In the fast day-to-day of managing nursing care and services, it’s easy for a a disconnect to develop between the Director of Nursing (DON) and the Minimum Data Set (MDS) Coordinator. This division is exacerbated when the DON is inexperienced in the MDS role, given that the MDS process is quite complex and driven by multiple sources of instruction. Most new MDS nurses require 6-12 months of mentorship to become independent, so how can a DON be confident that the MDS department is functioning well? Let’s examine key MDS “vital signs” to consider including in monitoring activities to ensure good MDS workflow and accurate information on MDS assessments.
Primary MDS References and Source Documents
The MDS process is driven by both the Resident Assessment Instrument (RAI) Manual, as well as state specific supportive documentation guidelines for many states. There are rules from the Quality Reporting Program that influence MDS completion and many Federal and State regulations that influence MDS coding as well.
With the MDS linked to Medicare reimbursement, Quality Measures, QRP Measures, and Medicaid reimbursement in case mix states, it is imperative to regularly monitor the following areas:
Are your MDS assessments timely?
- MDS assessments are required to be completed within 14 days the assessment reference day (ARD) with the exception of an Admission or Significant change assessment which is due 14 days from the admission or change itself.
Is the interdisciplinary team timely with MDS interviews?
How are MDS schedule changes communicated to the IDT?
- Some centers use the communications portal of their EHR, and others use secure email correspondence, but there should be consistent communication to ensure the IDT is aware of interview needs, care plan updates and their section responsibilities.
Who is completing care plan updates?
- Often in bigger centers, unit managers or an ADON may be responsible for acute care planning, and the MDS completes routine OBRA care planning with the MDS schedule. In smaller centers, MDS may do all of the updates. It is important to know the procedure that is in place to ensure you remain compliant with OBRA regulations.
Physician certifications- if MDS is responsible for ensuring that physician certifications are completed and signed, is this process flowing smoothly and being completed accurately and timely?
- Physician’s certifications are due as soon as reasonably practicable on admission, with recertification required by the 14th day, and every 30 days thereafter.
MDS accuracy
- At least monthly, review a sampling of the MDS assessments for accuracy of the items coded to ensure your quality measures are accurate, care plans are complete and accurate, and Care Area Assessments are being completed. As a DON, you may not know all the coding rules, but you will likely identify any areas that do not accurately reflect a residents’ condition and can follow up and remedy noted concerns.
Proactive is your resource for MDS support and assistance in ensuring accurate reimbursement and Quality Measures. Contact us to learn more about how to add a Proactive expert to your team on a budget-friendly flat fee partner plan. Tap into Proactive’ s training, toolkits and resources for both the DON and MDS. Don’t miss the series that runs August-September on conducting an Abuse & Neglect Program Checkup.
Written by Rosanna Benbow, r RN, RAC-CT, DNS-CT, QCP
Director of Clinical Reimbursement
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