MDS Process nurses

Nascar nurse, ASN, RN · Oct 2, 2005

Hi. I don't know if this is exactly what your looking for, but I will share how we do it. There are 2 of us RN MDS co. in our LTC. We have 90 beds w/ about 25-28 being medicare (quick turnover of residents too! - may easily have 45 different m/c residents in those beds w/ in a month time period. Anyways, I do all the medicare assessments/RAPS/Careplans (I transmit for the entire building.. too confusing to have 2 people doing this) and manage the medicare A program, including running m/c meeting, monitoring documentation, education needs for staff, certification tracking, Non-covered decision making/letters/notifications, part of billing even, and ADR's (if we're unfortunate enough). She does the medicaid/private resident's MDS's (even tho her "caseload" is higher in numbers, I often end up with more assessment/month due to PPS schedule and constant turnover). She also handles the medicare part B/restorative program and all of the things that go with that. We are very fortunate as we work very well togeter - when I am swamped, she'll pick up some of mine and I do the same for her when she gets swamped. We are in a case mix state, meaning our MDS's determine our medicaid rates as well and she does all the tracking of that - while I do the RUG tracking on medicare A.

fluffwad · Oct 2, 2005

I am the MDS coodinator in a 99 bed facility. I have an LPN who also is a full time MDS nurse.

I find it works best if we can both are able do everything, but it makes sense to divide up the tasks so that we aren't duplicating efforts.

Our # of Part A varies a lot, we both work the PPS and non-PPS case loads. I run the care plan meetings and UR. She does the restraints monitoring. I do all the electronic records submissions and billing reports. She updates the care plans in half the building, I update the other half.

nursegirl62 · Oct 2, 2005

Oh thanks for the information! We have never had 2 MDS people here I am a RN the gal we hired is LPN.Upper management has given me free rein as how to do this, and so I want to do it correctly and the most efficiently like the idea of both being able to do all, and I know DNS,or ADNS will sign off if I am not available.

Next question I have never "trained" someone to this how should I start?

In a perfect world she could go to some MDS classes....but I checked state note offering anymore till next spring and AANAC isn't in the budget right now.

She knows the MDS exists.....vaguely and I thought I could put her on the CMS website for a few hours each day....but when it really comes right down to it the only way to learn the MDS/RAPS process is to do it!(my opinion) Right along with the manual.....that's how I learned.

Well any suggestions on how to do this are welcomed

Nascar nurse, ASN, RN · Oct 3, 2005

I agree with you. The best way to learn it is to do it. I got a whooping 2 hours of orientation, then the MDS gal at the time got mad about something else in the building and walked out mid shift. I memorized the RAI like a bible and went from there - that was 6 years ago. Is your facility owned by a cooperation? Often they have training programs as well. Good luck. Enjoy going home on time once you get your partner trained!!

nursegirl62 · Oct 3, 2005

No my facility is privately owned,but great admistrator/Owner.I actually put in my notice about 3 weeks ago.....just couldnt keep up anymore,working way more than I want/need.....anyways boss called around found out I am doing the work of 2 people working a total of 70 hours,within minutes he said hire someone.Problem is we are very rural,and there seems to be a nursing shortage(lol),so after a few interviews we hired.

We are small 55 beds BUT generally 12-15 are medicare,and several are special needs r/t Psycho illness,Huntington's Chorea involves alot of careplanning re evaluation.....special state contract thing getting geriatrics out of state hospitals.....lots of extra documentation too.Never a dull minute.Plus my job entails alot of other areas not really just the MDS.

MDSlady · Oct 9, 2005

Hi, and congrats on getting help in your dept. I know how hectic it can be. I am in the other shoe. I was the LPN working 24 hours with an RN who was MDS Coordinator, but when she left I was promoted to the position. They have now hired an RN 20-24 hours to fill my previous position. She mainly does just the Med A MDS's. I find that since I was a charge nurse on the floor for the past 7 years, that I know the long term residents very well therefore, I do all the annuals and quarterly MDS's. I would eventually like for her to do them, but I find that it is too consuming for her. We have a 30 bed re-hab unit and the Med A people come and go too fast. I do all the care planning, weight meeting, pressure meeting, Resident Care conferences, and walking rounds weekly. It is alot and like I said, I would like her to do alittle more, but I'm working on that. If you have the opportunity to get someone 40 hours, have her do some of your meetings. I have to say that I am a control freak in some ways, and I like to have control over the care plans but everything else is free to be done. Good luck and keep us posted on how it goes. Maybe I could use some of your advice to help delegate tasks in my dept. also. Let me know how it goes.

catlady, BSN, RN · Oct 12, 2005

One of you might want to focus on becoming the PPS expert. A good PPS nurse is literally worth her weight in gold, because she understands how to time the assessments and work with the therapists to capture the most revenue. And revenue is what keeps your staff paid and your building afloat.

jarn · Oct 29, 2005

Im a new MDS Coordinator and need HELP with PPS please. Is there any books out there to help one understand it all . Like Med A a cancer -dialysis patient.( missouri )

Please email me [email protected]

jarn · Oct 29, 2005

Would You have any info on PPS and all the things a new Med A nurse needs to know

MDSlady · Oct 29, 2005

Hi, I too am a MDS nurse. First, good luck in your new position. Go to the CMS website. You can download the RAI manual for free. That's my bible. Are you taking over for someone, or starting from scratch?? Don't get frustrated, it's always changing. Once you think you understand the process, CMS will change it again. I just attended a seminar as a refresher and again, left with my head spinning. There are always changes. Just try to remember that accuracy is your best friend. If the documentation is not there to support an answer that you want to put on the MDS, remember to always write a nurses note of your own, (This writer observed resident ambulated with extensive assist in his room, for example if all the documentation says that he did not ambulate.) I find the hardest problem is CNA documentation. They all tend to copy what the person before them has charted. Also, I don't think that they know the true meaning of limited, extensive, supervision. Try to think of ways to inservice so that you could get the most accurate documentation. I'm in the process of working with staff development nurse on inservices. (On top of everything else!!!) But you will find how much this documentation effects your RUGS scores. Again, good luck and keep in touch with how you are doing. Anymore questions, let me know. I will try to help you out. And vice versa, anything that I can learn from anybody else helps me out too..............:chuckle

CoffeeRTC, BSN, RN · Oct 29, 2005

Try AANAC.org. Great place for tons of info.