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managed care and the mds

MDS   (9,952 Views 13 Comments)
by michmommylala michmommylala (New) New

1,105 Profile Views; 6 Posts

Hey guys,

I just started at a new facility, I have a question about how a managed care assessment in put into your system...for example...in the past any skilled managed care resident, just rec'd an admission assessment then followed the OBRA schedule. This building does an admission assessment, federally req assessment then a 5 day with the same ARD but codes it as "not a federally req assess" then the 14 day and so on like a Med A patient, all not labeled as a federally req assessment.

I am very confused and wondered if anyone in PA is doing this. Other RNACs I know in PA are not. maybe Aetna has changed they way they are billing and want to use the patient RUG score...any help would be appreciated,

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Ruas61 has 35 years experience as a BSN, RN and specializes in MDS/ UR.

1,366 Posts; 31,452 Profile Views

In Minnesota here and some contracts call for this with. One needs to check the fine print with requirements per each plan. Humana can be very tough.

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6 Posts; 1,088 Profile Views

There is no fine print. An admission assessment is required for federal. You put it in just as an admission, you do not have to put in as admission 5 day and you do not do two seperate admission assessments. You then would continue as you were doing for 14 day, 30 day ect not federally required

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6 Posts; 1,105 Profile Views

thanks for the response...this particular building does it like this which I found odd... I don't want to buck the rules being new but this is how our corporate RNAC said to do it...oh well. Was just wondering:unsure:

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Ruas61 has 35 years experience as a BSN, RN and specializes in MDS/ UR.

1,366 Posts; 31,452 Profile Views

Federal required MDS cannot be combined with insurance advantage plans. If the insurance company wishes the resident to have MDS done per PPS schedule you would do them but not submit them. As you have been doing so it seems. This would be in the fine print of the contract requirements for paymnt. If you are audited by the insurance company and have not followed the contract. You likely will have payment issues.

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silverbat has 22 years experience and specializes in Care Coordination, MDS, med-surg, Peds.

614 Posts; 17,884 Profile Views

My Corp had me do an admission, and use that for 5 day, then the 14, 30 etc., i did, printed, then deleted.

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cwrnracct has 7 years experience and specializes in MDS, admission.

1 Post; 535 Profile Views

I would be careful when marking not federally required for item A0410. This is about privacy, authority of entities to collect MDS information and should be programmed into your software and not varied from assessment to assessment. It is about how your beds are certified, not actually who receives the information. (From RAI page A-8, A-9)

1= Bed is not Medicare or Medicaid certified and state has no authority to collect information

2= Bed is not not Medicare or Medicaid certified, but state has authority to collect information

3= The MDS record is for a resident on a Medicare and/or Medicaid-certified unit

Our facility marks 3 with every assessment, then makes a seperate file before shipping to store our insurance MDS's in, it then populates our software with the correct RUGs for billing information

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124 Posts; 6,038 Profile Views

I confirm cwrnracct's post. Two weeks ago, CMS said exactly that on a conference call.

CMS also has said in the past that marking A0310B something other than 99 for a non-Part A record is incorrect, as well, since A0310B is for Medicare Part A PPS records. I know that CMS would prefer that Medicare replacement, etc. records be labeled and recorded separately. I have heard of at least one software vendor (don't remember which one) that allows you to mark a record as non-Part A, using a non-MDS field, so that the record never gets submitted to CMS and meets CMS's desire for non-Part A Medicare records to be maintained separately.

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124 Posts; 6,038 Profile Views

I found out from a colleague that CMS no longer endorses the following, "marking A0310B something other than 99 for a non-Part A record is incorrect, as well, since A0310B is for Medicare Part A PPS records." They got in trouble with the provider organizations and took it back.

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77 Posts; 4,782 Profile Views

So if I understand this correctly A0410 pertains to the certified beds, and not the payor? All of my beds are Medicare beds, no Medicaid beds, so I should be answering A0410=3 regardless of the payor for the NC eval? I'm in Texas.

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124 Posts; 6,038 Profile Views

ibtootie, you are correct. MDS completed for residents in certified beds require A0410=3. In Texas, residents in non-certified beds require A0410=2.

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4 Posts; 567 Profile Views

Wouldn't it be simpler if the software programs simply offered a selection option for a Managed care assessment? I doubt the Managed Care companies will ever be going away and will become more common in the upcoming years, so it would be nice to have a less obscure method to use in order to stay compliant.

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