MDS 3.0 RUGIII to RUGIV Medicare PPS Transition

[Talino]

If you complete a Medicare PPS assm't with a payment that will overlap from September to October using the MDS 2.0, the RUGIII payment will only be good until September 30th. In order to receive payment for the remaining days from October 1st onward, you will need to complete the same PPS assm't type using the MDS 3.0 w/ ARD of 10/1.

Example: You did an MDS 2.0 30-day PPS in September which you expect to be paid for 30 days from September 15 - October 14.

-->The MDS 2.0 30-Day RUGIII score will be paid from September 15-30.

-->The MDS 3.0 30-Day (ARD 10/1) RUGIV score will be paid from October 1-14.

If the MDS 3.0 is not done, you will be paid the default rate from October 1-14.

For further details go to Spotlight Skilled Nursing Facilities PPS and download these 2 files...

--> RUG-III to RUG-IV transition for the August 24, 2010 audio-conference

--> August 24, 2010 National Provider Call Training Presentation Slides

[Nascar nurse, ASN, RN]

I think the 2 of us that are doing the MDS' are going to have nervous breakdowns before this is all over.

Amen! They are going to have a build a special "looney bin" just for MDS coordinators that attempted to make the transition to 3.0. LOL

[Magaly63]

had some additional training today, still have concerns....somewhat confused about when to check "yes" for short stay assessment. What makes it a short stay assessment? Can anyone help?

[Talino]

MDS 3.0 Chapter 6, pp 6-12 to 6-15 explains the details. The algorithm p6-14 simplifies it.

[rukiddingme]

Note in my mailbox @ work this morning, from the DON: Attention IDT staff. We will be having a meeting every Friday, until October 1st, to discuss the new MDS 3.0. Everyone will receive a copy of the new MDS 3.0 form and we will then divide the sections and decide who will be doing what areas. Please bring all your ideas to the table.

What a joke. The last idea I gave her was "hire another mds nurse" and she replied "i can't do that".

Well, my new idea will be that I will no longer be called for 'stupid' things such as: Can you go talk to Marie because she's upset about her room change. Or, Nancy's Son wants to know how many times his Mom had Dilaudid in August, before it was scheduled. Or, Bertha wants to talk to you because she doesn't like her doctor and wants a new one.

[NurseMomDori]

We are moving back all MDS with an AR date of 1-8 October into September (doing quarterly MDS a few days early) so that the first week is freed up. We will work that first week doing the interviews so that we are in the reference week, not completing the MDS after the AR date. I also designed my CNA charting to reflect the new questions. We have a small facility with 60 beds, so my average workload is 8 or so MDSes per week. We have also been doing at least one 3.0 MDS a week for practice. Activities does the preference and mood interview, social services does the BIMS minimental, and I do the pain. I will start doing the skin assessments quarterly for the new wound section M. I actually think 3.0 runs a lot smoother, and takes less time. We switched our CNA charting to reflect the new questions on August 1 so that we could work out the kinks before Oct 1. We did adjust in September when we saw what didnt work. I can send my "worksheet" next week if anyone needs ideas.

[KingDom64]

These spreadsheets with the 3 options......I'm thinking option 1 is the best?? What is everyone else going with? I've had very little training on this whole thing and I'm the only MDs coordinator with barely any time to look anything over! AARgh!

[grannybhere]

from all i have been reading ( and I am in a train yourself facility) it looks to me like the option of doing the mds 3.0 early is the best. it is very confusing. i have contacted cms to see if i can get a reply but nothing yet. i have downloaded and printed all the information off of cms website about the medicare transition.none of us knew about this at all until i found it. our provider AHT is unaware and wants me to let them know what i find out.

[Talino]

OPTION #1 is the safest way to undertake this transition, that is, if you don't mind the extra assessments.

OPTION #2 and OPTION #3 will relieve you w/ the extra assm'ts but may be risky when Med A is discontinued prior to a completion of a required MDS 3.0, or the next MDS 3.0 rug may be lower than what the same type MDS 2.0/3.0 (as in option #1) would have been done.

IMO, OPTION #2 & #3, is doable and less work. To avoid missing an assm't because a resident is discharged from Med A and getting a default, create an MDS 2.0 within the ARD window (but no later than Sept 30). Do not complete it. Do either OPTIONS #2 or #3. When a discharge does occur on Oct 1, you can go back and complete the MDS 2.0 you've initially set up.

I have attached a PDF for each assm't (5, 14, 30, etc) required during this transition that maybe less confusing.

MDS 3.0 5-DAY.pdf

MDS 3.0 14-DAY.pdf

MDS 3.0 30-DAY.pdf

MDS 3.0 60-DAY.pdf

MDS 3.0 90-DAY.pdf

[evalesco]

CMS was still revising the 3.0 RAI manual mid August at the Las Vegas conference. That is the reason your corporation seems slow to train everyone. I really do feel that my company and I are in this all together. I was at the AANAC conference in Las Vegas in May, they didn't even have the rugs IV, and were not even sure if it was going to be ready until December 2010. It is a mess I agree.

[MystyDreamer]

Ok now i'm really confused. We called our CMS contact person to clarify the transition dates. What she told us and what i'm reading here is total opposites. If I do what she says it sounds like I will be in default days for most of my 25 skilled starting oct 1. This is crazy, how can we be expected to complete 25 new assessments in as little as 4 days??? Any suggestions???

[NurseMomDori]

We are using grace days to extend our Medicares so that our AR date falls on Oct 1 for the 3 that are within range. Also, try to work your skilled ones in as soon as possible if in the middle of say a 30 and 60 day. This will minimize your default payment days.

[evalesco]

Spotlight Skilled Nursing Facilities PPS

The CMS website has some downloads for the transition from rugs III to rugs IV. We are redoing all our assessments on October 1st, 2nd, and 3rd. Yes it sounds crazy, but our company is not going to accept any default rates. We are making our schedules now to pass out to the staff.