwithstakeholderstoensureasuccessfultransition. HHSCishostingaseriesofinformationsessionsonseveralMedicaid managedcareinitiatives,including theSTAR+PLUStransition.Questions canbesentto: [email protected] x.us. 2) ICD‐10Delayed:TheICD-10implementationhasbeendelayedbylegislativebilluntilOctober1,2015.CMS isreviewingtheimpacttorelated changesfortheOctober2014MDS updateandwillbeissuingastatement.CMSstaffareawarethatICD11isscheduledtobereleasedlater thisyear.CMShasnoplanstotransitiontoICD-11atthistime. 3) Processingmanualchangere‐ questsforitemA0410changesand incorrectFACIDs:CMShasremindedthestatesthatonlycurrentchange formswillbeaccepted.Asthese formschangeoccasionally,please contactBrianJohnson,theMDSAutomationCoordinator(referto‘Contact Us’detailsonpage6)togettheapprovedversionandthecorrectform foryourfacility.Facilitieswhichhad anylicensed-onlybeds(bedsnotapprovedforMedicareorMedicaidresidents)fromthetimeMDS3.0went live(October1,2010)arerequiredto illoutanassessment-levelchange request,oneformforeachassessmentinvolved.Thosethathavehad onlycerti iedbedsinMDS3.0,will completeafacility-levelchangerequest,oneformperfacility. 4) AppendixB,RAIM3:TheMarch14 updateofAppendixBtotheRAIManualcontainschangestothelistofstate RAIcoordinators,MDSautomationcoordinators,RAIpanelmembers,and regionalof icecontacts.The ileislocatedintheDownloadssectionat http://www.cms.gov/Medicare/ Quality-Initiatives-Patient-AssessmentInstruments/ NursingHomeQualityInits/ MDS30RAIManual.html. 5) NewMDSItemSets:Staffwhowant tostayabreastoftheproposedchangestotheMDSItemSetsandDataSpeciicationsfortheOctober1,2014releaseshouldoftenvisithttp:// www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/ NursingHomeQualityInits/ NHQIMDS30TechnicalInformation.html. Currently,thelatestversionoftheData Speci icationsisversion1.14.0(with errata)andthelatestversionofthe MDS3.0ItemSetsisversion 1.12.0.Pleaserem.Pleaseremember thattheseversionsshouldbeconsideredprovisionalordraftandsubject tochangeuntilthe inalspeci icationsarepublished. 6)NewMDSProviderTrainingvideos: OnMarch24,2014,CMSpostedupdatedtrainingvideosforseveralMDSsections(SectionI,G,MandO)to YouTube.Theycanalsobefoundinthe RelatedLinkssectionathttp:// www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/ NursingHomeQualityInits/ NHQIMDS30TrainingMaterials.html. VOLUME 7, ISSUE 1 PAGE 6 Contact Us CherylShiffer,BSN,RN,RAC-CT MDSClinicalCoordinator 11307RoszellStreet,Room1310 MailCode:279-4 BrianJohnson SanAntonio,TX78217 Phone:210.619.8010 Austin,TX78714-9030 Fax:210.871.6484(sharedfax—call irst) Fax:512.438.4285(sharedfax—call irst) QIESandMDSAutomationCoordinator DADSP.O.Box149030 MailCode:E-345 Phone:512.438.2396 Useful Web Links DADSMDSWebSite:TexasMDSsiteforMDSpolicy,procedures,andclinicalandtechnicalinformation(includingTheMDSMentor);http://www.dads.state.tx.us/providers/MDS/ SignupforMDSResourceE‐mailupdates:Gotohttp://www.dads.state.tx.us/,clickonthe “Subscribe”tabandfollowthedirections.The“DADSTexasMinimumDataSet(MDS)Resources” emailsarethekeylineofcommunicationforMDSupdatesandalertstonursinghomeandswing bedfacilitiesfromtheDADSMDSstaff. CentersforMedicare&MedicaidServices(CMS)MDS3.0website:MDS3.0RAIManual, ItemSets(forms),relatedMDS3.0materialsandleft-sidetablelinkstoMDStechnicalinformationandMDS2.0;http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/NursingHomeQualityInits/MDS30RAIManual.html CentersforMedicare&MedicaidServices(CMS)FY2012RUG‐IVEducation&Training: Clari icationandfollow-updocumentsrelatedtoMedicareMDS;http://www.cms.gov/ Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/RUGIVEdu12.html QIESTechnicalSupportOf ice(QTSO):MDS3.0/2.0,jRAVEN/RAVENandCMSNet(Verizon) information.ValidationReportMessages,Guides,TrainingandDAVE/DAVE2Tipsheets; https://www.qtso.com/ QualityReportingSystem(QRS):DADSinformationsiteonTexasnursinghomes; http://facilityquality.dads.state.tx.us/qrs/public/qrs.do NursingHomeCompare:CMSsitethatcomparesnursinghomesinagivenarea; http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp 5StarTechnicalManual:Explainsdatausedtocreatethe5StarReport; http://www.cms.gov/Medicare/Provider-Enrollment-and-Certi ication/ Certi icationandComplianc/FSQRS.html This guidance is being provided on the published date of The MDS Mentor (May 12, 2014). The reader should be aware that guidance regarding topicsinTheMDS Mentor may be time-limited and maybesuperseded by guidance publishedbyCMS orDADSatalater date. It is each provider’s responsibility to stay abreast of the latest CMS and DADS guidance.