MDS Alert
Check Out The Case-Mix States
PDF
Three have case-mix systems of a different feather. You have more than a 50 percent chance of being in a Medicaid case-mix state -- and those odds will likely grow as more states adopt this reimbursement approach. Colorado
There are about 26 states that use MDS-based RUG-III case-mix systems, according to Carol Job, RN, board chair for the American Association of Nurse Assessment Coordinators and a consultant with Myers & Stauffer in Topeka, KS. "Most of the Medicaid states use RUG-34 versus 53," she adds.
3 Case-Mix States of a Different Feather
New York uses RUG-II and the Patient Review Instrument, although the state is in a two-year transition to the RUG-III, which is the MDS system, says Patrick Cucinelli, financial policy analyst for the New York Association of Homes & Services for the Aging.
Texas currently uses the TILE system, which is based "roughly" on an earlier version of the RUG system, says Tom Plowman, spokesman for the Texas Health Care Association. But the "short answer" is that Texas is moving to an MDS-based RUG-III system. The state projects it may be in place by September 2008, he adds, "but we have a lot of work to do" to make that happen.
In addition, on Jan. 1, Illinois implemented an MDS-based reimbursement system to determine the nursing component of the facility's Medicaid rate, says Marilyn Mines, RN, RAC-C, BC, director of clinical services with FR&R Healthcare Consulting in Deerfield, IL. Fifty-one "reimbursable MDS items" are assigned minutes for one or more staff types, including unlicensed, licensed, social worker and activities, Mines explains.
"These reimbursable areas are very different than any RUG calculation for PPS or other state Medicaid systems," says Mines.
Following is the list of MDS/RUG-based case-mix states as of December 2006:
Georgia
Hawaii
Idaho
Iowa
Indiana
Kansas
Kentucky
Louisiana
Maine
Minnesota
Mississippi
Montana
Nebraska
Nevada
New Hampshire
North Carolina
North Dakota
Ohio
Pennsylvania
South Dakota
Utah
Vermont
Virginia
Washington
West Virginia
MDS Alert
- INFORMATION MANAGEMENT:
Stay In Good Survey Form: Keep The CMS-802 Info Ready To Go
Follow these steps to get your survey off on the right foot. You might think [...] - QUALITY OF CARE:
Use The MDS To Make Sure Residents' Meds Are Helping
These 3 snags can lead to F329 tags. The MDS can tell you if all [...] - MEDICATION MANAGEMENT:
These Tips Help You Match Diagnoses, Conditions To A Resident's Meds
Identify whether a resident really has a need for a medication. Pills are for ills [...] - CASE STUDY:
Meet The Short-Stay Challenge In Completing The CMS-802
This subacute facility knows where to collect information for the form -- and quickly. Facilities with [...] - CODING QUIZZER:
Is This Resident Delirious?
Cut through the coding confusion. How would you code this case example in Section B5 [...] - CLIP & SAVE:
Beware Differences Between MDS, CMS-802 Definitions
Find out where the crosswalk diverges. Picture this: A surveyor demands to know why the [...] - PAYMENT:
Keep Your Medicaid Case-Mix Straight
Use these strategic tactics to achieve fair payment. MDS teams in states where the MDS [...] - MEDICAID:
Check Out The Case-Mix States
Three have case-mix systems of a different feather. You have more than a 50 percent [...] - MEDICARE PRIVACY:
Don't Let HIPAA Breaches Trip Up Your Facility
HHS security guidance targets electronic PHI. HIPAA is back on CMS' radar screen, so watch [...] - WHAT DO YOU THINK?:
Can An LPN Stage Pressure Ulcers?
Here's how to find out the answer. Whether an LPN can stage pressure ulcers is [...] - CLIP & SAVE:
Has Your Facility Shored Up Its HIPAA Security For These Devices?
Take steps now to ensure EPHI is secure or CMS might cite you. When HHS [...] - MDS & BILLING NEWS TO USE:
Prepare for the new UB-04 form.
By May 23, all institutional paper claims must use the new UB-04 form to accommodate [...] - CLIP & SAVE:
TAKE A CLOSE LOOK AT THE CMS-802