MDS 3.0/RUG IV Distance Learning Series January - May 2016 OVERVIEW In keeping with the success of their previous highly-rated distance learning education offerings, LeadingAge state affiliates and Plante Moran have teamed to offer a series of affordable, up-to-date distance learning educational sessions about the process of completing the Minimum Data Set (MDS) 3.0, and the impact of its accuracy. The MDS is the focal point of everything in long-term care (survey, quality measures, Five-Star, Nursing Home Compare data and reimbursement). Successful surveys (Traditional or QIS) demand accuracy. The information to consumers must accurately reflect the level of care and services the facility provides. Rightful reimbursement for Medicare and Medicaid requires an accurate MDS. Seventeen basic and intermediate sessions designed to meet each member of your team involved in the assessment process at their point of need. Each session has time for questions and answers. The team can access the same information at the same time via audio format, and sessions are specialized for particular disciplines to help you maximize your time; no travel expenses for the facility and continuing education certificates are sent via email following each session. SPEAKER Jane Belt, MS, RN, RAC-MT, Consulting Manager, Plante Moran, PLLC, Columbus, Ohio Jane is the manager of the Plante Moran Clinical Group and has been involved with the long-term care profession for more than 40 years serving as a director of nursing and a nurse consultant. She has a Master s in Nursing and is a Resident Assessment Coordinator Certified and a Master Teacher through the American Association of Nurse Assessment Coordination. SCHEDULE Please note that each event is scheduled for 12:00-1:30 p.m. CT: January 7, INTERMEDIATE: NEW- What the Admn, DON and Accounting Must Know Regarding the MDS January 14, BASIC: Breaking Down the MDS: Section A-Which Assessment and When (Nursing) January 21, BASIC: Breaking Down the MDS: Sections B, C, D, E and F (Social Services, Activities, Nursing) January 28, BASIC and INTERMEDIATE: The Nitty Gritty of Section G-ADLs and Reimbursement (Nursing, Therapy) February 4, BASIC: Breaking Down the MDS: Sections H, I and J (Nursing) February 11, BASIC: Breaking Down the MDS: Sections K and L (Dietary, Nursing) February 18, BASIC: Breaking Down the MDS: Sections O and Q; Nursing Restorative Programming (Nursing, Therapy, Social Services) February 25, BASIC: Breaking Down the MDS: Sections M, N and P (Nursing) March 3: This is a courtesy acknowledgement; no session today. March 10, BASIC: Breaking Down the MDS: Sections V, Z and Working the CAAs (IDT) March 17, INTERMEDIATE: NEW- What You Need to Know Regarding the Focused Surveys for Dementia Care, MDS 3.0/Staffing and Medication Safety (IDT) March 24, INTERMEDIATE: NEW- Sleep Hygiene and Reducing Falls (IDT) March 31, INTERMEDIATE: Can I Skill this Resident? (ED, Admn, Nursing) April 7, INTERMEDIATE: How do We Get Paid for Medicare Part A Beneficiaries? (Nursing, Therapy) April 14, INTERMEDIATE: Quality Measures and Survey (Nursing, Social Services, Activities, Dining Services) April 21, INTERMEDIATE: QAPI (ED, Admn, DON, Corporate Staff, Nursing, Social Services, Activities, Dining Services) April 28, INTERMEDIATE: Reaching for the Stars - Five-Star (ED, Admn, DON, Corporate Staff, Nursing) May 5, INTERMEDIATE: NEW- Where Do We Go from Here? Best Practices for MDS Coordinators (MDS Coords.) INTENDED FOR Administrators, MDS Coordinators, Directors of Nursing, Directors of Social Services, Directors of Activities, Directors of Rehabilitation Services, Admissions Staff
CEUs Nursing Home Administrators - Each live webinar session counts for 1 hour. This program is intended to meet the criteria established by the Iowa Board of Examiners for Nursing Home Administrators. If audited, you will be asked to provide your certificate of attendance and program material. Retain certificate for four years. Iowa Board of Nursing Provider #67 -.12 CEUs for each live webinar session. Retain certificate for four years. Social Workers Each live webinar session counts for 1 hour. This program is intended to meet the criteria established by the Iowa Board of Social Work Examiners. If audited, you will be asked to provide a certificate of attendance and program material. Retain certificate for four years. What the Administrator, Director of Nursing and Accountant Must Know Regarding the MDS January 7, 2016, 12:00-1:30 p.m. CT MDS 3.0 is critical in defining your facility s resident care, survey outcomes, payment, and public perception on Nursing Home Compare. Failure to adequately manage and monitor the MDS process often results in negative outcomes. This webinar will not detail MDS completion, but instead provide the tools you need to effectively manage the MDS/PPS process. Understanding critical timing and provider liability issues; accessing key reports; working with team members to improve MDS systems and outcomes. This is a must attend for experienced and new Administrators, Directors of Nursing and Accountants. 1. Identify the key issues regarding the critical need for accuracy on the Resident Assessment Instrument (RAI) process. 2. Delineate timing and provider liability issues. 3. Review strategies to improve coordination and RAI management. Which Assessment and When January 14, 2016, 12:00-1:30 p.m. CT As we start our breakdown of the MDS Section A with the items related to the type of assessment to be completed is critical for survey and appropriate reimbursement. Whether a rookie to the process or an experienced MDS nurse, the MDS 3.0 items in A0310 with the revisions and updates have created confusion and frustration about what assessment to do and when. In this session we will complete a brief view of the key resident identification items and then shift to identifying the types of assessments required for both OBRA and PPS and the timing for completion and submission. 1. Identify the key items and coding issues in the resident information portion of Section A. 2. Delineate the Types of Assessment including the Federal OBRA Reasons, PPS Assessments, Other Medicare Required Assessments and Entry/Discharge Reporting. 3. Detail the timing issues of assessment completion and submission.
Breaking Down the MDS: Sections B, C, D, E, and F January 21, 2016, 12:00-1:30 p.m. CT Gain insights during a review of the information gathering processes and interviews used to determine the resident s hearing, speech and vision (Section B), cognitive patterns (C), mood (D), behaviors (E), and their preferences for daily routines and activities (F). We will also discuss interview tips and timing of the interviews. These sections are vital to accurate care planning, culture change, Quality Measures and reimbursement. 1. Discuss the accuracy needed for completion of the resident s assessment of hearing, speech, and vision. 2. Delineate the components of the Brief Interview for Mental Status (BIMS) as well as the Signs and Symptoms of Delirium. 3. Describe the Resident Mood Interview (PHQ-9) and how to determine the Total Severity Score. 4. Review coding and completion of the Behavior section (E) of the MDS 3.0. 5. Break down the interview process for determining the resident s daily preferences and activity preferences. The Nitty Gritty of Section G ADLs and Reimbursement January 28, 2016, 12:00-1:30 p.m. CT Unfortunately it still seems that the Activities of Daily Living (ADLs) (Section G) offers several coding challenges for those members of the interdisciplinary team responsible for its accuracy. Any lack of accuracy even if very minimal can amount to hundreds of dollars of lost reimbursement for the facility. The care was provided, but the facility did not take credit for the services provided. We will review the assessment process and definitions for determining the resident s level of performance in ADLs and the key difference in coding the amount of support provided to accomplish the task. We will also review how to complete the balance and range of motion portions of the MDS. And lastly we will look at how Section G accuracy affects reimbursement, survey, Quality Measures, Five-Star ratings, and care planning. 1. Detail the definitions used to complete item G0110 on the MDS 3.0. 2. Describe the difference between limited assistance and extensive assistance. 3. Identify the testing used to complete the Balance and Functional Limitation in Range of Motion items. 4. Review the impact of ADL coding on the RUG IV ADL scoring.
Breaking Down the MDS: Sections H, I and J February 4, 2016 12:00-1:30 p.m. CT Get a working knowledge of Section H of the MDS 3.0 (with a 7-day look back) which describes appliance use, the use and response to urinary toileting programs, urinary and bowel continence status and bowel training programs. We will review the determination of an active diagnosis for Section I and detail the pain assessment, falls, and other health conditions in Section J. 1. Review definitions of appliances and implications for care planning. 2. Delineate the types of toileting programs and the documentation needed for the trial of a toileting program. 3. Describe the revised definition of incontinence (both bladder and bowel). 4. Identify the time frames for determining active and inactive diagnoses for the completion of Section I. 5. Review the components of the pain assessment interview and what to do with the information. 6. Delineate the key elements in Section J of the MDS and the coding guidelines for pain, other health conditions, and falls. Breaking Down the MDS: Sections K and L February 11, 2016, 12:00-1:30 p.m. CT As we continue our guidance for accurate coding of the MDS, we will focus on the conditions that could affect the resident s ability to maintain adequate nutrition and hydration with a look at Sections K (Swallowing/Nutritional Status) and we will review the items in K involving accurate calculations about Percent Intake by Artificial Route. The program will end with a discussion regarding the assessment process for the oral cavity and coding of the Dental items in Section L. 1. Review the key elements and coding guidelines for Swallowing/Nutritional Status, and Oral/Dental Status. 2. Conduct a nutritional assessment with the resident and then what to do with that information on the Care Area Assessment (CAA) and plan of care. 3. Assess and code findings of the oral cavity and dental examination for Section L.
Breaking Down the MDS: Sections O and Q; Nursing Restorative Programming February 18, 2016, 12:00-1:30 p.m. CT This session will look at the following sections of the MDS 3.0: Section O (Special Treatments, Procedures, and Programs) the timing for the coding of particular procedures and treatments; coding of delivered rehabilitative therapy minutes, distinct calendar days; respiratory therapy; what are the documentation requirements for coding restorative programs and recording of the resident s participation and expectations for goal setting (Section Q) and what steps must be taken with the information. 1. Delineate the items in Section O including special treatments and programs, and vaccines. 2. Identify the accurate coding of therapy days and minutes. 3. Describe the necessary components and documentation requirements for restorative services in the facility. 4. Review the implications of Section Q regarding the resident s overall expectations and return to the community. Breaking Down the MDS: Sections M, N and P February 25, 2016, 12:00-1:30 p.m. CT In talking with nurses, there are always many questions about the coding of the items in Section M, especially staging of pressure ulcers, accurate coding of present on admission and worsening pressure ulcers. In addition, in Section N we will review coding of injections and medications received. Finally for Section P (Restraints) we will breakdown the definition of a physical restraint and the appropriate coding of those items in P0100. As always, we will leave time at the end of the program for your questions and answers. 1. Delineate the items in Section M including determination of risk, present on admission and worsening in pressure ulcer status. 2. Identify the appropriate coding of the other wounds and skin problems from Section M. 3. Identify the accurate coding of numbers and orders for injections and the classification categories of medications in Section N. 4. Review the physical restraint definition for Section P and appropriate coding of the devices.
Breaking Down the MDS: Sections V, Z and Working the CAAs March 10, 2016, 12:00-1:30 p.m. CT Section V summarizes care areas triggers or the CATs and then leads to completion of the Care Area Assessments (CAAs). We will look at this additional assessment process and completion timelines and what must be documented after the review of each triggered CAA. We will review the documentation components required for the completion of the items in Section V on the actual MDS and how that information provides the foundation for the resident s plan of care. And finally we will close our MDS Basics with a review of the documentation of billing information and documentation of the participants in the Assessment Administration (Section Z). 1. Identify the 20 Care Assessment Areas and the triggering process. 2. Describe the Care Assessment Area review process and documentation requirements. 3. Review coding instructions and timing requirements for Section V and Z on the MDS 3.0. What You Need to Know Regarding the Focused Surveys for Dementia Care, MDS 3.0/Staffing, and Medication Safety March 17, 2016, 12:00-1:30 p.m. CT CMS has continued its newer process of developing and implementing specific focused surveys for areas identified as needing closer inspection. The Focused Dementia Care Survey is a part of the industry effort to improve care by expanding the use of nonpharmacological approaches and reducing the off-label use of antipsychotics. Accuracy of the coding of the MDS and the corresponding supportive medical record documentation was targeted in the nationwide expansion of these MDS Focused Surveys as well as validation of staffing levels in the facility. The latest addition to the bunch is the Focused Survey on Medication Safety and the development of an Adverse Event Trigger Tool. This session will give an overview of each type of focused survey and provide recommendations for how to be prepared for closer inspections of specific areas of risks. 1. Identify the focused surveys and current timing of each. 2. Delineate specific areas that will be closely monitored in each of the surveys. 3. Review available CMS Tools used in the specific surveys and how to best use them to be as prepared as possible.
Sleep Hygiene and Reducing Falls March 24, 2016, 12:00-1:30 p.m. CT More and more research and investigations have revealed the great need for quality sleep in long-term care facilities. This session will focus on the sleep disorders in our facilities that are secondary to medical conditions or environmental issues. We will look at the major risk factors for sleep problems in the nursing home and discuss what the facility can do to implement a facility-wide sleep program. Outcomes of better quality sleep will be discussed and what can be initiated to achieve better healing, reducing falls, reducing use of psychoactive medications improving behaviors and improving psychosocial well-being of the residents. 1. Identify current clinical practice guidelines for sleep disorders in long-term care facilities. 2. Describe the issues related to sleep deprivation and the impact of the related problems to function and health of the elderly in our facilities. 3. Delineate non-pharmacological strategies that can lead to positive effects on resident satisfaction. Can I Skill This Resident March 31, 2016, 12:00-1:30 p.m. CT As consultants, we get this question so frequently can this resident be skilled? This session will focus on the components of the traditional Medicare program technical and administrative criteria as well as the clinical criteria especially the other reasons to skill a resident if he/she cannot be skilled for rehabilitation (therapy) services. In other words, the Medicare world beyond therapy! We will make certain that the participants understand the starting and ending of a benefit period. In addition, we will look at the basics of what it takes to skill the resident and the covered services and appropriate documentation. 1. Detail the basics of skilled Medicare Part A for all skilled nursing home residents and what it takes to keep them skilled. 2. Describe the technical, administrative and clinical criterion for determining Medicare Part A skilled services. 3. Identify the role of the MDS in Medicare reimbursement. 4. Describe the supportive documentation requirements, including tools to support MDS coding and the needed backup documentation.
How Do We Get Paid for Medicare Part A Beneficiaries? April 7, 2016, 12:00-1:30 p.m. CT Now that we know what comprises the skilled level of care services, we will continue our focus on the Medicare resident, but this time on the payment system RUG IV (Resource Utilization Groups, Version IV). What are all those acronyms like RUC, RMA, and CB2? We will review the components of the Resource Utilization Group IV methodology for PPS (skilled Medicare) reimbursement, what specific items from the MDS 3.0 drive reimbursement and how they impact the payment categories. We also will briefly review the scheduling dilemmas caused by the multiple Other Medicare Required Assessments (OMRAs), such as the End of therapy, Start of therapy and Change of Therapy. 1. Identify the items on the MDS 3.0 that drive reimbursement. 2. Delineate the RUG IV methodology, including index maximizing, ADL scores, grouping criterion and the resulting payments for PPS. 3. Describe the scheduling requirements for the Other Medicare Required Assessments (OMRAs) and the impact on payment. Quality Measures and Survey April 14, 2016, 12:00-1:30 p.m. CT Just like with the Five-Star rating, the revised Quality Measures have generated confusion and frustration as facilities try to figure out what impacts which measure and what set of measures are being reported to the public versus the CASPER reports. Where do the numbers come from? How do we know if the resident is a long-stay or short stay? What is a stay and what is an episode? How do you respond to a nursing home prospect or their family about the reasons for your numbers? The answer is in understanding the QMs and where they are derived what are the exclusions, which indicators have covariates? This session will focus on the measures what they are, the definitions and risk factors and how the facility can use the information to identify root causes of care problems, measure goals, reduce risk of further adverse events, and fulfill a portion of the quality pledges and initiatives that continue to play a huge part in the success of each facility. 1. Review the background of the revised federal Quality Measures. 2. Identify the major components of the measures target period, target assessment, numerator and denominator. 3. Define the exclusions, risk factors and covariates and how they impact the QM. 4. Discuss the strategies for improving or impacting the facility s Quality Measures.
QAPI April 21, 2016, 12:00-1:30 p.m. CT According to a provision of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) must establish QAPI standards and provide technical assistance to nursing homes on best practices to meet these practices. In addition, Section 6102(c) of the Act requires that all nursing homes develop QAPI programs. CMS is also charged to coordinate the implementation of QAPI with the existing quality assessment and assurance activities already in the annual certification survey process (F-tag 520). The aim of the initiative is to expand the scope of current activities to not only correct quality deficiencies, but also to put practices in place to monitor all NH care and services to continuously improve performance. The reporting process will be critical to the process. All nursing homes will soon be required to submit to the Secretary of HHS a plan to meet the standards and implement QAPI best practices. This session will assist the facility to determine the readiness and most importantly the sustainability of their program. We will review the five (5) elements of the program and discuss steps to building the QAPI program. Strategize a facility plan by focusing on a CMS Quality Measure as a sample to view the ongoing positive results of the QAPI program. 1. Review the background of CMS QAPI Initiative. 2. Identify the five (5) elements of QAPI. 3. Discuss the strategies to building and maintaining a strong QAPI in-facility program. Reaching for the Stars Five Star April 28, 2016, 12:00-1:30 p.m. CT With so many benchmarks, performance measures and outcomes to analyze, have you figured out the changes on Medicare s Nursing Home Compare website? With the latest changes, consumers have an easier time identifying facility performance issues and comparing performance to surrounding facilities. Whether we like it or not, the facility is still Star Ranked related to: Health inspections: considering the number, scope and severity of deficiencies identified during annual surveys and complaint surveys; Staffing: nursing home staffing levels for RN hours and total nursing staff hours; and the Quality Measures (QMs): using nine (9) of the 18 QMs posted and based solely on MDS 3.0 assessments. In this session we will review these components, how they are scored and tabulated as well as what the facility needs to do with the data and how to improve the rankings. We will also differentiate which measures are used for the Five Star rating. 1. Review the history and background of the federally driven Five-Star program from the original implementation in 2008 to the present national update. 2. Identify the three (3) major components that generate the overall facility Five-Star rating. 3. Discuss the strategies for impacting the facility s Five-Star rating.
Where Do We Go From Here? Best Practices for MDS Coordinators May 5, 2016, 12:00-1:30 p.m. CT Our final session for this series delves into best practices for MDS Coordinators. You have learned the details of completing accurate MDSs, but now what? How can the MDS Coordinator lead the interdisciplinary team to appropriate reimbursement, quality outcomes and resident-centered care? We will discuss key timing and scheduling processes and how to stay on track. We will review the reports that must be used to get a snapshot of the MDS process, accuracy, and impact. Be the best you can be an MDS Coordinator Extraordinaire. 1. Identify best practices for scheduling and timing of the RAI process. 2. Describe the methods to be used to support the value of your job performance by summarizing the facility s results. 3. Discuss approaches when you have concerns that are impacting accuracy, timing, or appropriate reimbursement