Special Situations—Interrupted Stays, MDS Modifications and Inactivations
October 30, 2020
MDS data must be accurate. Payment (Medicare, Managed Medicare, and Medicaid in case mix states), survey, care planning and Quality Measures reported publicly are calculated from MDS data. When MDS responses are found to be in error through audit, Medicare or Medicaid reviews or when reviewing assessment data, the MDS errors must be corrected within 14 days of the identification of the error. Some errors can be corrected by a simple MDS modification while other errors require an additional MDS—a Significant Correction of Prior Comprehensive Assessment or Significant Correction of a Prior Quarterly Assessment. Some MDS errors cannot be modified; the entire MDS must be inactivated. And still other errors require the state and federal data base to correct the error manually.
The 10/1/19 implementation of PDPM added the confusing process of “interrupted stays” to the MDS management of Medicare assessment. This has caused frequent MDS errors that require correction. This webinar will walk the NHAs through the entire process from error identification through correction through billing related to the errors.
In addition to the above, this webinar will focus on the process for “adjusting an Assessment Reference Date (ARD).” If an ARD is inappropriately adjusted/changed when not allowed, the entire MDS is declared invalid on Medicare review. Understanding the limited examples where ARDs can be changed/adjusted is critical information for the Medicare team.
1. Participants will correctly report the timeframes for MDS corrections once errors have been identified.
2. Participants can explain when a resident discharge is an interrupted stay instead of the end of the Medicare stay.
3. Participants will state when an ARD can and cannot be changed.
4. Participants can report how MDS corrections can impact Medicare billing.
Carol Maher, RN-BC, RAC-MTA, RAC-MT, RAC-CTA, RAC-CT, CPC
Carol Maher is a Board Certified Gerontological Registered Nurse with over 30 years of long term care experience and has worked in long term care in many roles. She worked as the MDS Coordinator in a 300 bed SNF in Pennsylvania for 8 years before moving to CA to become the MDS Coordinator/Director for a 1200 bed SNF in San Francisco. She has also worked as the MDS Coordinator in a SNF that typically had 60-75 residents on Medicare in addition to 160 long-term care residents. Most recently she was the Senior VP of Utilization Services and Director of Reimbursement for large multi-facility organizations.
Carol has worked as one of the Gold Standard nurses for MDS 3.0, serving on the RAP workgroup to prepare the way for the CAAs for MDS 3.0, and participating on a number of Technical Expert Panels related to MDS, Quality Measures and care planning. A sought-after speaker, she has given presentations at AANAC, AHCA and Leading Age national conferences as well as many state organization presentations. She is also a frequent author of articles related to the RAI process and PPS. Carol served as a member of the AANAC Board of Directors for 9 years. She is presently serving as the chair of the AANAC Expert Advisory Panel and as an AANAC Master Teacher of the RAC-CT and RAC-CTA certification courses. Ms. Maher is the Director of Education for Hansen Hunter & Co. P.C., providing MDS and Medicare classes across the country, presenting monthly educational webinars and completing compliance audits. She is the author of Long-Term Care MDS Coordinator’s Field Guide (HCPRO 2016).
- 1.5 credit hours for RNs
- 1.5 credit hours for NABs
This pre-recorded webinar expires on September 1, 2022.