It’s time for MDS 3.0 Are You Ready?

Presented by Lizeth Flores, RHIT

9/10/10

Objectives

• Participants will review: • New transition plan issued by CMS transition

from for RUG III to RUG IV on October 1, 2010

• PPS Assessments

How will I handle assessments due at the end of September and beginning

of October?

Know your PPS Assessments

• Scheduled Assessments – 5 day – 14 day – 30 day – 60 day – 90 day – Readmission/Return Assessment

5 Day

– 1st Medicare required assessment upon initial admission for SNF Part A stay

– Authorizes payment from days 1-14 of the part A stay, as long as criteria for part A SNF level services is met

14 Day

– Authorizes payment for days 15-30, as long as the coverage criteria for part A SNF level services is met

– ARD must be set on days 11 – 14 of the covered stay

– May be combined with OBRA admission assessment but grace days may not be used when setting the ARD

30 Day

– Authorizes payment for days 31-60, as long as the coverage criteria for part A SNF level services is met

– ARD must be set on days 21-29, can be extended up to day 34 if using grace days

60 Day

– Authorizes payment for days 61-90, as long as the coverage criteria for part A SNF level services is met

– ARD must be set on days 50-59, can be extended up to day 64 if using grace days

90 Day

– Authorizes payment for days 91-100, as long as the coverage criteria for part A SNF level services is met

– ARD must be set on days 80-89, can be extended up to day 94 if using grace days

Readmission / Return

-SNF stay covered under Med A -Resident hospitalized, D/C return anticipated -Readmitted to SNF and continues to receive Part

A SNF level care services- ARD must be set on days 1-5 of the Part A

covered stay - May use grace days - Can be combined with OBRA Admission

assessment, must be completed by day 14 – Admission day counts as day “1”

Know your pay periods

Assessment Type

ARD Range Grace Days Payment Period

5 day

Medicare Return

1-5 6-8 1-14

14 Day 11-14 15-19 15-30

30 Day 21-29 30-34 31-60

60 Day 50-59 60-64 61-90

90 Day 80-89 90-94 91-100

PPS Unscheduled Assessments

– Start of therapy (SOT) OMRA – End of Therapy (EOT) OMRA – Significant Change in Status Assessment

(SCSA) – Significant correction to Prior Comprehensive

Assessment – Swing Bed Clinical Change Assessment

SOT – OMRA

• New - OPTIONAL

Classifies resident into a RUG IV Rehabilitation Plus Extensive Services or Rehabilitation group. If it does not classify under either of these groups the assessment will NOT be accepted by CMS

ARD must be set on days 5-7 after the start of therapy

EOT – OMRA

• Not New – NOT OPTIONAL Required when resident classified under RUG IV Rehabilitation Plus Extensive Services or Rehabilitation group and continues to need skilled level services after therapies are discontinued.

ARD must be set on day 1,2, or 3 after all rehabilitation therapies have been discontinued.

EOT – Continued…

The last day of therapy is considered day 0 when setting the ARD

New payment rate begins the day after the last day of therapy treatment

• Therapy Start Date – Date most recent therapy regimen started– Date initial therapy evaluation is conducted,

regardless if treatment was rendered or not

• Therapy End Date– Date most recent therapy regimen ended– Last date the resident received skilled therapy

treatment

SCSA & SCPA

• OBRA required

• May establish as new RUG IV Classification

Resident Expires before 8th day of SNF Stay

Medicare required assessment must be completed and submitted as required

If there is no PPS MDS in the system the provider will bill the default rate for any Medicare Days

Death in facility record must be completed

Transferred / Discharged before 8th day of SNF stay

Medicare required assessment must be completed and submitted as required

If there is no PPS MDS in the system the provider will bill the default rate for any Medicare Days

Discharge assessment must be completed

Short Stay

• NewMust be discharged from Part A on or before day 8 of Part A stayTo obtain a therapy RUG– Therapy is prorated based on average daily therapy minutes– RLx –15-29 minutes– RMx –30-64 minutes– RHx –65-99 minutes– RVx –100-143 minutes– RUx –144 or > minutes

Short Stay Conditions

• All 6 must be met Must be a SOT assessment A PPS 5 day or readmission / return has been completed ARD must be on or before day 8 of the covered stay ARD of the SOT OMRA must be the last covered Medicare Part A day Therapy started during the last 4 days of the covered stay At least one therapy continued through the last day of covered stay

CMS Options

• CMS issued a transition plan that includes 3 options for submitting PPS assessments

• The options apply for Medicare Part A residents with PPS assessments whose payment periods include both September days and October days

• RUG-III can be calculated from MDS 2.0 and MDS 3.0– RUG-IV can’t be calculated from MDS 2.0

Require MDS 3.0 to calculate RUG-IV

– Assessments will be rejected if they are MDS 2.0 with an ARD 10/01/10 or later or MDS 3.0 ARD 09/30/10 or earlier

It’s your $$ It’s your decision

• It is important that you know RUGs/payment rates for the resident in order to make decisions that will optimize reimbursement Rug-III and RUG IV group & associated payment (MDS 2.0 and MDS 3.0)

Option 1

NO SUBSTITUTION

– Provider does not substitute MDS 3.0 for MDS 2.0 or MDS 3.0

– MDS 2.0 –RUG-III covers September days for applicable payment window

– MDS 3.0 –RUG-IV covers October days for applicable payment window

– MDS 3.0(y) –RUG-IV covers remaining October days for applicable payment window when resident remains skilled

Food for thought

• You will complete 2 assessments for one payment period

• MDS 2.0 for September days and MDS 3.0 for October days– Continue with schedule when resident remains skilled

(MDS 3.0)– All covered days will have RUG assigned based on

an assessment– Least Risk - Avoids risk of not having an assessment

(no payment) or late assessment (default)

No Substitution ARD Rules

MDS 2.0 -Earliest date = day allowed for assessment window– Latest date = day allowed for assessment

window or 9/30, whichever is first

– MDS 3.0 -Earliest = 10/01 – Latest = see form

Example

Resident’s Medicare Part A covered stay Start Date 09/27/2010

• 5-day assessment covers 09/27 –10/10 (14 days)• Need RUG-III for 09/27 –09/30 (MDS 2.0) • Need RUG-IV for 10/01 –10/10 (MDS 3.0)

• 14-day covers 10/11 –10/26 Need RUG-IV • Only when resident remains skilled (MDS 3.0)

Option 2

Substitute MDS 3.0 for MDS 3.0

• Provider completes MDS 2.0 for September days and next MDS 3.0 for October days

• You will complete 2 assessments– MDS 2.0 for September days– MDS 3.0 for ‘early’ October (remaining 2.0

window) and October/November days for associated assessment

– RISKS All covered days may not have a RUGIf resident is discharged after 10/01 and before

allowed ARD of MDS 3.0 Discharge date becomes the ARD of early MDS 3.0 assessment

Example

Resident’s Medicare Part A covered stay Start Date 09/27/2010

• 5-day assessment covers 09/27 –10/10 (14 days)• Need RUG-III for 09/27 –09/30• Need RUG-IV for 10/01 –10/10• 14-day assessment covers 10/11 –10/26 (16

days)• Need RUG-IV

– Complete MDS 2.0 5-day with an ARD 09/27 –09/30

– This assessment will cover paid days 09/27 –09/30 (4 days)

– Complete MDS 3.0 14-day with an ARD 10/07 -10/15

– This assessment will cover paid days 10/01 –10/26 (26 days)

Option 3

Substitute MDS 3.0 for MDS 2.0

• Do not complete MDS 2.0– Complete required MDS 3.0 for required MDS

2.0 MDS 3.0 –RUG-III will cover September and October days for applicable payment window

– MDS 3.0 –RUG-IV will cover October days for applicable payment window

– MDS 3.0 Earliest ARD = 10/01

What to consider….

You will complete only 1 assessment for one payment period

• All covered days may not have a RUG • If resident is discharged before 10/01 and after the

allowed ARD for MDS 2.0Discharge date becomes the ARD of late MDS 2.0 assessment =DEFAULT

Example

• Resident’s Medicare Part A covered Start Date 09/27/2010

• 5-day assessment will cover 09/27 –10/10 (14 days)

• Need RUG-III for 09/27 –09/30• Need RUG-IV for 10/01 –10/10• 14-day assessment will cover 10/11 –10/26• Need RUG-IV

• You will complete MDS 3.0 5-day with ARD 10/01 –10/05

• This will cover paid days 09/27 –10/10 (14 days)• RUG-III 09/27 –09/30 (4 days)• RUG-IV 10/01 –10/10 (10 days)

– MDS 3.0 14-day with an ARD 10/07 -10/15– Only when resident remains skilled for

payment period

Some more ideas

• P & P Updates – Admission diagnosis – Diagnosis coding – MDS transition plan – Who will complete what– How will you store the MDS – Electronic Signatures

Q&A

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