Leah Klusch

Accuracy mistakes in MDS 3.0 data may cause additional payment problems, a reimbursement expert warns.

The federal government has determined “many documents were found to be inaccurate during audits and reviews of claims, and there were also deficiencies in the MDS documentation where certain services were not properly documented,” said Alliance Training Center Executive Director Leah Klusch, RN, BSN, tackling payment during the McKnight’s Online Expo. 

“One of the things we need to be careful about is that the accuracy of the MDS database is being questioned here in some instances, and since we pay our Part A Medicare claims, and many states have case mix indexing that pays Medicaid claims out of that same database, we have a large risk to the industry,” she said.

The survey process is essentially an audit, she said. Data errors frequently cost facilities reimbursement, and can now cause a facility to have significant negative survey results, in addition to civil monetary penalties, Klusch added. 

Administrators should look at F-Tag 272, which discusses comprehensive, accurate, standardized and reproducible assessment. Facilities should ask who is managing their data, and how the system process connects to regulations.

“We found out there were a lot of deficits in the medical record,” she noted. 

One problem area is dates on the MDS, dates of service in the medical record and dates on the bills not lining up. 

“You want to be careful here that when you look at the process you are documenting things properly and that you have your dates carefully determined,” she said. 

Additionally, staff should look at the October 2014 update in Section O, 400 ABC, which gives guidance on skilled therapy minutes, she said.