New mds nurse in trouble?!

[hairstonwingate]

NEW MDS NURSE IN SHORT TERM LONG TERM CARE. AGAIN, NEED YOUR HELP. TODAY I DISCOVERED I HAD NOT FINALIZED AN ASSESSMENT (14 day) WITH THE RAPS. IT WAS COMPLETED BY THE APPROPRIATE DATE BUT FOR SOME REASON I OBVIOUSLY WAS DISTRACTED AND JUST FILED IT AWAY. TODAY AS I WAS SUBMITTING THATS WHEN IT WAS NOTICED. MY VALIDATION REPORT CME BACK AS ACCEPTED BUT W/WARNING. THEN I REALIZED I HADNT EVEN FINALIZED THE 5 DAY ASSESSMENT. SO NOW IT WILL BE OUT OF SEQUENCE AND LATE. HOW MUCH TROUBLE AM I IN. I HAVE NO ONE IN THE FACILITY THAT IM AWARE OF HAS A CLUE. PLEASE HELP.

[Talino]

"Finalize" the 5-day and submit. The warnings are expected.

Fortunately, CMS has not imposed penalty (yet) for submitting the PPS assm'ts late. Just make sure the billing department's RUG score matches your submitted assm'ts RUG scores in the validation report.

Be careful next time. Recurrence may raise a flag. The MDS 3.0 will not be so lenient.

[nursefitzy]

I agree. nobody will know the difference. as long as you were able to validate you shouldnt have any problems.

[LPN3RAC-CTMDSC]

Everyone makes mistakes! Even the people at cms. Just submit the 5 day. You will get an out of sequence warning, but as long as it was submitted within 31 days of the completion date, they'll pay for the rug. Be more careful next time.

[edhcinc]

"In trouble" or out of compliance???

Medicare regulations require that an assessment used to set MC payment must be transmitted and accepted into the state (in October the CMS) data base (with very limited exception) before the RUG is billed. The billed RUG must match the RUG calculated by the state. CMS expects that the facility will comply with all guidelines and regulations about MDS scheduling, completion, and transmission as well as those related to billing. (As all staff who complete the MDS attest to...)

Payment for a SNF PPS claim will not be made unless the electronic system finds an MDS with an appropriate ARD to cover the span of the claim and a matching RUG.

Electronic claims billing can be set up in many ways. A fully integrated software system (where billing, finance, rehab, and MDS used for billing--or entire EHR) can track MDS submissions and validated RUGS and appropriately bill or not bill. As stated in other responses, "be careful"--but also let the billers know when all assessments are validated with a "green light" to bill.

Perhaps "no body will know the difference" if something is done, improperly done, or not done at all. But properly constructed electronic systems do "know" and can/will alert those who care about knowing...