Harmony Healthcare Blog

MDS 3.0, PPS rate adjustments, What is the Focus for Fiscal Year 2012

Posted by The Harmony Team on Fri, Aug 26, 2011

Edited by Kris Mastrangelo

PPS,CMS,MDS 3.0Looking for ways to off set the PPS rate adjustment? Take a look at the nursing RUG scores generated each month. Does the RUG mix include "2" scores for nursing? Some studies have revealed that up to 25% of the elderly in nursing home suffer from depression. The RAI process now includes the PHQ-9© designed to identify mood disorders and allow SNF staff to investigate individualized treatment approaches. Once identified on the MDS, the Special Care High, Special Care Low, and Clinically Complex RUG groups are all affected by the PHQ-9© -driven end-split.


MDS 3.0 determines the end-split using the PHQ-9© patient interview for mood and depression.  The answers of this interview generate the Total Severity Score.  The Total Severity Score is a summary of the frequency scores on the PHQ-9© that indicates the extent of potential depression symptoms and can be useful for knowing when to request additional assessment by providers or mental health specialists.  The Total Severity Score for the resident interview will be between 0 and 27.  A PHQ-9© score => 10 will result in the "2" value end-split, which will provide a higher clinical reimbursement level.  


The Total Severity Score is driven entirely by resident response to interview questions.  Therefore, additional staff documentation will not influence the RUG to a higher level.  For those patients who have multiple clinical issues it is likely there are symptoms of depression.  Harmony recommends that special attention is paid to the PHQ-9© resident interview.  Each resident should be given sufficient time to answer the questions according to how they feel.  This will ensure that the SNF is appropriately achieving as many of these end-split determinations as possible as well as the associated reimbursement. 




Monday, September 12:  

Oregon Healthcare Association Conference (9:00-10:00 AM): Kris Mastrangelo presenting  

"Administrators Guide to Strategies for Revenue Insulation and Medical Record Preparedness."  

Final Rule FY 2012 will also be discussed. 


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Tags: MDS 3.0, RAI, PPS

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