Ask The Payment Expert: Patricia Boyer

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Patricia Boyer, MSN, NHA, RN
Patricia Boyer, MSN, NHA, RN

Can you clear up confusion over quality measures and how long people remain on the report?

The quality measures identify a short-stay or long-stay resident. 

The definitions determine a short-stay as a resident who has 100 or fewer cumulative days in the facility (CDIF). Long-stay measures are for residents who have CDIF of 101 days or more.

Each measure has a defined numerator and denominator. You  need to review each quality measure's information to know those specifics.

Another term to be familiar with is the “look back scan.” According to the QM Manual, “The purpose of the look-back scan is to determine whether such events or conditions occurred during the look-back period. All assessments with target dates within the episode are examined to determine whether the event or condition of interest occurred at any time during the episode.”

The “look back” scan reviews all assessments during that episode. The scan could be up to 270 days. You will need to review the specific information under each measure. The scan can be for any resident who was identified during the selection period.

If this all seems confusing, it is. The best advice that I have is if you are flagging a measure above the 75th percentile, review that particular measure in the manual, identify which assessments are used, and develop your plan.

You might review your MDS coding to ensure it is accurate, and review the exemptions to make sure you have coded any exclusions. 

Review your clinical system that is triggering the quality measure and develop a plan. Remember that the QMs are only indicators and do not mean that you are doing anything wrong. If you have a high percentile that is due to the population you are treating, document that to share with referral sources and/or surveyors.