How do you handle insurance MDS transmissions?

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I have been doing MDS's since the beginning of the year in a LTC/ Rehab building. I am now being trained by one of the other MDS coordinators in our building to transmit. I need some clarification on how to handle insurance/ medicare replacement MDS's. I have been told we always code 3 in A0410 no matter what. When it comes to time to transmit, we put insurance MDS's in a seperate batch and do not transmit them. The only problem is, with 3 MDS coordinators and 1 transmission person for our whole building, it does not always get communicated to me who is insurance, so on two occasions now insurance MDS's have been transmitted. The first time, the coordinator training me told me that I had to send in a manual deletion request, which I did. The second time, she went in and did an inactivation request herself instead, without telling me or explaining to me why she corrected it differently. I cannot ask her questions or ask her to explain things without her feeling like I am stepping on her toes.

This way of handling insurance cases is new to our MDS team (I was told they were transmitting ALL MDS's just prior to me starting) and seems open for error. Do you always code 3 in A0410? It seems maybe we could code 1 for insurance cases and avoid this problem altogether? How do you guys handle insurance MDS's?

Talino

1,010 Posts

Specializes in ER CCU MICU SICU LTC/SNF.
The first time, the coordinator training me told me that I had to send in a manual deletion request, which I did. The second time, she went in and did an inactivation request herself instead, without telling me or explaining to me why she corrected it differently.

You can "delete" (or remove) from the submission files if the MDS is not submitted yet. Once submitted and accepted you can only "inactivate".

Do you always code 3 in A0410? It seems maybe we could code 1 for insurance cases and avoid this problem altogether? How do you guys handle insurance MDS's.

If A04410 = 1, you may not be able to pull the necessary MDS items that will generate an accurate RUG score or be able to close the assessment without warnings. That is why 3 is always used to replicate an exact PPS MDS. Communication is always key. Whoever is responsible for creating the MDS assessment for this type of payor should always change the status of the MDS assessment to "Hold, do not submit" (software-specific) prior to completing. Even if submitted, there is no penalty or repercussion. Simply inactivate each time.