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NEWS | Payment & Policy Ask The Payment Expert Feds unveil the new MDS 3.0, Patricia Boyer, MSM, NHA, RN President, 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
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