MIR-2006-10A, October 2006

Skilled Nursing Facility MDS QC & FI Extract Information

What’s New?
The Centers for Medicare & Medicaid Services (CMS) has released new Fiscal Intermediary (FI) extract software which enables the FI to review Minimum Data Set (MDS) information online once it is entered into the state repository.

This system, known as the Minimum Data Set Quality Control (MDS QC) System, provides the FI with the ability to access resident assessments and assure the quality of the assessment.

What Does It Do?
This software assists the FI by recalculating the Resource Utilization Group (RUG) values when discrepancies are noted during the review period by utilizing the CMS-approved RUG III Classification System (53 group) with Case Mix Indexing.

Why Is It Important?
Providers MUST ensure submission of all MDS to the state repository!
Empire Medicare Services Medical Review Department will no longer require hardcopies of the MDS for medical records requested after 10/01/06. Therefore, additional development requests (ADRs) will no longer require this portion of the resident medical record be submitted for review. However, the Appeals Department will still request hardcopies of the MDS from all providers.

If the CERT Contractor pulls a claim for review and the MDS is not in the state repository, the CERT Contractor will advise the FI to deny the claim and recoup the Medicare reimbursement.

How Will This Benefit Providers?
This new system not only decreases the chance for errors that cause denials during the Medical Review Process, it saves the provider time and money! By making this valuable information available online, the provider is not responsible for submitting copies of each MDS completed during the dates of services requested by the Medical Review Department for review.

Less Time/Copies + Less Errors + Less Postage = Less $$$