The Texas Health and Human Services Commission has issued the following memo regarding MDS 3.0 policy changes affecting Skilled Nursing Facilities: Transition for Implementation of Fiscal Year 2015 Minimum Data Set (MDS) 3.0 Policy Changes The Centers for Medicare & Medicaid Services (CMS) has issued instructions for Skilled Nursing Facilities (SNF) to properly implement the revised MDS 3.0 policy regarding completion of Change of Therapy (COT) Other Medicare Required Assessment (OMRA) MDS. … [Read more...] about CMS Issues New Instructions on MDS 3.0 Policy Changes Affecting Skilled Nursing Facilities
http://youtu.be/aZNMNvHJYgc At the conclusion of the onsite review, the HHSC-OIG nurse reviewer must hold an exit conference with the nursing staff. The Administrator, DON, charge nurse and other leadership of the facility should attend in order to gain a full understanding of the findings by the nurse reviewer. The nurse reviewer is mandated to provide “formal written notification of all MDS validation findings during the exit process.” You will receive a “List of … [Read more...] about RUG Reviews: The Exit Conference
http://www.youtube.com/watch?v=gAJV7FsoXkg During the exit interview of a RUG review, you will be asked to sign and initial documents. It is very important that you understand what you are initialing or signing. Carefully review the document that you are asked to sign and ask questions if you don’t understand it before you sign or initial. These documents create a record that may become relevant in a Reconsideration or Appeal. Let us discuss the details by first reviewing the … [Read more...] about RUG Reviews: Signing Documents Provided by the Reviewers
http://youtu.be/0My7cUQgW_w What are your rights during a RUG Review? It may be an overstatement to say that you have rights as the deck is so stacked against the provider and in favor of the OIG. But, there are a few things to which you are entitled as part of the process of which you should be aware. First, the OIG is required to give you a letter upon entrance into your facility. This is the signal that the review is beginning. The letter will explain the procedures of the … [Read more...] about YOUR RIGHTS DURING A RUG REVIEW
Your facility will have a RUG review in the near future. Being prepared for a review can be half the battle. Knowing where all your old documentation is and knowing what, exactly, is in that documentation will make a RUG review much easier on the facility. There are three important steps the facility can take to not only mitigate errors found by reviewers, but create a far less stressful review. Organization of old records is the primary key of your preparation. Make sure a minimum … [Read more...] about Three Ways to be Prepared for a RUG Review
As discussed last week, ADL's are the major target for HHSC-OIG. ADL's are the source for most errors resulting in RUG write downs. Not only did the facility lose money on incorrectly charted ADL's they will also face large penalties after a RUG review. Charting ADL's For most MDS nurses, ADLS are pieces of paper the CNA's have scribbled some numbers on. Ideally this number reflects both the Plan of Care and what care was really given. Calculating an accurate ADL score for … [Read more...] about DRILLING DOWN TO ADL MDS ERRORS: THE HOW AND WHY MONEY IS WALKING OUT YOUR DOOR
Nursing Homes will be facing a RUG Utilization review in the near future. This review will cover the years from 2008 through 2010 for MDS 2.0 items. What it is and how it works Reviwers select a group of residents from predetermined RUG categories. We have all read how Medicare/Medicaid is going after the therapy RUGs claiming this is the most abused category. However, surveyors are also targeting the ADL RUGs. Any error found for one resident RUG causes the surveyors to … [Read more...] about RUG REVIEWS: HHSC-OIG reviewers are here – help!