Table of contents for The MDS self-audit : a practical guide to ensuring minimum data set accuracy / Rena R. Shephard.


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1Chapter 1: The challenges of MDS coding       .. ............ .1
Section G-Physical functioning and structural problems .  .  . . . . . . .....  .2
Figure 11: FIM to MDS ADL code conversion chart . . .. . .  .  .  .  . ... .7
Section El-indicators of depression, anxiety, sad mood .. . .  . . . . .  .9
Section I-Disease diagnoses  . . . . . . .            . . .... .  . .  1
Section J- Health conditions  ..  .  .  . . . .         . . . . . . .  .12
A word about pain ......      .........                   .  13
A word aboutfalls ...........     ......... 14
Section 0-Medications    ............ .......... ...15
Section P-Special treatments and procedures .. . . . .  .... .. 17
item P1-Special treatments, procedures, and programs .  . . . . .... 17
item  P1b- Therapies  . . ............................. ....  .  18
item  P3-Nursing rehabilitation/restorative care  . . .  ..  .  . .   .  . . ..20
item  P4- Restraints  ..... . .. .                      .  ...21
item P7-Physician visits ........  ............         . .. . 22
item  P8- Physician orders  . . ... . .  ............ . .  .   .  ...23
Section T-Therapy supplement for Medicare PPS . .   . . . . . . . ....24
The MDS and the nine new RUG categories ............. 25
Common MDS-related errors that affect the claim . .. . . .   . . . .  . .26
Summary   . .....     .    ..      .  ......             .    . .28
hapter 2: The  audit  .................................31
Content of audits . . . . . .                       . . . . . . 33
Documentation to support MDS coding .. .    . .  . . . . . . .33
Figure 2.1: MDS documentation guide for PPS . .. . .. ........... 34
Figure 2.2: MDS documentation review .. . . ... .  .. . ... 36
UB-92 claim  form  accuracy  . . . . . . .      .   .  .... . 42
Auditing for daily skilled services for SNF PPS .. . . . ........ 42
Figure 2.3: Medicare Part A  coverage audit  .. . . .....   .. ... . 43
Figure 2.4: MDS/UB-92 audit tool  . ......       . .   .  .  .   ... . .46
Figure 2.5: Med-A MDS/UB-92 audit . ... ............  . .......... ...48
Figure 2.6: Medicare  Part A  technical review  . . ...... ..  ..   ...51
Figure 2.7: Medicare certification and MDS audit . .. . .. . . .   ..... ..54
Figure  2.8: Compliance  form  . .  .....  .   ....... .  ... . 55
Auditing for preadmission screening  ...... .   . . .  .  .  .  .  ..   . . 57
Auditing  for consolidated  billing  . . .  .... ............   .  . . . 57
Figure 2.9: Preadmission screening audit for skilled services  . .  .  . . . . .  .  59
Table 2.1: Major category explanation for SNF consolidated billing  ... 60
Figure 2.10: SNF responsibilities for consolidated  billing  . . .... ..... .  64
Figure 2.11: Retrospective audit for consolidated  billing  ... . .  .  . .  . ...65
Types of audits ........................ .. 66
Concurrent reviews   . .          .              . . . . . . . . 66
Monthly internal monitoring .. . . . . .............. 66
Focused weekly audits      .    . .  . .  . .    . .  . . . . . . 67
Figure  2.12: Focused  audit for ADLs  .  . . . .  ... .  .  . .  .   . ...68
Figure 2.13: MDS timing and scheduling .. . . ... .....  .. . . .  ..70
Figure 2.14: Focused audit for Medicare Part A  coverage  . . ..... ..... . .71
Figure 2.15: Therapy minutes audit . . . . . . . .... .  .   .  .  . . . .72
Inter-rater reliability  .... . . .               .  .  .  .  .   .  73
Retrospective reviews  .. . . . ........           . .. . .73
Routine  external auditing  . . .  .. .. .        . .  .  .  .  .   . . 73
Routine monitoring of summary online and Web reports . . . . . . . . ...73
Unscheduled audits   .. . . .. .                       . .76
hapter 3: Conducting audits ...........         ...............77
Identifying the auditors  .. . . . .... .                  . . . . 77
Identifying  the  charts  .  . . .  . . .             . . .  .  .  .   .  78
Preparing  for the  audit  . .....  . . .              . . . . .  . 78
The audit process . .       .   .   .                 . . . . . . . 79
apter 4: Putting audit resuts to work       . . . .    . . . . . . .  . .83
Follow-up of audit results .................                .  83
Continuous quality  improvement ..  . .  .. ......       .   .  .  .  .. ..  84
Figure 4.1: MDS audit deficiency follow-up protocol . . .  . . . .  .  . ... ...85
hapter 5: Organizational processes that foster
DS  accuracy   ....................................... 89
The MDS nurse . ....      .......               .   .......... 89
Job  description  . .     .  .  . .  . .             . . . . . . . . .89
Job  characteristics  ......   ......             ....    .   91
Staff competence .... .. .....                      ...    .     92
Interdisciplinary  teams  .     . . . . . .        . . .  . . . .93
MDS coordinator competency .  . .. ... . . . .     . . . . . . . 93
Figure 5.1: MDS competency evaluation . .  . . . .   .. . . ...  . .94
Figure 5.2: MDS coordinator competency evaluation #1 .. ..... .. . .  . 98
Figure 5.3: MDS coordinator competency evaluation #2 ....  . .. 99
Figure 5.4: MDS coordinator competency evaluation #3 .  ... .  .  .  . . .100
Documentation systems  . . .        .  . . .         . . . . . .  . 101
Data  collection                   .............              .102
Figure 5.5: Respiratory assessment flowsheet .... . . .  . . . . . .. 103
The  interdisciplinary  method  ...  .  . . . .        . . . . . .  104
Figure 5.6: The MDS by discipline . . . . . . .     . . .   . .104
The interdisciplinary method .   . . . . . .       . . . . . 106
The coordination method  .......... .  . .    .  .  .   . . 106
Communication  .. . . . ........... .                 . .   . .  106
Daily 'stand-up meetings' . . . . . .        .      .........   . 107
W eekly  rehab  meetings  .... ... . ... .... . . . . ..   .  .... .  107
Care  plan conferences  ... . . . .               . . . . . . ... .107
Medicare case  managers  .................. .  .  ....   .  107
Written communications among disciplines ..... ..  . . . . .. .108



Library of Congress subject headings for this publication: Nursing homes United States Medical records, Nursing Homes standards United States, Forms and Records Control standards United States, Long-Term Care standards United States, Nursing Assessment standards United States, Nursing Audit methods United States