CMS to redo nursing home validation reports due to MDS 3.0 system glitch

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Sheila Lambowitz
Sheila Lambowitz

The Centers for Medicare & Medicaid Services will have to reprocess validation reports for an estimated more than 100,000 records from nursing homes as a result of a glitch in the new MDS 3.0 system, Sheila Lambowitz, director of the Division of Institutional Post Acute Care at CMS, told McKnight's Monday.

Nursing home providers, meanwhile, across the country have felt anxiety and confusion as a result of the system snafu.  

The problem, which involved an error in lines of code, resulted in a suspension of the MDS system this past weekend for maintenance. It should be fixed by the end of this week, Lambowitz told McKnight's.

“We're watching it daily and think it all should be corrected by Friday,” she said.

The mistake showed up on the validation reports, which assign RUG groups to providers. Because of the code mistake, the reports may have provided incorrect RUG groups. CMS generates validation reports upon receiving MDS records from providers.

Those providers that submitted records after Oct. 1 will receive revised validation reports and should disregard the validation reports they already may have received since Oct. 1.

“Any validation report that was sent for a transmission that used MDS 3.0 will be revised and we'll delete the old one,” she said.

The problem has not affected payment because providers have not yet billed for October, Lambowitz said.

“Basically, the main problem is getting the validation reports for October so that all the facilities can calculate what their revenues are going to be when they submit their October billing,” she said.

Because of the delay, CMS is not imposing penalties on nursing homes that have been late in submitting their MDS records, Lambowitz said.

Lambowitz called the glitch small "in the scheme of things," but she said it still was large enough to have an effect.

“For a system this size, these problems were not gigantic, but it doesn't have to be gigantic to have an impact,” she said.

Nursing home providers have been on edge as a result of the system hiccup and the temporary idling of the system last weekend, she noted. CMS is is communicating with the provider groups about the progress and will post an update this week, Lambowitz said. Likely, the effect of the system failure on nursing homes in coming days will be more time spent on paperwork. When nursing homes receive new validation reports, they should make sure they have received a new one for every incorrect report they have received. They should use the new one for billing.

“All these things are manageable, but they will make people very nervous,” she said.

Nursing homes, which number about 16,000 in the United States, have submitted more than 100,000 records, Lambowitz estimates, since the start of MDS 3.0. Each record does not represent an individual resident, she noted.

“It (the 100,000 records) sounded gigantic to me, but considering you have over 16,000 nursing homes and they all started submitting Oct. 1, it's not all that bad, but much better we caught it now,” she said.