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Ask the payment expert
Ask the payment expert
With staff turnover, what can we do to ensure accuracy of the MDS?

We have been reimbursed for Medicare A and in many states for Medicaid under the RUGs system for awhile. Accuracy of data to optimize reimbursement is vital.

In addition, your state survey process is focusing more on the accuracy of MDS data. We frequently see survey citations under F-tag 272 and F-tag 279 due to not following the nursing process. This process includes: assessing clinical condition and risk factors, developing an appropriate plan of care, implementing that plan of care and periodically revising and updating the plan.

Everything starts with the assessment process and the MDS is an essential piece. Now, with the pilot implementation of the QIS survey, the new process includes identifying residents by use of the MDS data. Facilities are finding that they must invest in education for their MDS coordinators in auditing processes to ensure accuracy and implementation of QI processes to monitor for ongoing compliance.

Your MDS coordinator needs to complete a certification course and keep up to date on all updates. All together, this means that the MDS process is very significant and your risk is extremely high if your staff is not coding accurately. I can't think of a more important way to invest your money than in these important staff members. 

We have beds in our facility that are not certified for Medicare. Our long-term care residents want to go back to their own room. Is that OK?

You can have residents sign a waiver of benefits. A better solution is to certify your entire facility for Medicare. You can still focus on one unit for your Medicare short-term care residents and allow your long-term care residents to go back to their rooms. Most facilities find this to be a good solution. It usually only takes a notification letter to your fiscal intermediary.