Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
Stand Alone OMRAs between October 1, 2016 – November 4, 2016 must be Modified. According to a QTSO Memo, all standalone OMRA assessments that were submitted to the Assessment Submission and Processing (ASAP) system beginning October 1, 2016, through November 4, 2016 need to be modified.
An issue has been identified with MDS 3.0 assessment records that were submitted to the ASAP. All Nursing Home and Swing Bed providers that submitted NO and SO assessment records with target date on or after October 1, 2106 will need to be modified. These are the item sets for the End of Therapy (EOT) and Change of Therapy (COT) when they are not combined with a scheduled assessment (5 Day, 14 Day, 30 Day etc.).
The QTSO memo request for modification is due to the possibility for an inaccurate ASAP system calculated RUG Score for these assessments. The QTSO reports that no other assessment types were affected by this issue.
What was Affected?
- Submitted NO and SO MDS Assessment forms with Response Values for Unhealed Pressure Ulcers (M0300B1, MO300C1, M0300D1 and/or M0300F1).
- The submitted response value was NOT stored in the ASAP despite requiring providers to submit the information.
- Without items being stored, they were excluded from validation as was the RUG calculation.
Steps to Take
- Modify the MDS Assessments that fall within the 10/1/16 – 11/4/16 timeframe:
- Open up a modification for the selected MDS
- Do not make any adjustments to the MDS before validating and exporting. The ASAP system will calculate a corrected RUG classification to be used on the claim with accurate data stored for reporting purposes.
- Communicate the Medicare Part A RUG changes to the billing department for adjustment.
The QTSO Memo, further clarifies that providers should not re-submit the original record, creating a duplicate record.
Why is this MDS Assessment Modification Important?
Harmony Healthcare International (HHI) reiterates the importance of Modifying:
- Stand-alone End of Therapy (EOT) and
- Change of Therapy (COT) MDS assessments within the reporting period of October 1, 2016 through November 4, 2016.
Providers are at risk for billing an incorrect RUG level if the modification process is not followed for any applicable MDS Assessments. In addition, the data impacted supports the Quality Measures and Quality Reporting Program data calculations. Harmony Healthcare International (HHI) stresses the importance of timely modification of this data to support the RUG recalculation and accurate billing.
Harmony Healthcare International (HHI) encourages providers to review any October claims that may have already been submitted for payment with standalone OMRAs affected. Verify the RUG reported on the claim is consistent with the RUG recalculated by the ASAP system and complete any necessary billing adjustments timely.Harmony Healthcare International (HHI) is available to provide onsite analysis and associated medical record reviews to help you improve your MDS Accuracy. Please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413.
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