MDS 3.0 Scheduling, Reporting and QA Webinar - Hi-Tech Software ...

Hi-Tech Software Solutions MDS 3.0 Scheduling, Reporting and QA Webinar

Sept 2014

Hi-Tech Software Solutions www.Hi-TechSoftware.com

Table of Contents Stay Tables ..................................................................................................................... 2 Edit Stays .............................................................................................................................. 2 Medicare A and Commercial Stay Records .......................................................................... 4 MDS Scheduling / Pre-Assessment .................................................................................. 7 Medicare .............................................................................................................................. 8 Other Payers ...................................................................................................................... 12 Assessment Alert ............................................................................................................... 14 COT Assessment Alert: ....................................................................................................... 15 Unresolved Conditions....................................................................................................... 16 MDS/Billing Diagnosis Review ........................................................................................... 18 Edit List ............................................................................................................................... 19 Assessment RUG Scores ................................................................................................ 21 Print Billing RUG Changes .................................................................................................. 22 Key Date List....................................................................................................................... 23 Incomplete Sections........................................................................................................... 24 Medicaid MDS Review (Maine).......................................................................................... 25 Quality Assurance ......................................................................................................... 26 MDS .................................................................................................................................... 26

G:\HITECH\Webinars\Webinar Docs\MDS3.0SchedulingReportingQA.docx

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Sept 2014

Stay Tables Admission Procedures >

Edit Stays RBB9

The Stay Table holds Stay Records as defined by Admit Date, Insurance and Primary Payer. •

If Clinical Records system is not integrated with Resident Accounting: the clinical staff creates Stay Records by entering or changing the Primary Payer, Insurance and/or Admit Date through the Edit Medical Record program.

•

If your Clinical and Resident Accounting systems are integrated, the accounting staff creates and updates Stay Record through Enter Census Changes.

•

Changes to diagnoses (Edit Medical Record > Diagnosis) update current stay record.

•

You can access and change previous stay records through Edit Stays. o Billing pulls the diagnosis codes from the stay record with matching service dates. It is very important that the diagnosis codes are kept current. o Diagnosis codes submitted on the resident bill should be consistent with the diagnosis codes submitted on the resident’s MDS 3.0 assessments. View a resident’s stay records through Edit Stays. Click the item (see on right) to view details of that Stay Record (see below). Admit Time and Disc Time are the military times entered through the Resident Accounting > Edit Census program (or on the Demographics screen of the face sheet, for Clinical only facilities).


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Sept 2014

Discharge: If integrated with accounting, this will be done through the RB Census program. Clinical Only facilities: Enter a discharge date and time on the Demographics screen. Update current stay record’s Stay End Date, Discharge Date and Discharge To fields.

Edit Stays will display a list of all Stay records created for a resident. Note the following: •

Start Date is the date the resident began using this payer.

•

End Date is the date resident stopped using this payer.

on the Payer Information screen of the Edit Resident Stay Data screen allows you to add a stay record directly into the program. If you neglected to record an admission or payer change into a resident’s face sheet record, this allows you to update the Stay Table with the missing stay record.


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Sept 2014

Medicare A and Commercial Stay Records RBC1

•

If your Resident Accounting and Clinical Records Systems are integrated, maintain Stay Records through RB Census. Diagnosis codes are maintained thru the resident demographics screens, or thru Edit Stay for a residents previous stay record.

•

If these two Systems are not integrated, maintain records in both systems. Nursing staff must provide Medicare RUG information to accounting office for Medicare billing. Accounting and nursing staffs coordinate the tables and track assessments for billing.

Medicare Case Mix Information

The information entered on this screen will be used to build the Medicare Assessments Schedule at the bottom of the screen. . Admit Date For this Stay. Will be updated through Enter Census Changes. Disc. Date When discharged from facility or Skilled unit, no longer covered by Medicare or commercial payer. This item will be updated when a Discharge Assessment Form is printed (if Clinical System is not integrated with Resident Billing). For integrated facilities, this field will also be updated at time of discharge through the Enter Census Changes program Start MCR/Ins Days Days resident had available upon admission. Start Co-Insur Days Days resident had available upon admission. If full 100 days, enter 20 for MCR/Ins and 80 for Coinsurance for both start and available days. If there are two stays in the same month, you should manually calculate the available days for the second stay based on the number of days used in the first stay. Avail. Days available after the most recent billing. The System updates this through the Update Billing Data program for that type of payer. For a commercial payer, check mark Use Medicare Asmnt Schedule to follow the Medicare A assessment schedule. Leave unchecked to follow the OBRA schedule. The required PPS MDS records will be included on the Medicare MDS Schedule Review, printed through Resident Accounting > Billing > Preparation > M’Care MDS Schedule or Create Comm’ PPS Adj. Hospital Stay Code Enter code of 70. Prior SNF Stay Code** Use when resident returns within 30 days, enter code 78. Date From and Date Thru Enter qualifying hospital stay dates.


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Sept 2014

When filled out with the required information the screen will display the Medicare Assessments Schedule at the bottom of the screen. For this resident, you must complete an MDS assessment for each Observation period. The Assessment Reference date should be within that Observ. Start date range, and the Reason for Assessment must be coded correctly for that date range. Please refer to HCFA regulations for more information.

Printed and submitted MDS will update Current Assessments. The assessment date and RUG data will be used on UB billing for Medicare A and commercial payers.

•

The Medicare Case Mix Information screen now displays PPS Room Record information (also available through Billing > Preparation > Create M’Care A PPS Adj -- PPS Room Rate Review.

•

To help you compare the Room Records with the submitted MDS 3.0, Current Assessments now includes the HIPPS codes column.

•

Schedule Start Date: re-calculates the assessment schedule if the payer changes during a stay.

At Condition Codes to pull to UB, enter up to four codes that will flow to Condition Codes FLN 18-28 on the UB. The program will first include any required “hard-coded” conditions codes. Codes that you enter here will flow to the remaining spaces.


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Sept 2014

Edit Leave Days. If Leave Days have been entered through Enter Census Changes, they will be included in the Leave Days column of the Stay Table (see below). If you did not record a Leave Day through the Census process and those days have been posted, you can enter the Leave Day directly into the resident’s Stay Table. IMPORTANT: If you record Leave Days in this manner, accounting must manually adjust the Room Detail. Choose the resident and the stay. On the first screen, click Ok to display the Medicare Case-Mix Information screen. At bottom center of the screen, click Edit Leave Dates to display the Edit Leave Dates pop-up screen (on right). Enter up to 10 dates. Click OK. NOTE: You cannot enter future dates. If you enter dates out of order, the program will resort them. Zero out dates to remove them. On the Medicare Assessment Schedule (below), Leave Days will display the number of recorded leave days. The subsequent Observation and Days Covered date ranges will be adjusted for all the required assessments.

•

• •

The Leave day of 6/4/2012 extends the Observation Days and Days Covered by one day. Leave Days will be noted on the Room Rate Review. Leave Days entered here must agree with Room Records before doing the Room Rate Adjustment. See Create M’Care A PPS Adj and Create Commercial PPS Adj.


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Sept 2014

MDS Scheduling / Pre-Assessment

Use these programs to determine which residents’ MDS records are due. •

Medicare residents: verify accuracy of the Medicare Stay Records through Admissions Procedures > Stays Tables. Print the required assessment schedule through Medicare.

•

For commercial insurance payers that reimburse according to RUG scores, follow Medicare A procedures.

•

For non-Medicare residents: Other Payers prints a schedule of quarterly and annual assessments that are due. This listing if based on MDS records already completed.

•

The Assessment Alert list MDS that need your attention.

•

The COT Assessment Alert lists residents due for a COT review based on the ARD of the most recent MDS used for payment.


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Sept 2014

Medicare MDTH

This Medicare scheduling report will help you track the scheduling and completion of MDS required for PPS billing. As you print these MDS, they update the Stay Table with the MDS date and type of assessment. When you submit the MDS, RUG rates will update the stay table, making this information ready to include on PPS billing. (October 1, 2011 CMS regulations) This report will include the following disclaimer regarding Change of Therapy (COT) Assessments: Change of Therapy assessments with ARDs from the 1st through the 6th could affect RUG categories and payment for days in the previous month. Please review each resident with a COT assessment and print the Billing-RUG Changes Report for more information. IMPORTANT: •

To be included on this list, a Medicare resident must have accurate Stay Records for each stay. This also applies to commercial insurance payers that base reimbursement on RUG scores. See instructions on creating Stay Records on Page 2.

•

If your Hi-Tech Accounting and Clinical Systems are integrated, your accounting staff is responsible for creating and maintaining the accuracy of the Medicare Stay Tables.

•

If you run a stand-alone Clinical System, you must maintain the Stay Tables and provide Medicare billing data to your accounting staff for billing.

Use dates that match the billing period. Remember that the assessment schedule could change from one day to the next as residents are admitted and discharged, and as assessments are printed and submitted. Scheduled List of Scheduled MDS that have not yet been created, printed or submitted. Completed Lists scheduled MDS that have been printed and/or submitted. Printed records will not yet include a RUG score. Submitted records will include the RUG. Click Print. The next page describes the information provided on each report.


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Sept 2014

Scheduled (Due) format: Scheduled: allows you to enter an Assessment Date range. If your facility uses the Hi-Tech Therapy system you can also select: Include Detail and Skip if no Therapy.

Each resident is identified by ID number, first initial, and last name. Day: The number of the day in this stay, based on the resident's admit date. Observation Period: The Assessment Start Date Observation. Covered Days: This MDS and its RUG are used to determine payment for this date range. Days: The Days Covered date range includes this number of days. MDS Therapy Day/Minutes: Number of days and minutes recorded in the Therapy program for OT, PT, ST. These numbers should agree with the Assessment Therapy amounts for the MDS records that have been completed. Optimum Start date: The system will look at the therapy minutes recorded for the seven days previous to each day in the Observation Period (including "grace days"), and determine which Assessment Start Date will capture the maximum amount of therapy time in the previous seven days. Grace days therapy time will not be considered if therapy time within the observation period already meets highest RUGs classification. If you do not use the Therapy System program, this date will be filled with stars (********).


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Sept 2014

Completed Format: for each assessment, includes items above and those listed below: Completed: Requires that you enter a Month End date. You can also select Therapy / MDS Discrepancies Only if your facility uses the Hi-Tech Therapy system. You can also select: Include Submission Date Include Diagnosis Codes

The Medicare MDS Schedule Review will indicate Leave Days with a # (pound sign/hash mark) in the Days column next to the number of days.

Names concealed

The number of Leave Days will be listed at the bottom of the report:

Continued next page.


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Sept 2014

Additional Sample and Legend:

*Day does not match AA8b or A310B identifies an MDS with a type of assessment outside the required Observation period. For example a 30-day with an ARD in the 14- or 60-day Observation Period date range. Act Start: The actual assessment start date. CM Cat: The RUG case mix category and score calculated for this MDS. Assessment Therapy: The number of days and minutes recorded in the MDS for Physical, Occupational, and Speech Therapies, (OT, PT, ST). Therapy Charges: The number of days and minutes recorded in the Therapy program for Physical, Occupational, and Speech Therapies, (OT, PT, ST). These numbers should agree with the Assessment Therapy amounts for the MDS records that have been completed.


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Sept 2014

MDS / Care Plans> MDS > Scheduling/ Pre-Asmnt >

Other Payers MD63

Use this program to print a list of nonMedicare and non-PPS MDS records that are due. Print this listing at least once a week-it can change from day to day as records are completed, and as residents are admitted and discharged, or have a significant change in status. IMPORTANT: If the list includes a resident who is no longer in the facility, verify that the resident has a discharge date on the Demographics screen of Edit Medical Record. Verify that you have completed a Discharge Assessment for the resident. The Report Date will print at the top of the report. It is not used to select records. Due Thru Date: the date for which assessments should be completed. To include MDS that are due and already started, uncheck Skip Assessments in Process.. To include Medicare residents check  Include Medicare Stays. This will include the next assessment due for this resident, based on the OBRA schedule. If you leave this item unchecked and Medicare residents are included, verify that you have an accurate Medicare Stay Table record for the resident, and that you have completed all required Medicare assessments. If you want a listing of Medicare and PPS Assessments that are due, print the Medicare report described on Page 8. To include residents whose face sheet codes at Level of Care other than 1 and 2 uncheck Nursing Levels Only (1+2). You can Sort by Unit and select a specific unit. Or Sort by Date (Next Assessment due date). Click Print. Continue on next page. NOTE: The report will not reference assessments that are over one year old. Continued next page.


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Sept 2014

The report will include the following: New Admits. If a new admit does not have an existing assessment, the program schedules the Admission assessment 13 days after the Admit date in the resident’s face sheet record. If your Clinical and Resident Billing Systems are integrated, the resident might not be listed until after the census program has been run to input admit dates. Existing residents: The program looks at each resident’s existing MDS records and finds the most recent Complete MDS. Within the most recent record, the program finds the Assessment Reference Date and calculates the Next Asmnt Due Date using the Quarterly Review Days recorded under Libraries > Facility > Clinical Profile. If the three most recent assessments are quarterly records, the next assessment scheduled will be an Annual. Discharges: If the most recent record is a Discharge--Return Not Anticipated, the resident will not be included on the list. If the most recent record is Discharge--Return Anticipated the next Assessment Reason will be listed as an Entry Tracking Record. An Entry Tracking record will not be listed if the most recent Discharge--Return Anticipated is more than 30 days old The Entry suggestion will be dropped from the report 30 days after the discharge date. In Process: If the program finds that a new assessment has already been started before the Due Date, the Next Asmnt column will provide the Type of Assessment and the Assessment Date. The Comments column will indicate In Process. •

Program will calculate next assessment date based on the ARD in the previous record depending on the type of assessment. Examples: • Annual: ARD of previous OBRA comprehensive plus 366 days. • Quarterly: ARD of previous OBRA assessment plus 92 days. It will use the Libraries > Facility > Clinical Profile > Quarterly Review Days entry to schedule quarterly assessments. The default is 90 days and you can change it if you want to schedule the quarterly earlier.

•

The report will also alert you if an annual is due within 30 days of the next suggested quarterly date, and if the next suggested quarterly is the 4th, 5th or 6th quarterly.

•

If the reason is a Quarterly MDS, the Next Annual Due date will be printed in the Comment column.

•

If there is a Discharge Date in a resident’s face sheet, and you have not completed a Discharge Assessment, this resident will be listed as requiring that record as the Next Assessment.

IMPORTANT: MDS 3.0 scheduling is based on ARD to ARD.


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Sept 2014

MDS / Care Plans > Scheduling / Pre-Asmnt Reporting > MDS

Assessment Alert MD68

List residents and MDS records that need your attention. Enter Alert Date: check MDS records with Assessment dates up through this date. Select  Include Assessments flagged as Do Not Submit to include MDS with  Do NOT submit this MDS Assessment in Edit MDS, at A410. Submission Requirement:

This report will identify the following conditions: •

Not Printed (Chart Copy): Open records that have not been printed, or were printed and changed, and the changed pages have not been printed. To complete and submit any of these records, you must print  All Changed Sections.

•

Not Printed (Sec V only): The MDS has been printed but the required Section V (CAA) is not printed. This record is still Open and cannot be submitted. Finish and print the CAA to make the MDS ready for submission.

•

90 Day Alert: The most recent MDS for this resident is not a Discharge form, and the Assessment Reference Date on the record is approaching or beyond 90 days old. A nonMedicare resident is probably due for the next assessment.

•

14 Day Alert: This Completed record has not been submitted and it is near or beyond the submission deadline date.

• New Residents who do not have an assessment started yet NOTE: This program will not list assessments that are over one year old.


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Sept 2014

MDS / Care Plans > Scheduling / Pre-Asmnt

COT Assessment Alert: TH87 This report is available even if you do not use the HiTech Rehab Therapy System. Run this report weekly to determine if there are any residents who need a COT review. Work with your therapists to determine if a COT assessment is needed. The report will list COT Review dates based on the ARD of each Medicare resident’s most recent assessment used for payment. A COT Review date will be calculated for 7, 14 and 21 days after the ARD. On the sample screen, we asked the program to list COT Review dates through 6/11/2012. For Resident 61, the last ARD is 5/28/2012. Seven days after that is the COT review date of 6/4 and 7 days after that a COT Review date of 6/11/12.

Resident names have been concealed intentionally. Residents are listed in alphabetic order by last name.


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Sept 2014

QI / QA / Survey Reports > Quality Assurance

Unresolved Conditions MD64

Compare residents’ two most recent assessments and list specific responses that are the same on both. The final page of the report prints a legend that defines these responses.. Census Date: This date will be compared to residents' admit and discharge dates in their face sheet records. For residents in the facility on that date, the program will compare the two most recent assessments in History as of that date. Initial assessments will not be included. Unit to Print All: to print all residents in order by ID number.. Selective: to print for a specific unit. Enter the Unit number at Enter Unit ID Click Print..

See legend on next page.


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Sept 2014

The program compares the following responses. If both assessments have the same response the assessment dates will be listed and an X will be printed under each condition that still exists.


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Sept 2014

Reporting > MDS

MDS/Billing Diagnosis Review M356

List the diagnosis recorded in the residents’ stay records and the MDS records so you can verify consistency between the two records.


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Sept 2014

Reporting > MDS

Edit List M362

Select Report Option  Most Recent Complete MDS: The most recent printed record for each resident.  Incomplete MDS List: Open records to be finished and printed before they can be submitted.  Not Changed Since List: Printed MDS records with ARDs before the date that you enter at List Active Residents that have not had an Assessment Since. If you enter a date that is 3 months old, this will list residents now due for OBRA assessments.  MDS not Printed List: Open MDS records that must be printed before they can be submitted.  BIMS-CPS List: residents’ most recent BIMS and CPS scores, and the previous score when available. See example below.


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Sept 2014

 All Printed List: all printed MDS. Current MDS with RUG Weight and ADL: Discharge Tracking Exception List: residents who have a Discharge Date in Edit Medical Record > Demographics and who do not have an MDS Discharge Tracking Assessment with an equal or later discharge date Deactivated MDS List: List Inactivated MDS records that you have also de-activated to remove them from a resident’s MDS history. Sample below:

Select the date range of the assessments you want to print. Decide if you want to Include Discharged Residents. Uncheck any MDS Item Sets you do not want to include on the list.


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Sept 2014

Reporting > MDS >

Assessment RUG Scores New: Prints all RUG scores and categories from the MDS 3.0 Section Z and also RUG III scores. Use this report to locate MDS 3.0 that need attention, i.e: •

MDS with a default rate of AAA.

• MDS with a RUG III calculation used for September billing. Note that scores are not listed for Entry records, Reason 99-99-01 or Death in facility Reason 99-99-12, etc.


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Sept 2014

Reporting > MDS >

Print Billing RUG Changes MD78

This program prints the RUG Scores of MDS records that have been Modified or Inactivated. The list will indicate any changes in the Case Mix score from original MDS to the Modification or Inactivation record. Use this information to make corrections to Medicare billing.

The list will also include MDS Change of Therapy (COT) records with ARDs from the 1st through the 6th of the month. Use this report to alert billing about changes in RUGs that should be reported through billing.


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Sept 2014

Reporting > MDS

Key Date List MD69

List MDS records and the dates assigned to the MDS as it is processed (see below). Use this list to determine why an assessment has not been picked up for submission, or if an assessment is already stamped with a Submit Date. Report Date: This date will be printed at the top of the report and is not used to select records. Accept the date displayed if it is correct. Assessment Dates to Print:  Range: HTS recommends this option to print a range of assessment dates. Click Print

•

Resident ID and Name

•

The Reason for Assessment entered at A310A A, B and F

•

The Assessment Date

•

PRINT DATE: The date the MDS was printed.

•

PRINT-V DATE: The date the CAA Summary was printed. If the record does not require a CAA Summary, this date will be the same as the PRINT DATE.

•

The END DATE (see table below):

•

CORRECTION No. on Modification or Inactivation Records

•

DATE SUBMITTED: Date the record was copied to diskette or file for submission. The various MDS forms use different MDS dates as the End Date. Examples: Form

Date used

Form

Date Used

Form

Data Used

NT

ARD

NC

V200C2

Modfication, Inactivation

X1100E


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Sept 2014

Reporting > MDS

Incomplete Sections N3D8

This optional program helps you to track the MDS records that have been started but not marked as complete. It is especially helpful in facilities where different staff members complete different parts of the MDS. In Edit MDS, at the end of each section, you can check mark the Section as Complete. This report lists assessments with sections not checked as complete.

The letters printed identify the sections that are not checked complete.


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Sept 2014

Medicaid MDS Review (Maine) MD79

For use with MaineCare MIHMS billing, this report lists the OBRA assessments and case mix scores that will be used for billing the State of Maine. When you print a required MDS for a Medicaid resident, information from the MDS will be posted to the resident’s Medicaid Stay Table, and this information will be printed on the Medicaid MDS Review.

You can access the Medicaid Stay Table through any of the following: Ë Admission Procedures > Edit Medical Record > Stay Tables Ë Admission Procedures > Stay Tables > Edit Stays Ë Resident Accounting > Billing > Preparation > Edit Stay Tables


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Sept 2014

QI / QA / Survey Reports > Quality Assurance

Quality Assurance

MDS Q374

This program scans the MDS file to locate all assessments that include a specific response to an MDS question; for example, a check mark,  (Yes), at B. Comatose. If you have saved and named your choices, these will be displayed first. See sample screen on the right. You can click a saved report and then click Print to print QAs for MDS records as of the date entered at Date to Use on Reports. You can also click Edit to change the report criteria and resave it. Click New Report to display:


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Sept 2014

Click the binoculars to look up the Section, Question, Level and Response range. The program will display these items in the required format.

Starting Section, enter the Section ID and press the [Enter] key to display items in that that Section. Example:

Scroll up and down till you find the item you want. Click your select to highlight it:

For the selected item, select the responses you are looking for. Indicate a Range or All.

NOTE: The QA program will not locate non-standardized responses. For example, the program will not provide a listing for


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Sept 2014

Add to Criteria List This allows you to search for MDS that include more than one item and its responses. After you identify a question and response(s), click this button to add it to the Criteria List on the right side of the screen. Continue to identify other questions and responses and click Add to the Criteria List after each one. NOTE: If you select only one item and you will save this QA report, add it to the Criteria List. Must Meet: All:  Any Criteria  All to locate MDS with all the responses on the Criteria List.  Any: to locate MDS with any of the responses on the Criteria List. Click Clear Criteria List to clear all entries from the Criteria List. Report based on: Census Date: The program will scan the MDS file for the most recent, printed assessment for each resident as of this date. to locate MDS records. A resident’s admit date must be on or before this date. If there is a discharge date, it must be after the census date. ARD Range: Enter a range of MDS 3.0 assessment dates. Report by Unit:  No: print the entire facility by resident ID number.  Yes: to list residents in a specific unit, or all residents Unit / room number order. Units to Print:  All: to report on all residents, sorted by unit and room number  Individual: to select a specific Unit. Unit ID: enter the Unit ID number or press the [F2] key to select the unit from a list. Click Print. On the next page, see sample of an MDS that includes two criteria.


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Sept 2014

Click Save to save the selected criteria for future use, enter a report code and description. Click Save again. The program will ask if you want to print the report now. If you save the report, it will be displayed on the opening list of save reports the next time you run this program.


Page 29

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