Yep – we do that too!
Services designed to make your life easier.
Most of our services can be customized to meet your facility’s goals and expectations.
MDS Coordination Services
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MDS System Management |
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This service includes developing and maintaining the MDS Schedule, communicating schedule changes with facility staff, attending meetings as requested, opening MDS Assessments, scrubbing completed MDS Assessments as requested, signing-off and closing MDS Assessments, and submitting MDS Assessments to iQIES. **A one-time mandatory MDS Scheduling Audit will be completed with this service (please see description below).** |
MDS Assessment & Care Area Assessment (CAA) Completion |
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This service includes the accurate completion of the agreed upon sections of the MDS Assessments and triggered CAA’S using the coding requirements outlined in the RAI Manual. |
Care Plan Development and Revision |
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This service includes the development and/or revision of residents’ Care Plans following the completion of each OBRA MDS Assessment by our staff. This will ensure that the Care Area Assessments (CAAs) that triggered on the MDS Assessment are recorded and that Care Plan reflects the residents’ current care needs. New admission Care Plans will be developed using data collected from the Medical Record and the Admission OBRA MDS Assessment. **This service does not include the development of the 48-Hour Baseline Care Plan.** |
Maintenance of 671 and/or 802 Forms |
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This services includes the routine updating of the facility’s Long-Term Care Facility Application for Medicare & Medicaid form (CMS-671) and the Matrix for Providers form (CMS-802). |
UB-04 Review and Attend Triple Check Meetings |
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This service includes the review of all UB-04 Claims to ensure all fields on the claim are consistent with the Medical Record and final PDPM Score. If requested, our staff will attend the monthly Triple Check Meetings to substantiate all claims. |
Coding and Reimbursement Services
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ICD-10 Coding |
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This service includes the review of the Medical Record and Clinical Documentation to identify the primary and secondary diagnoses for all new admissions and re-admissions using proper ICD-10 CM coding guidelines. Clinical and rehabilitation treatment and condition ICD-10 codes will be entered and sequenced to align with the UB-04 billing claim form. This service may be customized to include quarterly review of ICD-10 codes. |
Case Mix Index (CMI) Management |
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This service includes the weekly review of the Medical Records to determine the best Assessment Reference Date (ARD) for the upcoming OBRA assessment to maximize reimbursement opportunities for Medicaid residents. All resident CMI Scores will be monitored to ensure the Medical Record substantiates all scores obtained on the MDS. If requested, this service also includes the State submission of CMI as requested/mandated by the regulatory agencies. **This service is available for ALL states that calculate CMI.** |
Education and Training Services
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Education/Training |
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This customized service includes the one-on-one or small group education and training of the MDS Coordinator(s) and/or Interdisciplinary Team (IDT) members. Education and training topics include MDS Completion, MDS System Management, Care Plans, MDS Submission and Validation, state specific Case Mix, PDPM, ICD-10 Coding, Quality Measures, and Five Star Quality Reporting. |
Auditing and Review Services
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Case Mix Index (CMI) Audit |
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This service includes the auditing of resident Medical Records and OBRA MDS Assessment(s) to identify missed reimbursement opportunities related to MDS scheduling for residents with Medicaid related payors within a specific look-back period. A report of our findings and recommendations will be completed and provided at the conclusion of the audit. |
Corporate Integrity Agreement (CIA) Audit |
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This service includes the auditing of the MDS Assessment(s), Primary and Secondary Diagnosis ICD-10 Coding, PDPM Component Scoring and Documentation, BIMS Assessment, Functional Scores, Therapy Evaluations, Resident Demographics, and the UB-04’s. Upon completion a spreadsheet explaining what needs review or modification and if re-billing is recommended will be provided. |
MDS Data Integrity Audit |
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This service includes the thorough audit of a specific number of MDS Assessment(s) completed by facility staff each month for coding accuracy. Following the audit of each MDS Assessment a narrative report of our findings will be provided to provide education on items/sections that could have been coded differently using substantiated excerpts from the RAI Manual. |
MDS Scheduling Audit |
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This service includes the auditing of all census changes in the 92-day lookback period to ensure that all required OBRA and PPS MDS Assessments are properly scheduled in accordance with federal requirements. This audit will identify issues related to MDS scheduling that will provide education for accurate preparation and maintenance of the MDS Schedule going forward. |
Patient Driven Payment Model (PDPM) Audit |
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This service includes the audit of a specific number of Medicare PPS MDS Assessments to identify MDS coding that impacts reimbursement. The documentation in the Medical Record and the Medicare PPS MDS Assessments are thoroughly reviewed to determine that all aspects for all of the PDPM components were captured. A narrative summary will be composed to identify the findings for each PDPM component and recommended MDS Assessment modifications impacting reimbursement. |
Care Plan Review |
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This service includes a thorough review of the entire Medical Record and the most recent MDS Assessment for all current residents to ensure all Care Plans represent the current resident care needs at the time of the audit. A report will be provided of the audit findings and recommendations. This service can be customized to only review and recommend or review and update. |
Chart Readiness and Documentation Review |
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This service includes the review and collection of supporting documentation for the MDS Assessment(s) requested during State Medicaid or Federal Medicare audits. The Medical Record(s) are reviewed to locate the data to substantiate the information coded into the MDS Assessment requested by the auditing agency. The facility is provided with the data needed for submission along with a report of the findings. |
Medicare Documentation Review |
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This service includes reviewing all aspects of the Medical Record in an effort to provide oversight that the necessary documentation to substantiate the need for Medicare A coverage is identified. An in-depth review of the MDS Assessment(s), Care Plans, Primary and Secondary Diagnosis ICD-10 Coding, Skilled Nursing Progress Notes/Assessments, History and Physicals, Therapy Evaluations/Treatment Notes, Physician Certifications, Advanced Beneficiary Notices (ABNs), and Notice of Medicare Non-Coverage (NOMNC) is completed to ensure all aspects of the records are in compliance with Medicare A Guidelines. A detailed write-up with recommendations to ensure all criteria is met to bill Medicare is provided. |
Quality Measure Review |
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This service includes an in-depth review of the MDS Assessment(s) and Medical Record to identify the root cause impacting the Quality Measure (QM) outcomes identified in the facility’s CASPER Report. A narrative summary of the audit findings and recommendations will be provided upon completion of the review. |