Download The MDS Mentor - Texas Department of Aging and Disability Services

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
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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
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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
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PAGE
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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
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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
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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
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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.