Survey Tags that can be associated with the completion of an MDS assessment

The following are the Survey Tags that can be associated with the completion of an MDS assessment. F272: Facility must conduct initially and periodically a comprehensive, accurate, standardized reproducible assessment of each resident’s functional capacity. F273: When required, a facility must conduct a comprehensive assessment of a resident within 14 days of admission. F274: When required, a facility must conduct a comprehensive assessment of a resident within 14 days of determining a significant change in status has occurred. F275: A comprehensive assessment must be completed not less than once every 12 months (366 days). F276: A facility must assess a resident using the quarterly review instrument specified by the State and approved by CMS not less frequently than once every 3 months. F278: The assessment must accurately reflect the resident’s status. F279: A facility must use the results of the assessment to develop, review and revise the resident’s comprehensive plan of care. F280: The resident has the right to, unless adjudged incompetent or otherwise found to be incapacitated under the laws of the State, participate in planning care and treatment or changes in care and treatment. F286: A facility must maintain all resident assessment completed within the previous 15 months in the resident’s active clinical record (centralized location). F287: MDS data must be submitted within CMS established time frames

BIMS: Rules for stopping the interview before it is complete

RAI Manual page 2-4 Rules for stopping the interview before it is complete: — Stop the interview after completing (C0300C) “Day of the Week” if: 1. all responses have been nonsensical (i.e., any response that is unrelated, incomprehensible, or incoherent; not informative with respect to the item being rated), OR 2. there has been no verbal or written response to any of the questions up to this point, OR 3. there has been no verbal or written response to some questions up to this point and for all others, the resident has given a nonsensical response. If the interview is stopped, do the following: 1. Code -, dash in C0400A, C0400B, and C0400C. 2. Code 99 in the summary score in C0500. 3. Code 1, yes in C0600 Should the Staff Assessment for Mental Status (C0700C1000) be Conducted? 4. Complete the Staff Assessment for Mental Status."

MDS Drug Class Index references

Hydroxyzine is not included as an antianxiety agent on the MDS Drug Class Index from the American Society of Consultant Pharmacists (published by Med-Pass). This is an authoritative resource, since the ASCP members are the consultant pharmacists in long term care. However, they are not the only authoritative resource out there. The best place to look is on the website of the Food & Drug Administration (FDA), since they are the ones who assign the classifications. But in the end, if you can show a surveyor you're using a generally accepted resource and you coded based on that resource, you should be just fine. (AANAC Rena Shepard 11/2015)

Therapy Cap update 4-2015

Therapy Caps

 

https://www.cms.gov/Medicare/Billing/TherapyServices/index.html?redirect=/TherapyServices

Latest Applicable Legislation/Law:  This section was last updated to include revisions to Medicare law for therapy caps, and related provisions, through Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  MACRA extended the therapy caps exceptions process through December 31, 2017 and modified the requirement for manual medical review for services over the $3,700 therapy thresholds.  MACRA also extended the application of the therapy caps, and related provisions, to outpatient hospitals until January 1, 2018.

Under Medicare Part B, the annual limitations on per beneficiary incurred expenses for outpatient therapy services are commonly referred to as “therapy caps.”  The therapy caps amounts are determined on a calendar year (CY) basis which means that all beneficiaries begin a new cap each year. For CY 2015, the limit on incurred expenses is $1,940 for physical therapy (PT) and speech-language pathology services (SLP) combined. There’s another limit of $1,940 for occupational therapy (OT) services. Deductible and coinsurance amounts paid by the beneficiary for therapy services count toward the amount applied to the limit.

With the passage of MACRA, an “exceptions process” to the therapy caps is currently in effect for the remainder of CY 2015 and for all of CY 2016 and CY 2017.  For services furnished during a calendar year that exceed the therapy caps, with an exceptions process in place, providers and practitioners may request an exception on a beneficiary’s behalf when those services are reasonable and necessary.  To indicate this medical necessity, the therapy provider or practitioner is required to add a KX modifier to the claim for each applicable service.  By using the KX modifier, the provider attests that the services are both (a) reasonable and necessary and (b) that there is documentation of medical necessity in the beneficiary’s medical record. Manual policies relevant to the exceptions process apply only when exceptions to the therapy caps are in effect.

The therapy caps exceptions process applies an annual manual medical review (MMR) requirement when a beneficiary’s incurred expenses reaches a threshold of $3,700.  Each beneficiary’s incurred expenses apply towards the MMR thresholds in the same manner as it applies to the therapy caps. There’s one threshold for PT and SLP services combined and another threshold for OT services.  Now, through MACRA, not all claims exceeding the thresholds are subject to MMR as they were before.  The MMR is currently in effect through December 31, 2017 for some claims over the $3,700 thresholds.  For a general overview of the medical review process, go to the Medical Review and Education website.  For more information on the MMR of therapy claims above the $3,700 thresholds, visit the Medical Review and Education website’s Therapy Cap section.

L0200B edentulous

Q: Should L0200B, edentulous, be coded if the resident has no teeth, but also has no mouth problems?
A: The RAI User's Manual instructions state that if the resident "lacks all natural teeth or parts of teeth," this must be coded on the MDS. The CAA will trigger and it will systematically be determined whether there is a problem for the resident related to this.