Whether you are just beginning your career or are a veteran MDS coordinator, you play a pivotal role in managing the long-term care residents’ care.
The MDS coordinator role is vital to:
- Accurate care planning
- Accurate reimbursement from state and federal funds
The resource utilization group (RUG) from the prospective payment system (PPS) MDS (minimum data set) assessments also provides the basis for Medicare payment. MDS coordinators play a crucial role as a member of the facility’s Medicare team. By understanding the Medicare regulations and Medicare coverage rules, the MDS coordinator can assist the clinical team to make decisions that will provide the resident with appropriate Medicare coverage and ensure that the SNF is working within the regulatory guidelines.
The following tools will aid you during your MDS coordinator journey, including:
- The RAI MDS 3.0 User’s Manual: This manual is an absolute must-have for MDS coordinators. The RAI MDS 3.0 User’s Manual contains the Center for Medicare & Medicaid Services (CMS) instructions for coding the MDS. It is crucial that you have the most-updated version. CMS updates the manual at least annually, typically in October. Having a hard copy of the manual is nice, because you can then highlight important text and write notes in the margins. Most MDS software also includes links to the RAI manual.
- Hard copies of the MDS forms (item sets): These copies can be used in case of internet or software errors. They are also helpful to review when learning the process. It is easier to see the skip patterns when looking at the item sets. You can purchase MDS forms; some of the purchased forms have payment items highlighted and CAA triggers listed. You can also download the most updated MDS item sets from the CMS website for free.
- MDS interview cue cards: It is important to have cue cards available for the residents during the MDS resident interviews. It is helpful to have a set that is laminated so that it can be wiped off after the resident points to the answer on the cue card during the interview. It can also be helpful to print each different set of cue cards in a pastel color. I think it is easier for older eyes to see the black print on light-colored paper than on stark black and white. Each one of your IDT members will need their own set of cue cards.
- Portable hearing amplifier (pocket talker): In order to ensure that your residents can hear the interview questions, it is helpful to have a portable hearing amplifier available for them to use. Hearing amplifiers are available in larger discount and electronic stores or on the internet. Consider infection control guidelines when choosing a model.
- MDS software: Your facility should have MDS software where you will enter data from the MDS assessments and transmit them to the federal database. You will need time to learn how to use the software system. Specific areas to focus include how to:
- Create new assessments
- Set Assessment reference dates (ARD)
- Modify an MDS when an error occurs
- Find the MDS scheduler
- Print the forms
- Sign the forms for accuracy and for completion
- Batch the forms to prepare for transmission
- Mark the assessments as accepted or rejected
- Complete the CAAs
- Complete the care plans
- MDS Scheduler: Your software should include an effective scheduling tool for determining when the new MDS ARD is due. Some MDS software systems do not include a scheduler or have an ineffective scheduler. Setting the schedules is one of the most important parts of the job and one of the most difficult to master. CMS releases an MDS scheduling tool each year, which you can find on the CMS website. For Medicare residents, you will also need a PPS scheduling tool. Many MDS coordinators use spreadsheets (100-day tools) to help them keep track of their Medicare residents’ PPS assessments. Other MDS nurses use a tool like a spinner/wheel that is available for purchase.
- ICD-10 Coding Manual: You will want to be sure that the correct diagnosis codes are entered onto the MDS and onto the Medicare claims (UB-04s). You will need a new ICD-10 Coding Manual every October, when the codes are updated.
- Care planning books: Part of the RAI process is to develop the resident care plans. You will need to learn what style of care plans your facility prefers. Care plans range from formal care plans to “I” care plans. HCPro published MDS Care Plans: A Person-Centered Interdisciplinary Approach to Care by Debbie Ohl, that comes with over 100 customizable (print and digital) care plans.
- Medicare binder: If your facility contains Medicare certified beds, you will need a binder to keep your Medicare information together. The Medicare binder should contain, at a minimum:
- Medicare Benefit Policy Manual
- RUG IV Guide
- 100-day tools for each of the residents who are presently covered under Medicare A or Medicare Advantage programs that require the PPS MDS schedule to be followed
- 100-day tools for those Medicare A residents who have discharged during the present month (need information for Triple-Check meeting)
- Change of therapy observation tools (if used by your facility)
- RUG IV Guide: It is helpful to keep a copy of the qualifiers for the Medicare RUG payment groups in the front of your Medicare binder. Many states are “case mix” states, meaning that the RUG from the MDS affects the Medicaid payment to the facility. You will eventually want to memorize the RUG qualifiers, but in the beginning it helps to keep a copy close by.
- Medicare Benefit Policy Manual: You are expected to know about Medicare benefits in your MDS role. There are many Medicare manuals that are pertinent to Medicare coverage in SNFs, but the Medicare Benefit Policy Manual is convenient because it contains lists of Medicare nursing and therapy skilled services along with lists of non-covered services. It can be downloaded from the CMS website. To find it, enter the complete name of the manual, including the chapter, in the search box on www.cms.gov.
This is an excerpt taken from the Long-Term Care MDS Coordinator’s Field Guide by Carol Maher, RN-BC, RAC-CT.
Inform your facility about common deficiencies found in MDS 3.0 assessments highlighted by CMS in November 2016.