Ask The Payment Expert by ProQuest


More Info
									 NEWS | Payment & Policy

                   The Payment Expert
                                                 Feds unveil the new MDS 3.0,
                   Patricia Boyer,
                   MSM, NHA, RN
                   Boyer & Associates, LLC
                                                 but assessment tool pending
                                                 By James M. Berklan                                                                        December, according to gov-
 Why are we having denials in Medi-              Federal regulators have taken                                                              ernment regulators.
 care Advantage claims even when                 providers to the next step for                                                                “The form was released but
 they authorized resident coverage?              conversion to the new MDS 3.0                                                              the manual was delayed,”
                                                 assessment tool. The Centers                                                               noted MDS exper t Lea h
 This has been happening all over the            for Medicare & Medicaid Ser-                                                               Klusch, executive director of
 country. The Centers for Medicare               vices last month released the                                                              The Alliance Training Center.
 & Medicaid Services established a               MDS 3.0 Item Set, which con-                                                               “We can start to look at the
 new procedure this year for dealing             tains information on the final                                                              content and the scoring but
 with Private Fee for Service Medicare           version of the new format.                                                                 we do not have the definitions
 Advantage Plan (PFFS) and provider                 MDS 3.0 is scheduled for                                                                for the coding,”

                                                                                                                       Photo: iStockphoto
 billing issues. A facility must file an          implementation Oct. 1, 2010,                                                                  She said that there were “not
 appeal with the PFFS. If the facility has       but providers have a lot to do                                                             many surprises” among the
 an unfavorable appeal with the Medi-            before then. While they had                                                                associated forms because they
 care Advantage Plan, this new service           had access to draft versions       Regulators are providing nursing                        were similar to the last draft.
 will provide an expedited approach to           of the new system for several      home operators with the latest                             “(However,) operational
                                                                                    MDS 3.0 changes.
 billing issues.                                 months, CMS only recently                                                                  platforms do need to begin to
    You should review the Medicare               released the final version.        information providers need to                           adjust some of their assessment
 Advantage appeal process and follow             The MDS 3.0 Data Item              prepare for MDS 3.0 became                              protocols to include the new
 that process. If you do not receive a           Set, Data Specifications and        available, publication of the                           components of the 3.0, such as
 timely response, try this new process.          other informative material for     RAI manual was temporarily                              the interviews and the quality
    You can locate the appeal and                providers were unveiled at a       delayed. Chapters 1, 2, 3, 5 and                        of life-focused items, as well
 grievance procedures for Medicare               CMS Open Door Forum for            6 were to become available in                           as the new expanded sections
 Advantage at http://www.cms.hhs.                nursing home providers.            November, while Chapter 4                               like the skin and pain assess-
 gov/MMCAG.                                         T hou g h muc h of t he         was set to become available in                          ments,” she added. ■
    The Medicare Advantage appeal pro-
 cess is very similar to the Medicare A
 appeal process. Most of your insurance
 companies also will have this informa-          Earlier fix for Part D gap?                                                                  Gofigure
 tion on their Web site. Before you take a
 Medicare Advantage patient, you need
 to make sure your staff reviews the
 information so you know your rights.
                                                 By Brett Bakshis
                                                 Lawmakers are stepping up
                                                 efforts to close the Medicare
                                                                                    sible for cov
To top