MDS Alert
MDS & BILLING NEWS TO USE
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The Pressure Is On With Revised F314 Tag. The Centers for Medicare & Medicaid Services has released the long-awaited revised survey guidance for pressure ulcers - 40 pages of it, including a new survey investigative protocol and new language at F309 (quality of care) defining several types of non-pressure skin ulcers.
The guidance went into effect Nov. 12, according to the CMS transmittal at www.cms.hhs/gov/manuals/pm_trans/R4SOM.pdf. (For details, see the next MDS Alert.)
Facilities are out of luck when residents qualify for both RHC and SE3. In such a scenario, the RUG group will automatically place the resident in RHC, rather than the more lucrative SE3 clinical category. The Centers for Medicare & Medicaid Services told providers that its hands are tied in fixing the glitch in the payment algorithm, which arose out of congressionally enacted RUG add-ons. The agency will look at the issue as part of RUG refinements, according to information provided at a recent CMS-hosted SNF/LTC Open Door Forum.
CMS has released draft revised survey interpretive guidelines for tags F329-F331 (unnecessary drugs) and F425-432 (the entire pharmacy services section) for public comments. The draft includes language citing use of two antipsychotic drugs at the same time as a potential example of unnecessary drugs. That language was actually included previously in the now deleted Section N of the State Operations Manual, says Tom Clark, RPh, MHS, a member of the expert panel that developed the new guidelines. The draft also includes suggested behavioral monitoring tools for evaluating residents taking antipsychotic medications, which facilities could choose to use now, says Clark. These tools include the Cohen-Mansfield Agitation Inventory and The Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD).
MDS Alert
- Payment and Regulatory Compliance:
Keep Your RUGs Straight And Enjoy A Clean Compliance Slate
Jettison this dangerous idea about MDS accuracy. Don't be misled: MDS undercoding can be a [...] - Survey Compliance:
When Residents Take Antipsychotics, Keep Your Eye On QI 19 And The MDS Driving It
Use these strategies to survey-proof your coding and documentation. The MDS tells surveyors a tale [...] - Coding Quizzer:
Be Forewarned When You Code B4
A quick assessment won't do the trick. If a resident seems to have severe cognitive [...] - Drug Monitoring:
Is That Antipsychotic Med Really Helping? Check These MDS Sections Before Surveyors Do
Hint: Evaluate target behaviors in Section E4, but don't stop there. Let the MDS be [...] - Medicare Payment:
Kick Your Medicare Skilled Coverage Determination And Documentation Skills Into High Gear
Cover the coverage triad and combat these 4 expensive myths. Myths about Medicare skilled coverage [...] - What Do You Think?
Question: Do Medicare regulations ever allow a facility to delay skilled services beyond 30 days [...] - Case Study:
Ready, Set, Audit: Ensure Your Skilled Nursing Documentation Makes The Grade For Part A Coverage
Top-notch documentation builds a solid case for the resident being skilled ... here's how to [...] - Clip 'N Save:
Check Out The Exclusions, Risk Adjustments For QI 19
Mark sure to code excluded psychiatric diagnoses conditions. - Clip 'N Save:
Combine A Skilled Care Checklist And Narrative Notes Form
Here's an example of how to individualize documentation of skilled services. - MDS & BILLING NEWS TO USE
The Pressure Is On With Revised F314 Tag. The Centers for Medicare & Medicaid Services [...]