mds 3.0 update

1. MDS 3.0 Update Cecilia Vinson, MSN, RN

3. If the registered user's employment is terminated, the provider is left without the appropriate access to assessment submission and CASPER Reporting applications. To alleviate the potential for gaps in processing, it is strongly recommended that each provider have two registered users. The zip file below contains a list of providers with only one registered user by state. If the registered user's employment is terminated, the provider is left without the appropriate access to assessment submission and CASPER Reporting applications. To alleviate the potential for gaps in processing, it is strongly recommended that each provider have two registered users. The zip file below contains a list of providers with only one registered user by state.

4. Topics to be Covered

5. Reality Check The first several months have been challenging for everyone Remember, the MDS assessment is for the resident first to make sure their needs are met appropriately; everything else is secondary Yes the MDS takes time to complete, but the length is basically the same as the MDS 2.0 The MDS 3.0 is still in its infancy and we are all still suffering from growing pains

6. Top Issues/Comments

7. What Changes Are Expected?

8. What Does the Data Look Like?

9. Quality Measures

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13. Coding Conventions Z = none of the above If an interview, 9 = unable to answer - (dash) = item not assessed Most often occurs when discharged before assessment completed Some items, dash not allowed (e.g., reason for assessment, ARD, additional dx)

14. Top 10 Fatal Errors (1-5) 14 These are message are from the 3,017,076 records submitted to the ASAP system from January 1, 2011 through February 24, 2011 9:00 am ET. -1007 - The most common fatal error is the duplicate assessment error. This usually occurs when the submitter presses the submit buttom multiple times. It may also occur when the submitter doesn�t know if a file has already been submitted so submits it to be sure. 136,340 or 4.5% of assessments have this error. -1030 - The second most common error is that active items for the record�s ISC were not submitted on the record. Many times these are the state Medicaid items Z0200 and Z0250. Even if the state does not collect these items, when active on the ISC, the items must be included in the record with a value of ^. 97,354 or 3.2% -3676 - The third most common error occurs when the submitted value for an item is not one of the values listed in the data specifications as a valid value for the item. 24,510 or 0.8% -3668a 15,010 errors or 0.5% -3573a 14,735 errors or 0.5% These are message are from the 3,017,076 records submitted to the ASAP system from January 1, 2011 through February 24, 2011 9:00 am ET. -1007 - The most common fatal error is the duplicate assessment error. This usually occurs when the submitter presses the submit buttom multiple times. It may also occur when the submitter doesn�t know if a file has already been submitted so submits it to be sure. 136,340 or 4.5% of assessments have this error. -1030 - The second most common error is that active items for the record�s ISC were not submitted on the record. Many times these are the state Medicaid items Z0200 and Z0250. Even if the state does not collect these items, when active on the ISC, the items must be included in the record with a value of ^. 97,354 or 3.2% -3676 - The third most common error occurs when the submitted value for an item is not one of the values listed in the data specifications as a valid value for the item. 24,510 or 0.8% -3668a 15,010 errors or 0.5% -3573a 14,735 errors or 0.5%

15. Top 10 Fatal Errors (6-10) 15 -3677 12,417 errors or 0.4% -3704b 10,140 errors or 0.3% -3693a 8,701 errors or 0.3% -3534a 8,584 errors or 0.3% -3785a 8,221 errors or 0.3% -3677 12,417 errors or 0.4% -3704b 10,140 errors or 0.3% -3693a 8,701 errors or 0.3% -3534a 8,584 errors or 0.3% -3785a 8,221 errors or 0.3%

16. Top 10 Warning Messages (5-7) 16 -3616b The �Incorrect RUG Logic Version� is usually due to vendors not reading the RUG III Specifications and entering 5.20 rather than 07, 08, or 09. 293,722 or 9.8% -3616a 236,168 or 7.9% -1018 139,360 or 4.6%-3616b The �Incorrect RUG Logic Version� is usually due to vendors not reading the RUG III Specifications and entering 5.20 rather than 07, 08, or 09. 293,722 or 9.8% -3616a 236,168 or 7.9% -1018 139,360 or 4.6%

17. Top 10 Warning Messages (8-10) 17 -1056 This occurs only for non-PPS records where the submitted Z0100A or Z0100C is a blank ^. The ASAP system will calculate the RUG even for non-PPS assessments (ie OBRA quarterly or admission that is not marked as PPS) so that the provider will have the correct Medicare RUG in the event that the resident actually is covered by Medicare. 130,735 or 4.3% -3616c This is the Medicare short stay indicator. Facilities seem to have issues correctly identifying short stay assessments per the CMS definitions. 120,596 or 4.0% -3749a 96602 or 3.2%-1056 This occurs only for non-PPS records where the submitted Z0100A or Z0100C is a blank ^. The ASAP system will calculate the RUG even for non-PPS assessments (ie OBRA quarterly or admission that is not marked as PPS) so that the provider will have the correct Medicare RUG in the event that the resident actually is covered by Medicare. 130,735 or 4.3% -3616c This is the Medicare short stay indicator. Facilities seem to have issues correctly identifying short stay assessments per the CMS definitions. 120,596 or 4.0% -3749a 96602 or 3.2%

18. Section S: State Specific 18

19. Frequently Asked Questions B0700 � is the coding for this item used to determine whether or not to conduct the interviews? You can use this information to inform you but it should not be the sole indicator on whether or not to complete the interviews. During testing many residents coded as rarely or never understood could still complete the interviews. 19

20. Frequently Asked Questions C1600 - What is meant by "acute change in mental status from the resident's baseline"? That is, are we looking back to the last assessment? The previous responses in Section C? You are using your clinical judgment to say the resident has had an acute change from what you know to be the resident�s baseline in the past 7 days 20

21. Frequently Asked Questions D0200E � How is this coded if the resident is tube fed? You would code zero �No symptoms present� as they are being fed D0200I � If the resident has stated they'd rather be dead, but says they do not have any thoughts of hurting themselves, how is this item answered, and what follow-up is required? You would code this item as one �yes� and then code the frequency. The facility needs to then gather additional information and assess the resident and follow per policy and procedure. 21

22. G0100�ADL Coding Tips Do not code ADLs based on what residents should receive, or their potential, but on what they DID Do not include assistance provided by family or other visitors For residents with tube feeding, TPN or IV fluids coding depends on resident�s participation in oral intake 22 Code extensive (3) if resident participated in oral nutrition but not enteral/parenteral (staff did this) Code totally dependent (4) if resident was assisted in eating all food items and liquids at all meals and snacks and did not participate in any aspect of eating. Code extensive (3) if resident participated in oral nutrition but not enteral/parenteral (staff did this) Code totally dependent (4) if resident was assisted in eating all food items and liquids at all meals and snacks and did not participate in any aspect of eating.

23. Frequently Asked Questions G0100 � Who are considered "facility staff"? Those employed by the facility or contracted by the facility. No students, family, hospice, private aides, ambulance staff. G0100 � Where is daily peri-care coded? Toilet use G0400 � How is this coded for amputations? You would need to assess the resident to see the effect of the amputation upon the resident. For example, if the resident had a prosthetic and it had no effect on ADL�s, then this would not be coded as a limitation. G0400 � How is this coded if the limitation isn't due to ROM limits, but cognitive deficits? You would code this item �yes� if the effect was the same, and effected ADL�s. G0100 and G0400 � are Geri-chairs and other wheeled chairs (e.g. Broda) considered wheelchairs? No 23

24. Update to Manual Section G Definition of facility staff G0300D adding a bullet under coding for: Code 2, not steady, only able to stabilize with staff assistance. Adding : If a lift device(a mechanical device operated by another person) is used because the resident requires staff assistance to stabilize. 24

25. Frequently Asked Questions H0100 � If the resident is admitted with an indwelling catheter, and it is removed 2 days after admission, how is this item coded? You code each appliance that was used at anytime in the past 7 days, this item does not look back into the hospital. H0200 � What constitutes a "toileting program"? Individualized, based off an assessment, communicated to the resident and staff, evaluation of the resident's response and updated as indicated. H0200 � If you have already tried a toileting program and it didn't work, how do you code this section in the future? H0220A Has a trial of toileting program attempted = 1 (Yes) H0220B Response = 0 (no improvement) H0200C Current toileting plan = 0 (no) 25

26. Frequently Asked Questions H0300 � How do we code a resident who had a Foley for five of the seven day look back period? You would code continence during the time frame that the Foley was removed H0400 � If a paraplegic is being manually stimulated to facilitate defecation, is this coded as continent or incontinent? Yes, if they void in an appropriate receptacle with maneuver H0500 � If a paraplegic is being manually stimulated according to a specific schedule, can this be coded as a bowel toileting program? Yes, if it protocol meets the criteria for a toileting program that is in the manual then you can code it 26

27. Frequently Asked Questions What medications are considered in "scheduled pain medication regimen"? Only those pharmacologically classified as pain medications, or any pharmacologic agent that is primarily being used to treat pain (e.g. Neurontin)? You, can count all medication which the primary use is to treat pain. Can routine pain meds (Celebrex) be counted here? Yes, they are counted as a scheduled pain medication. J1400 - What documentation is required to code this item? Terminal illness diagnosis? There needs to be physician documentation in the medical record that the resident has a life expectancy of six months or less. If the resident is being covered by Hospice there is a requirement that there be documentation in the medical record that the resident has less than 6 months to live. 27

28. Frequently Asked Questions K0100 - If someone has a swallowing disorder but there are interventions in place for successful swallowing, how is this item coded? If they do not have any of the signs or symptoms in the past 7 days then you would code Z none of the above K0200 - What height is recorded for lower extremity amputees? The facility must have a policy how they measure residents and this should include the methodology used for amputees 28

29. Frequently Asked Questions K0500B - If a feeding tube is in place, but only free water is being given via tube, how is this item coded? You would code the feeding tube if they were receiving free water as part of the resident�s hydration plan K0500D - Are supplements given between meals coded in this item? Pending an Answer from CMS K0700B - If only free water is put through a feeding tube, is it coded here? Yes, under K0700B 29

30. Frequently Asked Questions If a pressure ulcer heals during the 7-day look-back period, how is it coded in Section M? Code what is noted closest to the ARD M0700 � How is this item coded for Stage 1, closed Stage 2 blister, sDTI, or non-removable/dressing device? You would put a dash if none of the codes are reflective of the tissue type M1200D � Can vitamins be coded here even if not ordered specifically for prevention of skin problems? No M1200G/I � Are band aids and corn pads coded in these items, respectively? No 30

31. Frequently Asked Questions O0600 - Can telehealth physician "visits" be coded in this item? Yes, if it meets the definition in the RAI manual for physician/practitioner and the telehealth was a billable visit 31

32. Modification Beginning April 1st Providers will NOT be able to modify: A0200-Type of Provider A0410-Submission Requirement Event date (ARD, Entry Date , Discharge Date) Correction of these items requires a Special Manual Record Correction Request The Modification Request can modify any MDS items with the exception of Type of Provider (Item A0200), Submission Requirement (Item A0410), and the control item containing the State-assigned facility submission ID (FAC_ID). Correction of these items requires a Special Manual Record Correction Request (discussed later in this chapter). The Modification Request can modify any MDS items with the exception of Type of Provider (Item A0200), Submission Requirement (Item A0410), and the control item containing the State-assigned facility submission ID (FAC_ID). Correction of these items requires a Special Manual Record Correction Request (discussed later in this chapter).

33. Available Training Resources

34. Things to Remember with Regards to the MDS Assessment

35. Contact Information Cecilia Vinson, MSN, RN 501-837-8159 Abbie Palmer or Mark Kilburn 501-682-8430