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MDS & BILLING NEWS TO USE

Published on Sun Jan 16, 2005

Beware: DAVE has lots of MDS integrity issues on the front and back burners for 2005. The Centers for Medicare & Medicaid Services gave a sneak preview at a recent SNF/LTC open door forum of what the government's MDS watchdog has on tap for next year.

DAVE will be doing onsite medical review at randomly selected nursing facilities, and will continue to do offsite record reviews, as well, said DAVE staffers. DAVE will use the offsite reviews to develop further areas of MDS vulnerability and integrity issues.

Other areas of focus on DAVE's agenda:

  •  The impact of the preadmission care (IVs and suctioning) on 5-day and 14-day RUGs classifications;

  •  RUG mismatches. Evaluation of accuracy of RUGs on Part A claims compared to those recalculated by the state system when facilities transmit their MDSs;

  •  Predicting discrepancies on pressure ulcer MDS items; and

  •  Identifying vulnerabilities related to Other Medicare Required Assessments where facilities are completing early OMRAs or skipping ones that should have been done for residents who qualify for continuing skilled care.

    DAVE analysis has found that facilities are doing a good job completing the 5-day assessment as required, although a "small group of facilities" are having difficulties meeting that requirement, said CMS representatives. The DAVE program is working with CMS to determine what steps might be taken to address the facilities with high rates of missing 5-day MDSs.

    Payback time: CMS is giving providers an opportunity to evaluate Medicare fee-for-service payors. As a first step in an initiative to evaluate Medicare contractors, the agency will be tapping about 7,400 providers this year to complete a Medicare Contractor Provider Satisfaction Survey (MCPSS). The MCPSS is a Web-based survey that will be administered as a pilot in the early part of 2005. The survey will ask providers to rate their fiscal intermediary or carrier on a number of administrative functions, such as  claims processing, reimbursement, medical review and appeals.

     For more information about the initiative, go to     www.cms.hhs.gov/providers/mcpss/default.asp.

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