Mds-rugs

Talino · Jan 9, 2006

Lets see if I understand. Sometimes I am alittle slow. I can do the short form for the 5 day for patients that go home before day 14. But if they are not DC then I need to do a full 14 day, with RAPS, and care plan decisions. Is it ok to use the 5 day short form routinely? I never know what the length of stay is going to be. Its hard to second guess the doctors and Therapist sometimes. But its a low percentage of our residents that stay 14 days or longer.

You can use the MPAF when you do the 5-Day. If the resident is still in facility on day 14, you will be compelled to complete a full MDS for OBRA required Initial Adm w/ RAPs. If the resident would still be in facility on day 15, you will need to combine this Initial Adm MDS w/ a 14-day PPS.

Refer to the RAI pp 2-32 to 2-36 regarding use of MPAF

Be advised also - the RAI's most recent update is Nov. 2005

The 53-Grouper RUGs are explained on pp 6-8 to 6-28

You may also view it here...

http://www.cms.hhs.gov/SNFPPS/02_Highlights.asp#TopOfPage

Click on -- RUG-53 Education Material [ZIP, 43kb]

This is a zip file. Once unzipped, open ..

CrosswalkMDS2-RUGIII(53)FINALRULE

RondaS · Jan 10, 2006

Thanks so much. I will check it out.

shannon5555 · Jan 10, 2006

HI! I just joined this group last night. I am a MDS Coordinator in OH and have been doing MDSs for one year. aanac.com has a free case mix discussion group email list serve which I have been getting for free for most of the past year. Just go to aanac.com. You do not have to be a member of aanac. It is free. You give your email address and get all the emails posted to the list serve. I get about 100 in a 24 hour period. I delete the ones with subjects that do not interest me, and read the ones that do. When I have a question or need a resource or advice I sent an email to the group.

There is an MDS expert that is in charge of monitoring the site and she corrects people when they send incorrect info or advise. She doesn't monitor it 24/7, but I think she does at least once a day. There are also numerous experts and experienced professionals responding to the emails. The best ones always include reference to the RAI manual or a link to a CMS website or something like that to support their advise.

Something else related to this thread... in Ohio we use the MPAF for all quarterlies in addition to the PPS assessments. We only have to use the long form for Initial Admissions and annuals! This just started several months ago and is so nice! It is a state thing.

shannon5555 · Jan 10, 2006

Correction to my post:

It is aanac.org, not aanac.com.

Sorry!

click on the "discussion group" link near the top right. That will prompt you to enter your email address and then click "subscribe." Simple!

afadel · Jan 10, 2006

I just started doing the MDS after not doing them for about 2 years. I know there is now a shorter 5 day MDS for MCR. We are currently still using the full assessment. How do you go about changing that?

To switch from using the full assessment to the MPAF form for your medicare assessments, you should contact your MDS software vendor and ask if its software supports the newer, shorter form.

As far as whether to use the MPAF for your Medicare 5-day assessments, there are different schools of thought on that.

Some people combine the Admission assessment with a Medicare 5-day, in which case you'd need to complete 10 pages and RAPs and Care Plan and submit the assessment with AA8a = "01" and AA8a = "1". If the resident discharges prior to day 14, you would then not do the RAPs and Care Plan and submit it as a AA8a="00" and AA8b ="1". The advantage of this approach is the facility can set the assessment reference date in the grace day period for both the Medicare 5-day and the Medicare 14-day. I believe CMS is tolerant of use of grace days on the Medicare 5-day and less tolerant of its use on the Medicare 14-day. Does anybody have any experience with this?

The other theory is to delay the comprehensive admission assessment to combine it with the Medicare 14-day. The advantage of this is you do less work since you never even start the full assessment form if the resident discharges before day 14. The disadvantage is that you must have your assessment reference date on day 14 or earlier.

Ideally, the facility MDS coordinator would use whichever combination would give the best information for resident care and Medicare reimbursement.

catlady, BSN, RN · Jan 14, 2006

You can use the MPAF when you do the 5-Day. If the resident is still in facility on day 14, you will be compelled to complete a full MDS for OBRA required Initial Adm w/ RAPs. If the resident would still be in facility on day 15, you will need to combine this Initial Adm MDS w/ a 14-day PPS.

I was taught to plan on doing a 1/1 (full assessment with the 5-day Medicare assessment) and an 0/7 MPAF, because if I didn't, I couldn't use grace days if needed for the 14 day assessment. (The initial assessment and RAPS have to be done by day 14, which precludes using Medicare grace days 15-19.) If I knew for sure that they'd be gone by day 14, I just did an 0/1, 5-day MPAF without the initial assessment.

MDSlady · Jan 15, 2006

What's going to give you higher payment with the RUGS is your therapy and ANYTHING in section P that you can check off. IV'S, transfusion, suctioning, etc. Since the new RUGS have come out, instead of picking day 8 which I usually did for higher payments, you may pick day 5-6 so that you can you can use your IV's on the 5 and 14d MDS. Talk to your therapy people and see what day you can use that will pay the best for the 5 AND the 14d MDS. That's where the money is.....

Carrie162 · Jan 17, 2006

RondaS, check out the AANAC website. You can capture the nine new rug categories when residents are receiving therapy and extensive services, specifically IV meds, IV fluids, vents, trach's, or suctioning. Minutes of therapy have not changed. It is important to track the ADL sum score; residents will only make the nine new rugs if they are heavier care, ADL sum score of at least 7.

RondaS · Jan 17, 2006

Anyone know where there is training for the RUGS. I seem to need it.

Faeriewand, ASN, RN · Jan 17, 2006

OMG I thought this was a thread regarding the bad wigs some Doctor's wear! :chuckle :coollook: :imbar :uhoh21: :rolleyes:

evalesco · Jan 19, 2006

Anyone know where there is training for the RUGS. I seem to need it.

I think that it depends on your state. My company is always sending me to seminars for updates etc. I am in Illinois, what triggers the new rug codes are the ADL's AND skilled services combined, IV meds, IV fluids, suctioning, and I belive trach care, depending on the ADL score 16+ will put you in the X catagory and below that will put in the L catagory.If you have no skilled services in the 14 day lookback and just therapy your score will remain the same as it always did. Although in Illinois the usual rehab scores kinda went down in payment. Try to look online for a seminar or do you have a sister facility or hospital in your company that you can go to for training. Good Luck:)

RondaS · Feb 5, 2006

Here is another question. I had a patient who came in for 6 days of IV antibiotics. Well on day six it was decided he was to weak to go home and the Doctor ordered physical therapy. I had already done his 5 day MDS so I don't know exactly what to do. Can anyone help?