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MDS Tracking

MDS Tracking. Aaron Weg ADL Data Systems, INC. Introduction. Goals of the Session Understanding the MDSTRK screen AI codes – what they mean and how to bill Special Cases Cases to avoid Penalties for errors HMO’s and special MDS’s. MDSTRK What and Where. 2 Places Fields on the screen

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MDS Tracking

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  1. MDS Tracking Aaron Weg ADL Data Systems, INC. ADL Data Systems, Inc.

  2. Introduction • Goals of the Session • Understanding the MDSTRK screen • AI codes – what they mean and how to bill • Special Cases • Cases to avoid • Penalties for errors • HMO’s and special MDS’s ADL Data Systems, Inc.

  3. MDSTRK What and Where • 2 Places • Fields on the screen • Index Maximization • CMI scores • Medicaid Calculators ADL Data Systems, Inc.

  4. Where is it ADT/Registration Special Data MDS Tracking Billing Billing Wizard Pre-Billing Update RUGs Track ADL Data Systems, Inc.

  5. Fields in MDSTRK • ARD Date • Covered Dates • Completion Date • Therapy Date • PPS day 1 • Therapy dates • (Start and End) • RUGs scores (Medicare / Medicaid) • Therapy Resume Date • (EOT-R) • AI Codes • Assessment Types ADL Data Systems, Inc.

  6. Index Maximization • Medicare – Always check • Medicaid - State dependant • Urban – Rural • Index Maximization Rational • Higher score is not higher cost • Resident qualifies for both • Reimbursement is higher rate ADL Data Systems, Inc.

  7. RUG / CMI scores ADL Data Systems, Inc.

  8. RUG / CMI scores sorted ADL Data Systems, Inc.

  9. Meaning of RM? score • Total of PT Days, OT Days & ST Days = 5 • One class of therapy for 3 days • Can be Monday, Wednesday & Friday • Does not need to be spread over 5 days of the week • To be Medicare based on therapy it needs to be over 5 days • To be Medicare if not over 5 days, needs to be Medicare for another reason ADL Data Systems, Inc.

  10. Rug Calculators • 66, 57 & 48 (Rugs IV) • 34, 44 & 53 (RUGS III) • Urban / Rural • MCARE, MCARE2, OTHER • States may have their own CMI’s • Versions 5.01, 5.12, 5.20, E03/4 F03/4 • Over 30 tables in use • Set from security ADL Data Systems, Inc.

  11. PPS Day 1 • For both Medicare and Medicare HMO • For Medicare HMO this is not in the MDS book • Used to calculate standard periods • Days 1-14 • Days 15-30 • Days 31-60 • Days 61-90 • Days 91-100 ADL Data Systems, Inc.

  12. Start and End Therapy Dates • Copied from MDS • End date used to exclude Rehab score in certain cases even though the MDS shows the rehab score • Example 5 from RAI page 6-11 ADL Data Systems, Inc.

  13. Example 5 from RAI • The EOT OMRA assessment is performed with an ARD on Day 25 since therapy ended on Day 24. The PPS 30-day assessment is then performed with ARD on Day 28 to establish a Medicare RUG for the Day 31 to Day 60 payment period. • The Medicare Non-Therapy RUG (Z0150A) from the End of Therapy OMRA is billed for the remainder of the current payment period, Day 25 through Day 30. • The Medicare Non-TherapyRUG (Z0150A) from the 30-day assessment is then billed for the next payment period, Day 31 through Day 60. • The Non-Therapy RUG from the 30-day assessment is used since all therapy has previously ended. • The normal Medicare RUG (Z0100A) should not be used since it may contain a Rehabilitation Plus Extensive or Rehabilitation group RUG, because the 7-day reference period extends back before therapy had ended. ADL Data Systems, Inc.

  14. Therapy Resume Date • EOT-R Date • The date the resident Resumes therapy at the same level • No reassessment is needed • Best not to combine with scheduled assessment due to billing issues and confusion ADL Data Systems, Inc.

  15. Therapy Date • Normally end of therapy. • Used in combined SOT/EOT • Used with EOT in Grace Days • For Short Stays this is the therapy start date. ADL Data Systems, Inc.

  16. Assessment Types - OBRA • OBRA • 01 Admission • 02 Quarterly • 03 Annual • 04 SCSA Significant Change of Status • 05 Significant Correction - Comprehensive • 06 Significant Correction - Quarterly • 99 None of the above ADL Data Systems, Inc.

  17. Assessment Types - PPS • PPS • 01 5-day (1-14) • 02 14-day (15-30) • 03 30-day (31-60) • 04 60-day (61-90) • 05 90-day (91-100) • 06 Unscheduled – OMRA, SCSA, Etc… • 99 Not a PPS assessment ADL Data Systems, Inc.

  18. Assessment Types - OMRA • OBRA • 0 Not an OMRA • 1 Start of Therapy (SOT) • 2 End of Therapy (EOT) • 3 Start/End of Therapy (SOT/EOT) • 4 Change of Therapy (COT) ADL Data Systems, Inc.

  19. AI codes • 2 digits • First digit – Scheduled payment period • Second digit – Impact on standard payment period • First digit of 6 is non PPS • First digit of 0 is unscheduled PPS • First digit 1-5 same as PPS type 1-5 ADL Data Systems, Inc.

  20. AI codes Second Digit 0 • Either a scheduled PPS assessment not replaced by or combined with an unscheduled PPS assessment • an OBRA assessment not coded as a PPS assessment ADL Data Systems, Inc.

  21. Second digit 0 effects • No impact on the standard payment period (the assessment is not unscheduled). • If the second digit value is 0, then the first digit must be 1 through 6, indicating a scheduled PPS assessment or an OBRA assessment not coded as a PPS assessment • If the first digit value is a 6, then the second digit value must be 0. ADL Data Systems, Inc.

  22. MDSTRK for 5-day/Readmit assessment MEDAYS ADL Data Systems, Inc.

  23. Second Digit of 1 • Either an unscheduled OBRA assessment or Swing Bed CCA • Do NOT use if • Combined with any OMRA • Medicare Short Stay assessment ADL Data Systems, Inc.

  24. Second Digit 1 effects • If the ARD of the unscheduled assessment is not within the ARD window of any scheduled PPS assessment, including grace days (the first digit is 0) • If the ARD of the unscheduled assessment is within the ARD window of a scheduled PPS assessment, not using grace days • Use the Medicare RUG (Z0100A) from the ARD of this unscheduled assessment through the end of standard payment period ADL Data Systems, Inc.

  25. Second Digit 1 effects (cont) • If the ARD of the unscheduled assessment is a grace day of a scheduled PPS assessment • Use the Medicare RUG (Z0100A) from the start of the standard payment period. ADL Data Systems, Inc.

  26. MDSTRK for SCSA (2nd digit 1) Prior assessment changes From To MEDAYS ADL Data Systems, Inc.

  27. Second Digit 1 special case • If SCSA combined with 5 day assessment • AI code = 11 • If done in regular days • Covers from ARD date only • If done in Grace days • Covers from Day 1 • Do not combine if not in grace days ADL Data Systems, Inc.

  28. Second Digit 2 or 3 • Start of Therapy OMRA combined with either an unscheduled OBRA assessment or a Swing Bed CCA • Do NOT use if • Medicare Short Stay assessment • Combined with End of Therapy OMRA • 3 if combined with unscheduled OBRA or Swing Bed CCA – else 2 ADL Data Systems, Inc.

  29. Second digit 2/3 effects • If unscheduled assessment gives a therapy group in the Medicare RUG (Z0100A): • Use the unscheduled assessment Medicare RUG (Z0100A) from the earliest start of therapy date through the end of standard payment period. • Must have a Rehab RUG score or it is an invalid/unacceptable SOT. ADL Data Systems, Inc.

  30. 14 Day w/SOT (2nd digit 2/3) Prior assessment changes From To MEDAYS ADL Data Systems, Inc.

  31. Second digit 4 • End of Therapy OMRA not reporting Resumption of Therapy; whether or not combined with unscheduled OBRA assessment and whether or not combined with Swing Bed CCA • Do NOT use if • Combined with Start of Therapy OMRA • Medicare Short Stay assessment • End of Therapy OMRA reporting Resumption of Therapy (EOT-R) ADL Data Systems, Inc.

  32. Second Digit 4 effects • Use the unscheduled assessment Medicare non-therapy RUG (Z0150A) from the day after the latest therapy end date (speech-language pathology services in O0400A6, occupational therapy in O0400B6, or physical therapy in O0400C6) through the end of current payment period. • If in EOT date is in grace days and combined with a scheduled PPS (ADL) • Bill first grace days (thru EOT) at Therapy Rug (Z0100A) ADL Data Systems, Inc.

  33. EOT assessment (2nd digit 4) Prior assessment changes From To MEDAYS ADL Data Systems, Inc.

  34. SOT – combined with 5 day • If short stay • must be combined • If index maximized to non-rehab • Invalid SOT – invalid short stay • Optional assessment • Do not use if it will cause a lower reimbursement • From page 2-47 of RAI • An SOT OMRA is not necessary if rehabilitation services start within the ARD window (including grace days) of the 5-day assessment, since the therapy rate will be paid starting Day 1 of the SNF stay ADL Data Systems, Inc.

  35. Second Digit 5/6 • Start of Therapy OMRA combined with End of Therapy OMRA not reporting Resumption of Therapy and combined with either an unscheduled OBRA assessment or Swing Bed CCA • Do NOT use if • Medicare Short Stay assessment • End of Therapy OMRA reporting Resumption of Therapy (EOT-R) • Code 6 if combined with unscheduled OBRA or Swing Bed CCA. Else 5. ADL Data Systems, Inc.

  36. Second digit 5/6 effects • If unscheduled assessment gives a therapy group Medicare RUG (Z0100A): • Use the unscheduled assessment Medicare RUG (Z0100A) from the earliest start of therapy date through the latest therapy end date. • Use the unscheduled assessment Medicare non-therapy RUG (Z0150A) from the day after the latest therapy end date through the end of current payment period. • If Z0100A is not a Rehab RUG, this is an invalid/Unacceptable MDS ADL Data Systems, Inc.

  37. SOT/EOT/30-day (2nd digit 5-6) Prior assessment changes From To MEDAYS ADL Data Systems, Inc.

  38. Second digit B/C (skip 7 & A for now. 8-9 invalid) • Start of Therapy OMRA combined with End of Therapy OMRA reporting Resumption of Therapy (EOT-R) and combined with either an unscheduled OBRA assessment or Swing Bed CCA • Do NOT use if • Medicare Short Stay assessment • Code C if combined with unscheduled OBRA or Swing Bed CCA. Else code B ADL Data Systems, Inc.

  39. Second digit B/C effects • If unscheduled assessment gives a therapy group Medicare RUG (Z0100A): • Use the unscheduled assessment Medicare RUG (Z0100A) from the earliest start of therapy date through the latest therapy end date. • Use the unscheduled assessment non-therapy RUG (Z0150A) from the day after the latest therapy end date through the day before the resumption of therapy date (O0450B). • Use the unscheduled assessment Medicare RUG (Z0100A) from the resumption of therapy date through the end of the standard payment period. • If Z0100A is not a Rehab RUG, this is an invalid/unacceptable assessment. ADL Data Systems, Inc.

  40. SOT/EOT/EOT-R (2nd digit B/C) Prior assessment changes From To MEDAYS ADL Data Systems, Inc.

  41. Second Digit A • End of Therapy OMRA reporting Resumption of Therapy (EOT-R); whether or not combined with unscheduled OBRA assessment and whether or not combined with Swing Bed CCA • Do NOT use if • Combined with Start of Therapy OMRA • Medicare Short Stay assessment ADL Data Systems, Inc.

  42. Second Digit A - effects • Use the unscheduled assessment Medicare non-therapy RUG (Z0150A) from the day after the latest therapy end date (speech-language pathology services in O0400A6, occupational therapy in O0400B6, or physical therapy in O0400C6) through the day before the resumption of therapy date (O0450B). • Use the Medicare RUG (Z0100A) from the assessment (used for SNF/PPS) immediately preceding this End of Therapy OMRA, and bill this RUG from the resumption of therapy date (O0450) through the end of the standard payment period. ADL Data Systems, Inc.

  43. EOT/EOT-R (2nd Digit A) Prior assessment changes From To Special flag for EOT-R to notify to check RUG score MEDAYS ADL Data Systems, Inc.

  44. EOT-R special considerations • Can be done as a modification MDS • Must resume within 5 calendar days • Must expect same therapy level • Therapy Evaluation not Required • Resumes at rug level of prior assessment • Z0100A not from this book • Recommend not to combine with Scheduled PPS assessment ADL Data Systems, Inc.

  45. EOT-R weird cases • EOT combined with 30 day and EOT-R • ARD day 27 (6/27) • EOT day 24 (6/24) EOT-R day 29 (6/29) • Z0100A = RMB, Z0150A = LB1 • Prior assessment Z0100A RHA • Pays • 6/25 – 6/28 LB1 • 6/29 – 6/30 RHA • 7/01 - 7/30 RMB • Probably will need COT ADL Data Systems, Inc.

  46. EOT-R weird case 2 • EOT combined with 30 day and EOT-R • ARD day 29 (6/29) • EOT day 27 (6/27) EOT-R day 32 (7/2) • Z0100A = RMB, Z0150A = LB1 • Prior assessment Z0100A RHA • Pays • 6/27 – 7/1 LB1 • 7/2 – 7/30 RHB • Probably will need COT • The next slide is from CMS • NPC_Nov3_clarification_final.pdf last page ADL Data Systems, Inc.

  47. EOT-R weird case 2 (cont)part 1 In all cases where an EOT-R would be completed, the resident must resume therapy at the same RUG-IV therapy level as had been in effect prior to the break in therapy. However, it is possible that the ARD for an EOT OMRA reporting resumption may be set for the first grace day of the allowable grace days for a scheduled PPS assessment, while the ARD for the scheduled assessment was set for a day within the normal ARD window. In this limited subset of cases, the resumption of therapy should occur using the previous RUG-IV therapy level (which should be the same as the therapy level determined on the scheduled PPS assessment if the resumption is appropriate) but using the Activities of Daily Living (ADL) score from the most recent PPS assessment. ADL Data Systems, Inc.

  48. EOT-R weird case 2 (cont)Part 2 Consider the following example. A resident, Mr. P, is admitted on 10/01/11. The ARD of the 5-day assessment for Mr. P is set for 10/07/11 (Day 7) and the RUG assigned to Mr. P is RVB. The ARD of the 14-day assessment is set for 10/14/11 (Day 14) and the RUG assigned to Mr. P is again RVB. The ARD of the 30-day assessment is set for 10/28/11 (Day 28) and the RUG assigned to Mr. P is now RVA. Due to an acute illness, Mr. P is unable to receive therapy services from 10/29/11 through 10/31/11, but is expected to resume therapy on 11/2/11 under the same therapy regimen. The facility completes an EOT for Mr. P with an ARD of 10/31/11 and reports that the resumption of therapy will occur on 11/2/11. The EOT OMRA assigns Mr. P a non-therapy RUG of CE2. Mr. P is discharged from the facility on 11/12/11. ADL Data Systems, Inc.

  49. EOT-R weird case 2 (cont) Part 3 10/01/11 admitted 10/07/11 5-day RVB 10/14/11 14-day RVB 10/28/11 30 day RVA 10/31/11 EOT/EOT-R CE2 EOT-R date was 11/02/11 Discharge 11/12/11 In the case described above, assuming no intervening assessments were necessary, the facility would bill in the following manner. Days 1-14 would be billed under HIPPS code RVB10. Days 15-28 would be billed under HIPPS code RVB20. Days 29-31 would be billed under HIPPS code CE20A. Days 32-41 would be billed under HIPPS code RVA0A. This represents the one and only occasion where the three character RUG-IV therapy RUG code may differ from that which was billed prior to the break in therapy, and the difference may only be in the third character in the therapy RUG code related to the resident’s ADL score. ADL NOTE: 11/28/11 is not used for SNF/PPS payment and is not used for EOT-R rate calculation ADL Data Systems, Inc.

  50. Second Digit D - COT • Change of Therapy OMRA; whether or not combined with unscheduled OBRA assessment and whether or not combined with Swing Bed CCA ADL Data Systems, Inc.

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