Q:
I accidentally submitted a 5-Day assessment for Managed Care. What steps should I take to correct the situation?
A:
Updated information has been provided in the Final MDS 3.0 RAI October 2024 section 5.8 page 5-14 to clarify how facilities must take specific steps to correct erroneous assessments that were submitted for Managed Care or private insurance, not for OBRA or Medicare Part A purposes.
The RAI States:
“When a facility erroneously submits a record that was not for OBRA or Medicare Part A purposes, CMS does not have the authority to collect the data contained in the record. An inactivation request will not fix the problem, since it will leave the erroneously submitted record in the history file, that is, the CMS database. A manual deletion is necessary to completely remove the erroneously submitted record and associated information from the CMS database. In instances in which an erroneous PPS assessment is combined with an OBRA-required assessment, if the item set code does not change, then a modification can be completed. If the item set code does change as a result of a modification, the provider must complete an MDS 3.0 Manual Assessment Correction/Deletion Request. This action will completely remove the assessment from the database. As indicated, the provider would complete and submit a new, stand-alone OBRA assessment.”
To manually remove the assessment from the CMS database, the facility must contact the State Agency for corrective action. The following is a link to State RAI Coordinators and State MDS Automation Coordinators, Appendix B of the RAI manual, State Agency RAI/MDS contacts.
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The State Agency will provide the MDS 3.0 Manual Individual Assessment Correction/Deletion Request form. After completing the form per the instructions, the facility must send it to the State Agency via certified mail through USPS, as it contains Protected Health Information (PHI).
The State Agency will review, sign, and submit the form to the iQIES Help Desk. This process applies to assessments with an Assessment Reference Date (ARD) of October 1, 2023, onward.
Written by: Brandy Hayes RN, RAC-CT, RAC-CTA
Clinical Consultant
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