Harmony Healthcare Blog

ICYMI: The National Database MDS Resident Matching Process

Posted by The Harmony Team on Tue, Mar 19, 2019


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory/Rehab • Education/Efficiency


Magnifying glass showing assessment word on grey background-1The MDS 3.0 Missing OBRA Assessment Report affords the provider an opportunity to validate regulatory compliance with OBRA regulations in completing and submitting MDS Assessments.  

The MDS 3.0 Missing OBRA Assessment report lists the residents in select facilities for whom the target date of the most recent OBRA assessment (other than a discharge or death record) is more than 138 days prior to the report run date. The report also includes residents for whom no OBRA record was submitted for a current episode that began more than 60 days prior to the report run date. The information included in the report is only as current as the date of the last submission by the facility.  Ideally, the queried report should depict “no data returned,” indicating that there no residents identified as having a missed OBRA assessment, as of the last submission and run date. 

Harmony Healthcare International (HHI) recommends the review of this report on a regular basis to identify potential MDS coding, compliance or submission concerns.  Changes in resident identifiers may potentially create a second Resident Internal ID Number in the system.  The following information is provided to assist in determining the correct steps in modifying the MDS, based on the issue. 

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When a submitted record is accepted into the National database, the system compares the resident-identifying information contained in the submitted record to corresponding information in the existing resident records in the Resident table

Based upon specific criteria listed below, this process determines if the resident is a new resident or one for whom a resident record already exists. 

  • If the resident-identifying information submitted in the record is sufficiently similar to the resident information in an existing resident record, a match occurs and the submitted record is associated with the existing resident record. 
  • If the resident-identifying information in the submitted record is not sufficiently similar to an existing resident record, a new resident record is created in the Resident table and the submitted record is associated with that new resident record. 

The following fields, in various combinations, are the criteria used to determine if the resident identified in the submitted record matches an existing resident record in the Resident table: 

  • State ID
  • Facility Internal ID
  • Social Security Number (SSN)
  • Last Name
  • First Name
  • Date of Birth
  • Gender 

The criteria used for the Resident Match process are grouped into sets. Using these criteria sets, the Resident Match process compares the resident information in each submitted record to the existing information in the resident records in the Resident table in the order shown in the table below. 

When a match occurs, the Criteria Set ID of the criteria set that determined the match is stored in the resident_match_criteria column of the accepted submitted record for future reference. 

Resident Match Criteria Set 

Comparison Order

Criteria Set ID

State ID

Facility Internal ID

SSN

Last Name

First Name

Birth Date

Gender

1

1

Y

Y

Y

Y

Y

Y

Y

2

9

Y

n

Y

Y

Y

Y

Y

3

11

Y

Y

Y

Y

n

n

Y

4

3

Y

n

n

Y

Y

Y

Y

5

4

Y

n

Y

n

n

Y

Y

6

5

Y

n

Y

Y

Y

n

Y

7

6

Y

Y

n

Y

Y

C

Y

8

10

Y

n

Y

Y

Y

Y

n

 

  • Y = an exact match is required
  • n = field is not used as match criteria
  • C = a match of the month and year is required
  • Last Name and First Name are converted to upper case letters prior to comparison 

Note:  The middle name is not used in the Resident Match process. When two residents with unknown SSNs have the same: 

  • First Name,
  • Last Name, and
  • Date of Birth (MM/DD/YYYY or MM/YYYY),

(such as twins with the same first name, but different middle names), enter at least one of the resident’s middle name into the First Name field (along with the first name) to make the first names unique. This ensures that unique records for both residents exist in the Resident table. 

If identical names are entered in the First Name field for both residents and SSN are not entered, the system considers them the same resident and associates all the submitted records for both residents with that one resident record. This may cause some submitted records to receive warnings or be rejected

Using the resident match criteria sets defined above, the following flowchart depicts the Resident Matching process: 

Are the Following Identifiers the Same in the Assessment Record
and an Existing Resident Record?
 


When a match occurs, if the resident information in the submitted accepted record is more recent and differs from the resident information in the resident record in the Resident table, the resident record is updated with the newly submitted information. The following fields may be updated in this manner:  

  • Current Facility Internal ID
  • Social Security Number
  • Last Name
  • First Name
  • Middle Initial
  • Date of Birth
  • Gender
  • Ethnicity
  • Death Date
  • Medicare Number
  • Medicaid Number

Examples of when a resident record is updated (after a match occurs) with more recent resident-identifying information from a submitted accepted record include, but are not limited to: 

  • Different/corrected spelling of last name – if SSN, birth date, and gender match
  • Different/corrected spelling of first name – if SSN, last name, and gender match
  • Different/corrected/previously missing birth date – if SSN, last name, first name, and gender match
  • Different/corrected/previously missing SSN – if last name, first name, birth date, and gender match
  • Different Facility Internal ID – if last name, first name, birth date, and gender match (The resident table is based upon the state, not the provider. When a resident receives care from more than one provider within the same state, the resident record is automatically updated with the most recent Facility Internal ID.) 

Record Modification Considerations

If more than one of the resident-identifying criteria fields differ in a submitted modification record and its corresponding resident record, the action taken may vary depending on the system to which the record was submitted. 

For MDS if a new resident record is determined to be needed, it will be added to the resident table and the replacement record associated with the new resident. Depending upon the situation, this may or may not be the desired outcome. 

When you must modify multiple resident-identifying fields in a previously accepted record, refer to the flowchart provided. It will assist you in determining if you can submit all the necessary resident identifier changes in one modification. 

Compare the values of the resident-identifying fields (First Name, Last Name, SSN, Birth Date and Gender) in the modification record to those in the previously accepted record it is correcting. 

You may need to complete and submit multiple modifications to a record to ensure that a new resident record is not created. If the flow chart states that “A NEW resident is created”, the changes require multiple modifications to the record, if you do not wish to create a new resident record. 

For each modification, check the flowchart to determine the outcome of the change you are planning to make.  Based upon the flowchart provided and if you are not changing the State or Facility Internal ID, the following rules govern whether a new resident record is created when you submit a record modification with differing resident identifiers. 

You may update one of the following fields or combinations of fields without creating a new resident record if all other resident-identifying fields are present and matching: 

  • SSN (requires a match of the birth month and year minimally; day of month is optional)
  • First Name and Last Name
  • First Name and Birth Date
  • Gender 
  • If Gender is not available, you may not update any other resident-identifying field without creating a new resident record. 
  • If SSN is not available, you may only update the Birth Date Day without creating a new resident record only if all other resident-identifying fields, including birth month and birth year, are present and matching. 
  • If Birth Date (month, day and year) is not available, you may only update the First Name without creating a new resident record only if all other resident-identifying fields are present and matching. 
  • If Birth Date – day of month only is not available (birth month and year must be present and matching), you may only update the SSN without creating a new resident record only if all other resident-identifying fields are present and matching. 
  • If First Name is not available, you may only update either the Birth Date or Last Name without creating a new resident record only if all other resident-identifying fields are present and matching. If you update both the Birth Date and Last name, a new resident will be created.

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have.  You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


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Tags: MDS Assessments

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