星级的家庭护理质量评价体系

MDS3.0

LESSONSLEARNEDNEWASSESSMENTSWITHMDS3.0Short-stayAssessmentOMRA’sEndofTherapyOMRAStartofTherapyOMRAMEDICARESHORTSTAYASSESSMENTHowdowedetermineiftheassessmentcanbeaMedicareShortStayAssessment??LookattheMedicareShortStayAssessmentAlgorithmhandout……MEDICARESHORTSTAYASSESSMENTDidatleastonetherapydisciplinecontinuethroughthelastdayoftheMedicarePartAstay?MEDICARESHORTSTAYASSESSMENTAtleastoneofthetherapydisciplinesmusthaveadash-filledendoftherapydateindicatingongoingtherapyoranendoftherapydateequaltotheendofcoveredMedicarestaydate(A2400C)LookattheMedicareEndDateAlgorithmA2400Chandout……MEDICARESHORTSTAYASSESSMENTTherapyisconsideredtobeongoingwhen:Theresidentwasdischargedandtherapywasplannedtocontinuehadtheresidentremainedinthefacility,ORTheresident’sSNFbenefitexhaustedandtherapycontinuedtobeprovided,ORTheresident’spayersourcechangedandtherapycontinuedtobeprovidedMEDICARESHORTSTAYASSESSMENTTheRUGiscalculatedbasedonaveragedailyminutesprovided15-29averagedailytxminutes=RL30-64averagedailytxminutes=RM65-99averagedailytxminutes=RH100-143averagedailytxminutes=RV143orgreateraveragedailytxminutes=RUMEDICARESHORTSTAYASSESSMENT

EXAMPLE#1DAY1DAY2DAY3DAY4DAY5DAY6DAY7MedicareStartDateMedicareEndDateARDTherapyEvalTherapyTx40minutesTherapyTx45minutesTherapyTx40minutesDoestheresidentmeetshortstaypolicyrequirements?MEDICARESHORTSTAYASSESSMENT

EXAMPLE#1SOTOMRA5-dayassessmentStayis8daysorless(7days)ARDofSOTOMRA=endofMedicarestaydateARDisnotmorethan3daysafterstartoftherapyTherapystartedwithinlast4daysofstayTherapycontinuedthroughlastdayofstayRUGisRehabgroupRUGfordays4-7=RM(Z0100A)MEDICARESHORTSTAYASSESSMENT

EXAMPLE#2DAY1DAY2DAY3DAY4DAY5DAY6DAY7DAY8MedicareStartDateMedicareEndDateARDTherapyEvalNotherapyTherapyTx40minutesTherapyTx45minutesTherapyTx40minutesDoestheresidentmeetshortstaypolicyrequirements?MEDICARESHORTSTAYASSESSMENT

EXAMPLE#2SOTOMRA5-dayassessmentStayis8daysorless(Day8)ARDofSOTOMRA=endofMedicarestaydateARDismorethan3daysafterstartoftherapyTherapydidnotstartwithinlast4daysofstayTherapycontinuedthroughlastdayofstayDOESNOTMEETREQUIREMENTSFORSHORTSTAYBECAUSEOF#5AND#6MEDICARESHORTSTAYASSESSMENT

EXAMPLE#3DAY1DAY2DAY3DAY4DAY5DAY6DAY7DAY8MedicareStartDateMedicareEndDateARDTherapyEval20minutesNotherapyTherapyTx30minutesTherapyTx30minutesDiagnosisCOPD,SOBwhilelyingflat,sittingatrestanduponexertionDailyrespiratorytreatment,dailyO2PHQ-9totalseverityscore18ADLscore15MEDICARESHORTSTAYASSESSMENT

EXAMPLE#3Doestheresidentmeetshortstaypolicyrequirements?MEDICARESHORTSTAYASSESSMENT

EXAMPLE#3SOTOMRA5-dayassessmentStayis8daysorless(7days)ARDofSOTOMRA=endofMedicarestaydateARDisnotmorethan3daysafterstartoftherapyTherapystartedwithinlast4daysofstayTherapycontinuedthroughlastdayofstayMEDICARESHORTSTAYASSESSMENT

EXAMPLE#3WhatarethepossibleRUGassignments?Whatshouldyoucompletebasedonthisinformation??MEDICARESHORTSTAYASSESSMENT

EXAMPLE#3RUGsTherapy–RLB20+30+30/4=20minutesproratedADLindex15Nursing–HE2,CE2COPDw/SOBlyingflat=>specialcarehighRespiratorytherapy7days=>specialcarehighDailyO2=>clinicallycomplexMEDICARESHORTSTAYASSESSMENT

EXAMPLE#3CMIsRLB=44Rural,44UrbanHE2=46Rural,47UrbanCE2=35Rural,35UrbanDonotcompleteSOTOMRAWhileresidentmeetsmostofrequirementsforshortstay,therapyRUGpayslessthanHE2GrouperwillindexmaximizetoHE2andtheSOTOMRAwouldberejectedENDOFTHERAPY(EOT)OMRAEndofTherapy(EOT)OMRARequiredWhenareswasclassifiedinaRUG-IVRehabgroupandcontinuestoneedPartASNF-levelservicesafterthed/cofalltherapiesARD(ItemA2300)mustbesetonday1,2,or3afterallrehabtherapieshavebeend/c(ItemO0400A6orO0400B6orO0400C6,whicheveristhelatest).Thelastdayonwhichtherapytreatmentwasfurnishedisconsideredday0whendeterminingtheARDfortheEndofTherapyOMRA.Day1isthefirstdayafterthelasttherapytreatment(non-therapyday)wasprovided.ENDOFTHERAPY(EOT)OMRADay1wouldcorrespondtothefirstdayonwhichtherapyserviceswouldnormallybeprovidedafterthelastdaytherapywasprovided.Forexample:WhenaSNFprovidesrehabtherapiesMondaythroughFridayandtheresident’slastdayoftherapywasonTuesday,Day1isWednesdayIftheresident’slastdayoftherapywasFridayatthesameSNF,Day1wouldbeMondayIfaSNFtherapy6daysaweek(forexample,OTisprovidedSunday–Friday,PTisprovidedMonday–Friday,andSLPisprovidedTuesday–Friday).Day1wouldbeSunday,regardlessofthetypeoftherapytheresidentreceived.ENDOFTHERAPY(EOT)OMRAMustbecompleted(ItemZ0500B)within14daysaftertheARD(ARD+14days)Establishesanewnon-therapyRUGandMedicarepaymentrate(ItemZ0150A),whichbeginsthedayafterthelastdayoftherapytreatmentMustbesubmittedelectronicallytotheQIESASAPsystemandacceptedintotheQIESASAPsystemwithin14daysaftercompletion(ItemZ0500B)(completion+14days)STARTOFTHERAPY(SOT)OMRAStartofTherapy(SOT)OMRAOptionalCompletedonlytoclassifyaresintoaRUG-IVRehabgroup.IftheRUGisnotaRehabgroup,theassessmentwillnotbeacceptedbyCMSandcannotbeusedforMedicarebilling.ARD(ItemA2300)mustbesetondays5-7afterthestartoftherapy(ItemO0400A5orO0400B5orO0400C5,whicheveristheearliestdate).Thedateoftheearliesttherapyevaliscountedasday1regardlessiftreatmentisprovidedornotBeattentivetoCaseMixIndices(CMIs)BeattentivetopaymentratesMedicarepaymentbeginsonthedaytherapystartedMustbesubmittedelectronicallyandacceptedintotheQIESASAPsystemwithin14daysaftercompletion(ItemZ0500B)(completion+14days)FACTORSTHATCOULDAFFECTREIMBURSEMENTNon-CompliancewiththePPSAssessmentScheduleAnassessmentthatdoesnothaveitsARDwithintheprescribedARDwindowwillbepaidatthedefaultrateforthenumberofdaystheARDisoutofcompliance.Frequentearlyorlateassessmentschedulingpracticesmayresultinareview.ThedefaultratetakestheplaceoftheotherwiseapplicableFederalrate.ItisequaltotheratepaidfortheRUGgroupreflectingthelowestacuitylevel,andwouldgenerallybelowerthantheMedicareratepayableiftheSNFhadsubmittedanassessmentinaccordancewiththeprescribedassessmentschedule.FACTORSTHATCOULDAFFECTREIMBURSEMENTEarlyPPSAssessmentIftheassessmentisperformedearlierthanthescheduleindicates(theARDisnotinthedefinedwindow),theproviderwillbepaidatthedefaultrateforthenumberofdaystheassessmentwasoutofcompliance.Example:a14dayassessmentwiththeARDofday10(1dayearly)wouldbepaidatthedefaultrateforthefirstdayofthepaymentperiodthatbeginsonday15.FACTORSTHATCOULDAFFECTREIMBURSEMENTLatePPSAssessmentIftheSNFfailstosettheARDwithinthedefinedARDwindowforaMedicarerequiredassessment,includingthegracedays,andtheresisstillonPartA,theSNFmustcompletealateassessmentTheARDcanbenoearlierthanthedaytheomissionwasidentified.IftheARDonthelateassessmentissetpriortotheendofthepaymentperiodfortheMedicareassessmentthatwasmissed,theSNFwillbillallcovereddaysuptotheARDatthedefaultrateandonandaftertheARDattheHIPPSratecodeestbythelateassessment.FACTORSTHATCOULDAFFECTREIMBURSEMENTExample:a30dayassessmentwithanARDofday41wouldbepaidthedefaultratefordays31through40andattheHIPPSclassificationfromtheassessmentbeginningonday41.IftheARDofthelateassessmentissetaftertheendofthepaymentperiodforthatMedicarerequiredassessmentthatwasmissedandtheresisstillonPartA,theprovidermuststillcompleteanassessment.TheARDcanbenoearlierthanthedaytheomissionwasidentified.FACTORSTHATCOULDAFFECTREIMBURSEMENTTheSNFmustbillallcovereddaysforthatpaymentperiodatthedefaultrateregardlessoftheHIPPScodecalculatedfromthelateassessment.Example:a14dayassessmentwithanARDofday32wouldbepaidatthedefaultratefordays15through30.AlateassessmentcannotbeusedtoreplacethenextregularlyscheduledMedicarerequiredassessment.TheSNFwouldthenneedtocompletethe30dayassessmentwhichcoversdays31through60aslongasthebeneficiaryhasSNFdaysremainingandiseligibleforSNFPartAservices.FACTORSTHATCOULDAFFECTREIMBURSEMENTMissedPPSAssessmentIftheSNFfailstosettheARDpriortotheendofthelastdayoftheARDwindow,includinggracedays,andtheresidentwasalreadydischargedfromMedicarePartAwhenthisisdiscovered,theprovidercannotcompleteanassessmentforSNFPPSpurposesandthedayscannotbebilledtoPartA.COMBININGASSESSMENTSCombiningassessmentsoccurswhenoneassessmentiscompletedtosatisfybothMedicaidandMedicarePPSassessmentrequirements.Whenconsideringcombiningassessments,thetimeframesforbothtypesofassessmentsmustcoincide.Themoststringentrequirementmustbemet;thereforethenursinghomestaffmustfullyunderstandtherequirementstoremainincompliance.COMBININGASSESSMENTSCombiningassessmentsALLOWED:AdmissionAnnualSignificantchangeinstatusassessmentSignificantcorrectionofpriorcomprehensiveQuarterlySignificantcorrectionofpriorquarterlyAllMedicareassessmentsDischargeassessmentReturnanticipatedReturnnotanticipatedCOMBININGASSESSMENTSCombiningassessmentsNOTALLOWED:EntrytrackingrecordDeathinfacilityrecordCALCULATIONOFADLSCOREFORMEDICARETocalculatetheADLscoreforbedmobility,transfer,andtoiletuseSelf-PerformanceColumn1=SupportColumn2=ADLScore=-,0,1,7,or8AND(anynumber)02AND(anynumber)13AND-,0,1,or224AND-,0,1,or233or4AND34CALCULATIONOFADLSCOREFORMEDICARETocalculatetheADLscoreforeatingSelf-PerformanceColumn1=SupportColumn2=ADLScore=-,0,1,2,7,or8AND-,0,1,or80-,0,1,2,7,or8AND2or323or4AND-,0,or123AND2or334AND2or34CALCULATIONOFADLSCOREFORMEDICAIDTocalculatetheADLscoreforbedmobility,transfer,andtoiletuseSelf-PerformanceColumn1=SupportColumn2=ADLScore=0,1,or7AND(anynumber)12AND(anynumber)33or4AND0,1,or243,4,or8AND3or85CALCULATIONOFADLSCOREFORMEDICAIDTocalculatetheADLscoreforeatingSelf-PerformanceColumn1=ADLScore=0,1,or71223,4,or83FIVESTARANDTHEMDS3.0QM/QIratingwillnotbefactoredintheFiveStaroverallratinguntilSpringof2012CMSisstillworkingonwhichitemswillbecalculatedfromtheMDS3.0RESIDENTINTERVIEWSTIPSONCOMPLETINGACCURATERESIDENTINTERVIEWSIntroduceyourselfBesuretherescanhearwhatyouaresayingAskwhetherthereswouldlikeaninterpreter(languageorsigning)Findaquiet,privateareawhereyouarenotlikelytobeinterruptedoroverheardRESIDENTINTERVIEWSSitwheretherescanseeyouclearlyandyoucanseehis/herexpressionsEstablishrapportandrespectExplainthepurposeofthequestionstotheresSayandshowtheitemresponsesAskthequestionsastheyappearinthequestionnaireBreak