How To Write A Case Mix And Medicaid Cmi Report

Transcription

1 M M Division of Medicaid ississippi essenger Vol. 2, Issue 2 - June 2015 Current Information on Mississippi Case Mix Reimbursement The Mississippi Messenger is a publication produced under contract with The Mississippi Division of Medicaid by Myers and Stauffer LC, 9265 Counselors Row, Suite 100, Indianapolis, IN ARE YOU EXPECTING A PROVIDER SUMMARY LETTER? The Mississippi Messenger is published to keep all interested parties current on Mississippi Case Mix Reimbursement. It is our goal to provide official information on major issues such as: Clarifications/changes to the Supportive Documentation Requirements Upcoming Training The final review results are sent via a summary review results letter posted to the web portal within 30 business days following the exit date of the case mix review. An notification will be sent to the designated contact when the summary letter is available for download at DID YOU KNOW? Did you know that with a newly automated MDS assessment file transfer protocol, you can now enter bed hold information on the web portal within 3-5 days after MDS transmission? REMINDER! State RAI Coordinator (601) Case Mix and Medicaid CMI Report Questions Myers and Stauffer LC (800) Please remember that it is important that the facility enter bed hold information on the web portal regularly. This will facilitate a more accurate CMI report and count of bed hold days and may reduce the number of edits to be made at a later date. The Web Portal User Guide at is a helpful resource. Questions about the web portal may be addressed to the Myers and Stauffer Help Desk at mshelpdesk@mslc.com or you may call the Help Desk at

2 Think Before You Act (Fabrication of Medical Records) Have you carefully evaluated the statement on the Case Mix Review Entrance Conference form regarding the creation or alteration of medical records? Creating or altering original legal medical record supporting documentation during a Medicaid Case Mix Review is not appropriate. Suspected intentional alteration of or creation of clinical documentation after MDS assessments have been completed and transmitted or during the Medicaid Case Mix Review may be referred to the Medicaid Fraud Control Unit and or Program Integrity for investigation of possible fraud and may result in civil and or criminal penalties. In addition, the State may exercise the right to complete a follow-up review or an additional review. Creating or altering medical records is a serious offense; only you can decide if this is worth the risk for the sake of supporting an assessment during the Case Mix Review? Be aware that it is the responsibility of the RN Reviewer to report any suspected creation or alteration of medical records. Mississippi Timeline JULY Cut-off date for submitting MDS data applicable to the 2nd Interim Roster The 2nd Interim Roster Reports are copied to the portal Cut-off date for submitting MDS data applicable to the 3rd Interim Roster The 3rd Interim Roster Reports are copied to the portal Cut-off date for submitting MDS data applicable to the 4th Interim Roster The 4th Interim Roster Reports are copied to the portal AUGUST Cut-off date for submitting MDS data applicable to the Quarter Final Roster Report sion s i m s Tran ting & Pos the fo r Dates Ending er Quart 0/15 6/3 The Quarter Final Roster Reports are copied to the portal The 2015 Time-Weighted Case Mix Roster Report Calendar can now be found at by clicking on Case-Mix and Related Services, selecting Review Resources then Calendar. For your convenience and reference, the calendar is included with this newsletter.

3 Stay Informed If you would like to be among the first to receive seminar notifications, newsletters, resources, etc., please send an to to subscribe to our notification list. When sending your message, please type subscribe in the subject line. In the body of the message, please include your full name, title, phone number and facility/company name. As always, MDS 3.0 coding questions are addressed by your state RAI Coordinator. If you have general questions and/or comments pertaining to our website that you would like to submit to the Myers and Stauffer Help Desk, send us an at Please be sure to provide all of your contact information to ensure a speedy response. Remember, resident information is considered Protected Health Information (PHI). is not a secure format for transmitting this type of sensitive information. Please consult your HIPAA Security Officer for more information. Any question that includes specific resident information, for example, questions relating to the Roster Report must be referred by phone to our Help Desk at Meet the Help Desk Spotlight on Whitley Hello there, my name is Jessica but I go by Whitley. I ve been with the MDS Help Desk since April and with Myers and Stauffer for 18 months. I am a pharmacy technician and have 6 years experience in customer service. My husband and I have been married for 2 years. In my spare time I enjoy all things crafty and working in the garden. I look forward to meeting you through the Help Desk communication. ve a H u Do Yo ronic Elect cords? e R h t l Hea Case Mix Review Tip Do you have electronic health records? If the answer is yes, arrangements should be made prior to the RN Reviewer s arrival (i.e., computer access, password, staff available to assist) in order to facilitate the Case Mix Review process. Electronic access must be in a secure, read-only format. Recent reviews have identified concerns that facility staff may either not know how to access or may not actually have access to parts of the electronic health record. It is vital that staff assisting with the review be familiar with the software program to avoid undue delays and possible unsupported assessments.

4 Top 10 RUG Category Changes, Common Reasons for Changes and Ways to Avoid Category Changes Based on case mix reviews conducted between 12/1/14 and 5/15/15, below are the TOP 10 RUG category changes O0100M2 - (64 changes) ü Isolation or quarantine for active infectious disease O0500A-J - (27 changes) ü Restorative Nursing Programs Section I Diagnoses (26 changes) ü Pneumonia (6) ü Septicemia (3) ü Hemiplegia (3) ü Quadriplegia (8) ü Parkinson s (2) ü COPD (4) G0110A, B, H, I - (22 changes) ü ADLs D0200, D (18 changes) ü Moods: PHQ-9 (17) ü PHQ9-OV (1) Common reasons for category changes include: Insufficient documentation Lack of an evaluation of progress Time frame errors Lack of care planning Insufficient tracking Lack of an evaluation of progress Miscoding Miscalculation Conflicting documentation 6. C0200-C0400; B0700, C0700, C (11 changes) ü BIMS (9) ü Cognition (2) 7. O0100C2 - (9 changes) ü Oxygen Therapy 8. O0100A, E, H, I, J - (8 changes) ü Chemotherapy (3) ü Tach care (1) ü IV medications (2) ü Transfusions (1) ü Dialysis (1) 9. J1100C - (5 changes) ü Shortness of breath (dyspnea) when lying flat 10. M1040D, E - (5 changes) ü Open lesions (2) ü Surgical wounds(3) Avoid RUG category changes: Refer to the latest version of the RAI manual for coding rules Communicate the ARD Refer to and follow the Mississippi Division of Medicaid Case Mix Documentation Requirements Use a calculator when manually coding therapy minutes

5 Tips for Using the Web Portal The web portal developed by Myers and Stauffer was implemented in early 2015 and is the only location where the Roster Reports used in the preparation of Medicaid Rates, are available for distribution to the Medicaid provider community. Users need to be registered with Myers and Stauffer and access it using a password and other credentials. Please note that if changes are required to users or credentials it can take up to 3 business days during which time the web portal will be unavailable for that user. The following are some tips that will assist users in accessing their web portal in a timely manner. Provider Staff Changes and Web Portal User Succession The number of users with allocated access to an individual provider s Medicaid report data via the web portal at any given time is limited to 2 users. Please note that if this includes users who no longer have responsibility for obtaining that information then the providers access to information is reduced to existing contacts until staff changes have been communicated to Myers and Stauffer. Staff changes related to web portal access should be communicated via to our Help Desk at mshelpdesk@mslc.com as soon as possible. Managing Passwords More Web Portal Tips Users of the web portal have the ability to reset their passwords at any time. The steps for doing this are shown in the Web Portal User Guide at Click on Case-Mix and Related Services, select Review Resources and select the Web Portal folder. Changing an Exisitng Password To change an existing password, log into your web portal account and follow the steps found in Section 8 of the Web Portal User Guide (see screenshot). 1. Enter current password. 2. Type your New Password in the New Password field. 3. Type your New Password in the Retype New Password field. This must match what you had typed in the New Password field. 4. Click the Change Password button. (continued on next page)

6 Tips for Using the Web Portal, continued FIRST TIME ACCESS/ FORGOTTEN PASSWORD Enter address in the box provided and click on Forgot Password? link as shown at the bottom of the screen shot in Section 2. A second screen will display. Re-enter address and type the CAPTCHA (security text) in the line provided then click on Send Forgot Password link. Once the Send Forgot Password is selected, red text will appear that confirms the account was found and an was sent. Next, go to your account and open the from Myers and Stauffer. Click on the link provided in the . The user will then be presented with the screen as shown in section 8 (see screenshot). Leave Blank 1. Type your New Password in the New Password field. 2. Type your New Password in the Retype New Password field. This must match what you had typed in the New Password field. 3. Click the Change Password button. Please Note: The current password field on the presented form must be left blank. If a value is entered in the current password field the user will not be able to reset their password. (continued on next page)

7 Using the sort feature - The web portal contains a mixture of reports, newsletters, etc. These documents can be sorted to aid file retrieval and readability. By clicking on the up/down arrows in the Create Date or File Name column headers (see screenshot), the listed files can be sorted in date order or alphabetically by name. The Public Facing IP Add res s This IP ad dress (a g roup of fou ranging in r n value from 1 to 255, se umbers, dots par th at identify a ated by computer o particular n the Inter net) is imp has a role to ortant as it play in pro viding user the web p access to ortal and is a required information piece of when requ esting acce web portal. ss Users can o btain or rev to the using the fo iew it by llowing pro cess: To determin e the comp uter IP add the compute ress, from r you plan to use to ac Roster Rep cess your orts, conne ct to the in go to www ternet and.google.com. Using th search box e Google, type wh at is my address. B public IP ased on yo ur web bro IP address w ser, your will either be returned be prompte or you will d with seve ral web pag select that es you can will return your IP add ress. If the chang e in the IP a ddress has the web po prevented rtal from b eing displa Mye yed, please rs mshelpdesk and Stauffer Help and reques sk at Account Info t a User rmation Fo rm to upda your inform te/ch ation. Pleas e the followin be sure to in ange g informati clude in on in your e name, facilit mail: your y name, fac ility Medica and a phon id number e number. Up/Down Arrows Definition of File Names on the Web Portal The web portal will contain multiple files and file names with a naming convention similar to the following: 01AB_T_YYYYQXINT3.PDF ü The first set of characters (01AB) relate to the provider CMS fac_id ü Underscores _ are used to delineate information ü The T relates to the report type - Case Mix Roster Report (a Time-Weighted Report) ü The YYYY relates to the Year ü QX relates to the calendar quarter with X being 1 through 4 ü INT relates to Interim Report followed by the version number 1 through 4 or FINAL for the Final Report ü Other files (newsletters, training flyers, etc.) will begin with the provider CMS fac_id, followed by the respective file name

8 2015 Mississippi Division of Medicaid Time-Weighted Case Mix Roster Report Calendar January 2015 February 2015 March 2015 S M T W T F S S M T W T F S S M T W T F S April 2015 May 2015 June 2015 S M T W T F S S M T W T F S S M T W T F S July 2015 August 2015 September 2015 S M T W T F S S M T W T F S S M T W T F S October 2015 November 2015 December 2015 S M T W T F S S M T W T F S S M T W T F S the First Interim Distribution of the First Interim the Second Interim Distribution of the Second Interim the Third Interim Distribution of the Third Interim the Fourth Interim Distribution of the Fourth Interim the Final Distribution of the Final MDS Helpdesk: (800) MSHelpDesk@mslc.com Prepared by Myers and Stauffer LC 2015