Management Minutes Questionnaire (MMQ)
Massachusetts currently utilizes the Minutes Management Questionnaire (MMQ) to determine reimbursement rates for Medicaid patients. Facilities struggle with ensuring documentation supports MMQ requirements in addition to MDS and Medicare requirements. Massachusetts has announced that the MMQ system will be eliminated with conversion to an MDS based case mix system (RUG-IV 48). Implementation has been delayed but is expected in 2014. Audits are expected to continue. In addition to assisting facilities with MMQ compliance for accurate reimbursement of care provided, Harmony (HHI) currently assists facilities with MDS case mix reimbursement compliance in over 15 States. Harmony’s extensive experience assisting facilities with both MMQ and case mix reimbursement systems gives us a unique perspective to assist facilities with this transition. Facilities should begin to prepare for this transition.
Facilities must evidence documentation to support the MMQ definitions of care provided for at least 15 days (or 50% or greater for less than 30 days). MMQ ADL assist definitions differ from MDS definitions. For example, MMQ defines “Assist” to include Continual Supervision and Physical Assist up to but not including Dependent. Points are assigned only for the following care provided: Skilled Observation, ADLs (Positioning, Personal Hygiene, Dressing, Bathing, Mobility), Eating, Special Attention, Incontinence Care, Pressure Ulcer Prevention, Pressure Ulcer Treatment, Skilled Procedures Daily, Behavior, Restorative Nursing and Bowel and Bladder retraining.
Potential Risks to Providers:
Nearly 100% of the MMQs are audited on site by the state case mix auditor. The expectation is that the entire chart (ADL flow sheets, Nursing Summaries, Nursing Assessments, nursing and discipline specific notes, Physician Orders, Care Plan, Pressure Ulcer Risk Assessment etc.) must all support MMQ points scored on the MMQ. If a conflict is evident on audit, the lesser points apply and the MMQ score is reduced accordingly. The nursing summary is required in Massachusetts and must support all points with a reason and diagnosis for care provided. The auditors review the medical record and may observe care. The audit is very focused, comprehensive and stringent. Reductions in scores and payment are common. Comprehensive chart reviews during the MMQ completion process is the key to ensuring accurate reimbursement for care provided. Conflicts in documentation put the facility at risk for lost during audit which results in loss of payment for care provided.
How can Harmony Healthcare International (HHI) help?
HHI helps our clients by completing comprehensive chart reviews to ensure facilities are accurately reimbursed for the care they provide and secure revenue under the scrutiny of audit. Our team of experts is able to identify trends in documentation that indicate the need for a change in facility process. The HHI proactive approach provides facilities with focused facility specific education to members of the interdisciplinary team to impact change that can be practically applied to other patients.