Category: MDS

Error Message 3616b on the MDS 3.0 NH Final Validation Report

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CMS posted the following information to their MDS 3.0 Technical Information webpage on 10/2/19:

  • A new version of RUG-IV has been applied to the MDS ASAP system. Effective Sunday, September 29, 2019, the ASAP will evaluate all RUG-IV HIPPS codes using version 1.04. This version is backward compatible and will evaluate assessments with all target dates before or after October 1, 2019. To avoid receiving the ASAP system warning message -3616b, please update the RUG-IV version number to “1.04” to submit your HIPPS code.

Optional State Assessment (OSA)

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There is a new item, A0300A Optional State Assessment, that asks “Is this assessment for state payment purposes only?” The State of Missouri is not a case mix state so we do not require the Optional State Assessment (OSA), however, there may be some HMOs or replacement plans which ask you to complete the OSA for payment purposes. You will not submit these OSA assessments to the QIES ASAP system. You must contact the specific HMO or replacement plan to find out what they require.

Interim Payment Assessment (IPA)

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The IPA is an optional PPS (Medicare Part A) assessment. However, the switch over from RUG-IV to PDPM requires a “transitional” IPA in order for SNFs to bill Medicare for days in October if the resident was admitted to the SNF for their Med A stay prior to 10/1/19 . To set up an IPA assessment, including the “transitional IPA”, you will need to do the following:

  • Code item A0300 Optional State Assessment “Is this assessment for state payment purposes only?” as “0. No”;
  • Code item A0310A Federal OBRA Reason for Assessment as “99. None of the above”;
  • Code item A0310B PPS Assessment as “08. IPA – Interim Payment Assessment”;
  • Code item A0310E “Is this assessment the first assessment (OBRA, scheduled PPS, or Discharge) since the most recent admission/entry or reentry?” as “0. No”;
  • Code item A0310F “Entry/discharge reporting” as “99. None of the above”.

New MDS 3.0 RAI Manual Released

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On September 18, 2019 CMS released the MDS 3.0 RAI Manual v1.17.1, effective October 1, 2019. This version of the MDS 3.0 RAI Manual incorporates clarifications to existing coding and transmission policy; it also addresses clarifications and scenarios concerning complex areas. Since the preliminary release of the manual on May 20, 2019, changes have been made to clarify which assessments swing bed providers must complete; the definition of the “interruption window” for interrupted Part A-covered stays; the coding of item I0200B; and changes related to group therapy policies, as well as other corrections. Please see the document titled “MDS 3.0 RAI Manual v1.17.1 Replacement Manual Pages and Change Tables_October 2019” posted in the Related Links section at the bottom of the CMS MDS 3.0 RAI Manual page located at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html.

Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Non-Compliance Letters

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CMS is providing notifications to facilities that were determined to be out of compliance with the quality reporting requirements for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), which will affect their FY 2020 Annual Payment Update (APU).

Non-compliance notifications were sent to the Medicare Administrative Contractors (MACs) and placed into facilities’ CASPER folders in QIES on July 16, 2019. Facilities that receive a letter of non-compliance may submit a request for reconsideration to CMS via email no later than 11:59 pm PST, August 15, 2019.

Instructions for the reconsideration process are in the non-compliance letter and available on the SNF Quality Reporting Reconsideration and Exception & Extension webpage.

SNF QRP Deadline

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The submission deadline for the SNF Quality Reporting Programs (QRP) is approaching. MDS data for January 1 – March 31 (Q1) of calendar year (CY) 2019 must be submitted no later than 11:59 p.m. Pacific Standard Time on August 15, 2019.

As a reminder, it is recommended that providers run applicable validation/analysis reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

CORMAC sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@cormac-corp.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

Updated Section GG Web-based Training Course

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CMS is offering a web-based training course on how to properly code of Section GG. This 45-minute course is intended for providers in the following care settings: Skilled Nursing Facilities (SNFs), Long-Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), and Home Health Agencies (HHAs); and is designed to be used on demand anywhere you can access a browser.

The course is divided into the following four lessons and includes interactive exercises that allow you to test your knowledge in real life scenarios:

  • Lesson 1: Importance of Section GG for Post-Acute Care
  • Lesson 2: Section GG Assessment and Coding Principles
  • Lesson 3: Coding GG0130.Self-Care Items
  • Lesson 4: Coding GG0170.Mobility Items

Click here to access the training.

If you have technical questions or feedback regarding the training, please email the PAC Training mailbox. Content-related questions should be submitted to the Quality Reporting Program Help Desk for your care setting.

MDS Section Q Process

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MO HealthNet has sent the following note and bulletin regarding Section Q of the Minimum Data Set (MDS):

Although Section Q is a mechanism whereby our program can learn about residents who want more information, and who may possibly transition via Money Follows the Person (MFP), the MDS Questionnaire and Section Q were in place before MFP was available in Missouri. The MFP program helps aged and disabled Medicaid-eligible people transition from facility settings back into the community. Our program provides information, as well as transition services, case management, and other services to qualified participants. Please see this bulletin that covers the MDS Section Q process.

Skilled Nursing Facility Quality Reporting Program Provider Training Event

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August 13-14, 2019: SNF QRP Provider In-Person Training
Location: Four Seasons Hotel, Baltimore, MD

The Centers for Medicare & Medicaid Services (CMS) will be hosting a 2-day Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) in-person ‘Train the Trainer’ event for providers on August 13 and 14, 2019 at the Four Seasons Hotel, 200 International Drive, Baltimore, MD 21202. This event will be open to all SNF providers, associations, and organizations.

Like the May 2019 SNF QRP Provider Training, the primary focus of this ‘Train-the-Trainer’ event will be to provide those responsible for training staff at SNFs with information about:

  • The transition to the Patient Driven Payment Model (PDPM), which becomes effective on October 1, 2019.
  • A review of SNF QRP changes and updates to the Minimum Data Set (MDS) 3.0 Version 1.16.0, which became effective October 1, 2018.
  • An overview of the eleven SNF QRP Quality Measures.
  • An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification And Survey Provider Enhanced Reports (CASPER) system to develop quality improvement plans.

During this event, presenters will incorporate additional information into their presentations based on questions received from participants during the May training.

More information including the agenda and registration can be found at the link above.

MDS 3.0 RAI Manual v1.17 October 1, 2019 Posted

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On 5-20-19, CMS posted the MDS 3.0 RAI Manual v1.17, which will be implemented on 10-1-19. The MDS 3.0 RAI Manual v1.17 contains many updates including information related to the Patient Driven Payment Model (PDPM). You can find the new manual at www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/MDS30RAIManual.html. It is  at the bottom of the page in the Related Links section. Please check back prior to October 1, 2019 for a final posting which may contain additional updates.

State RAI Coordinator Coming to a QIPMO MDS Support Group Meeting Near You!

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June 21, 2019: Trenton
June 25, 2019: Louisiana
June 26, 2019: Jefferson City
July 9, 2019: Gower
July 11, 2019: Canton
July 12, 2019: Independence
July 19, 2019: Marshall
July 23, 2019: Macon

Stacey Bryan, the State RAI Coordinator, will present at QIPMO MDS Support Group Meetings across the state. More dates and locations to come!

Payroll-Based Journal (PBJ) Deadline

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The submission deadline for PBJ is approaching. PBJ data for 1/1/19 through 3/31/19 is due on May 15, 2019. CMS uses PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.

More information about PBJ can be found on the CMS webpage www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html.

SNF QRP Deadline

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The submission deadline for the SNF Quality Reporting Programs (QRP) is approaching. MDS data for October 1 – December 31 (Q4) of calendar year (CY) 2018 are due with this submission deadline. All data must be submitted no later than 11:59 p.m. Pacific Standard Time on May 15, 2019.

As a reminder, it is recommended that providers run applicable validation/analysis reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

CORMAC sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@cormac-corp.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

CMS – Skilled Nurse Facility Quality Reporting Program Provider Training

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May 7-8, 2019: Skilled Nursing Facility Quality Reporting Program Provider Training
Location: Sheraton Kansas City Hotel at Crown Center, Kansas City

The Centers for Medicare & Medicaid Services (CMS) will be hosting a 2-day Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) in-person ‘Train the Trainer’ event for providers on May 7 and 8, 2019, at the Sheraton Kansas City Hotel at Crown Center, 2345 McGee Street, Kansas City, MO 64108. This event will be open to all SNF providers, associations, and organizations.

The primary focus of this ‘Train-the-Trainer’ event will be to provide those responsible for training staff at SNFs with information about:

  • The transition to the Patient Driven Payment Model (PDPM) which becomes effective on October 1, 2019.
  • A review of SNF QRP changes and updates to the Minimum Data Set (MDS) 3.0 Version 1.17.0, which became effective October 1, 2019.
  • An overview of the eleven SNF QRP Quality Measures.
  • An interactive session on the use of reports to identify opportunities for process improvement and utilize information contained in reports available via the Certification And Survey Provider Enhanced Reports (CASPER) system to develop quality improvement plans.

Click here to access the full agenda.

Registration for the in-person training is limited to 250 people on a first-come, first-serve basis.

For those not able to attend in person, the session will be available via webcast. A URL to access the webcast will be provided to participants closer to the training event.

QIPMO – Administrator and DON Support Group – CASPER Reports

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March 26, 2019: CASPER/Reports, DON Support Group, NHA Support Group
Location: First Christian Church, Shelbina

Stacey Bryan BSN, RN, RAC-CT, State RAI Coordinator, Section for Long Term Care Regulation, Division of Regulation and Licensure is going to go over CASPER Reports and how to use them as a tool in your home. Administrators and DONs both will benefit by learning what to do with these valuable reports.

Updated MDS 3.0 RAI Manual Errata

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The PDF file labeled “MDS-3.0-RAI-Manual-v1.16R-Errata-v1.1-February-13-2019”, available in the Downloads section of the MDS 3.0 RAI Manual page, contains revisions to pages in Chapter 3, Section J, of the MDS 3.0 RAI Manual v1.16R, that (1) address coding item J0200 when the resident interview should have been conducted but was not conducted within the look-back period of the ARD and (2) amend the criteria for major surgery and correct the associated examples.

Changed manual pages are marked with the footer “October 2018 (R).”

The errata document begins with a table that lists all identified revisions and the pages to which they have been applied. Following the table are the actual corrected replacement pages for insertion into the printed manual.

MDS 3.0 QM User’s Manual Version 12.0 Now Available

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The MDS 3.0 QM User’s Manual Version 12.0 has been posted. The MDS 3.0 QM User’s Manual V12.0 contains detailed specifications for the MDS 3.0 quality measures. The MDS 3.0 QM User’s Manual V12.0 can be found in the Downloads section of this page and the MDS 3.0 QM User’s Manual V11.0 has been moved to the Quality Measures Archive page.

Two files related to the MDS 3.0 QM User’s Manual have been posted:

  1. MDS 3.0 QM User’s Manual V12.0 contains detailed specification for the MDS 3.0 quality measures. MDS 3.0 QM User’s Manual V12.0 is available under the Downloads section of this page.
  2. Quality Measure Identification Number by CMS Reporting Module Table V1.7 documents CMS quality measures calculated using MDS 3.0 data and reported in a CMS reporting module.  A unique CMS identification number is specified for each QM. The table is available under the Downloads section of this page.

SNF QRP Deadline

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The submission deadline for the SNF Quality Reporting Programs (QRP) is approaching. MDS data for July 1 – September 30 (Q3) of calendar year (CY) 2018 are due with this submission deadline. All data must be submitted no later than 11:59 p.m. Pacific Standard Time on February 15, 2019.

As a reminder, it is recommended that providers run applicable validation/analysis reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

CORMAC sends informational messages to IRFs, LTCHs, and SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@cormac-corp.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

Payroll-Based Journal (PBJ) Deadline

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The submission deadline for PBJ is approaching. PBJ data for 10/1/18 through 12/31/18 is due on February 14, 2019. CMS uses PBJ data to determine each facility’s staffing measure on the Nursing Home Compare tool on Medicare.gov website, and calculate the staffing rating used in the Nursing Home Five Star Quality Rating System.

More information about PBJ can be found on the CMS webpage www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ.html.

SNF PPS: New Patient Driven Payment Model Webpage

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On October 1, 2019, the new Patient Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV (RUG-IV) for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). Visit the new PDPM webpage to prepare for this change. This site includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation.

RAI Process from Start to Finish

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January 22-23, 2019: Columbia
April 17-18, 2019: Kansas City
June 18-19, 2019: Chesterfield
August 6-7, 2019: Columbia
October 15-16, 2019: Springfield

This workshop will look at the RAI process from the beginning to the end. The MDS is used for both a clinical assessment and a financial assessment and this workshop will discuss the rules on scheduling these assessments and meeting the requirements individually and combined. From coding the MDS, we will then look at the CAA to care plan process.

This workshop is for individuals in long-term care who coordinate and/or code the MDS. Typically, this is an RN or LPN with the title of MDS Coordinator or Care Plan Coordinator. This is also for the DON or ADM who needs a better understanding of the complexity of the RAI process.

 

Medicare from Start to Finish

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March 19, 2019: Columbia
May 21, 2019: Springfield
July 16, 2019: Kansas City
September 17, 2019: Chesterfield
November 13, 2019: Columbia

This one-day workshop will begin with how to gain access to and read the MDS reports from CASPER in order to self-audit your RAI process. The completion of the MDS is becoming more and more difficult and confusing. This workshop will help the MDS Coordinator and other members of the interdisciplinary team to understand the admitting criteria and the ongoing documentation needs of the Medicare resident. The RAI process in relationship to Medicare is also confusing and errors can be a financial nightmare for facilities. This workshop will help clear up the confusion surrounding the process.

This workshop is geared towards those individuals working in long-term care who have a leadership role such as the ADM, DON, ADON, or MDS Coordinator.