Medicare A PPS and MDS Essentials for the DON

If you are currently a Director of Nursing or are considering taking on that role, you understand that clinical knowledge is only one ingredient in the recipe that makes an effective nurse leader. Among numerous responsibilities, the challenging role of DON includes leadership, oversight, and integration of other individuals and departments responsible for completing complex tasks that are essential to facility success.  With this in mind, how well equipped are you (or your DON) to supervise and support the MDS department?

Depending on your specific facility, the DON or the Administrator may directly supervise the RAI Coordinator/MDS department. Either way, as DON you must have a solid understanding of Medicare requirements, the Resident Assessment Instrument (RAI), and the MDS process to monitor quality, ensure compliance and drive positive outcomes for your residents.

The RAI and MDS are inextricably linked to care planning, Quality Measures, Medicaid Case Mix and Medicare reimbursement via the Patient Driven Payment Model (PDPM). Ongoing monitoring of these key areas is important in assuring the provision of quality care and accurate Medicare and Medicaid reimbursement.

If you’re not well-versed in these areas, start here:

• • • Support the RAI coordinator(s)
      • A successful relationship begins with understanding that the RAI coordinator(s) in your facility have a challenging role themselves. While they are capable of assisting other departments and/or filling staffing needs, they don’t always have the same level of assistance in return to keep their duties on track. Allow them to focus on their MDS related responsibilities as much as possible and further support them by providing relevant and ongoing educational opportunities and up-to-date resources. The more adept they are in the position, the more efficient they will be (and the less you’ll have to follow up on their performance.)
    • Familiarize yourself with the RAI manual
      • The purpose of this manual is to offer clear guidance about how to use the RAI correctly and effectively to help provide appropriate care. The RAI coordinators are bound by the requirements within and shall follow the guidance for specific MDS coding responses, which are often not as clear-cut as expected. Becoming familiar with this user’s manual will assist the DON in completing targeted MDS reviews and improving systems for daily nursing assessments and documentation.
    • Complete MDS reviews
      • At least monthly, the DON should review a sample of MDS assessments to ensure the accuracy of both the patient assessment data, MDS coding and supportive charting. This helps identify areas of opportunity for improving care planning, quality measure management, and reimbursement.
    • Review CASPER and Quality Measure reports
      • A systematic approach to accessing and using analyzing the Certification and Survey Provider Enhanced Reports (CASPER) is necessary for QAPI, survey readiness, and reimbursement.
    • Analyze adverse events and clinical changes
      • As part of your daily responsibilities, your review of adverse events and clinical changes should also be discussed with the RAI coordinator(s) as appropriate. Certain events may need to be reported on the MDS and/or result in a change to an individual resident’s assessment schedule (i.e., Significant Change in Status Assessment)

Not all DONs have an MDS background – but it’s never too late to learn something new! Join Proactive on 9/7/22 for week 6 of the Dynamic DON Series: MDS and Medicare Essentials

This 8-week webinar series runs August-September 2022 and focuses on skill building for serving effectively as the Director of Nursing with a focus on effective leadership and staff engagement, nursing operations and systems of care for common conditions treated in the LTC setting, avoiding common deficiencies, staff training/competency, performance improvement and QA activities targeting QM areas, fundamentals of reimbursement and oversight of MDS performance, promoting 5-star quality. The upcoming session will discuss MDS and Medicare essentials for the DON.  Learn more and register

Contact Proactive for customized new DON orientation or support services.

Eleisha Wilkes, RN, GERO-BC, RAC-CT, DNS-CT
Clinical Consultant

Learn more about the rest of the Proactive team.