MDS Alert

Published on Tue Nov 04, 2003 PDF

Use the Internet to stay on top of MDS changes. The Centers for Medicare & Medicaid Services plans to post updates to the Resident Assessment Instrument user's manual on its web site on the fourth Monday of each month (www.cms.hhs.gov/medicaid/mds20/man-form.asp). The changes are effective the day CMS posts them to the Web site. However, don't expect frequent updates. CMS recently posted an August 2003 update that contained some reimbursement-driven and other key clarifications.
 


Using "NA" or a circled dash as a no-information code on electronic MDS records is a no go unless CMS changes the data specifications. The August 2003 revisions to the Resident Assessment Instrument (RAI) user's manual says facilities can use the circled dash or the "NA" for the no-information code, in addition to the standard dash. This will work on manual forms but not electronic ones. CMS has not changed the data specifications, so the "NA" or circled dash won't work on electronic submissions to the state.




Nursing home residents and facilities now have a new venue for settling quality-of-care complaints. State-run quality improvement organizations (QIOs) last month began providing a new mediation option to help dissatisfied Medicare beneficiaries or their relatives resolve complaints about a nursing home or other provider's care.
 
Here's how it works: The QIO reviews a complaint to determine whether it merits a medical record review. If the QIO finds the physician or other provider met the professional standard of care, but the care could have been better - or if miscommunication appears to have caused the complaint - then the QIO would set up mediation, explains Richard Deutsch, spokesperson for the American Health Quality Association.
 
Say the beneficiary's representative files a complaint stating his parent was discharged before he was able to walk. And the medical record shows the patient could walk with assistance and physical therapy in the home was ordered. But no one explained that arrangements had to be made to obtain therapy.
 "Both parties can learn from mediation, as the process gives them a chance to see each other's viewpoint," Deutsch tells Eli.




The Medicare SNF coinsurance amount is going up on Jan. 1. It soon will be time to adjust your SNF's billing systems to capture the annual increase to the daily coinsurance, which will go from $105 to $109.50 on Jan. 1. The coinsurance applies to days 21 through 100 of a Part A SNF stay.