Minimum Data Set Verification/Review
Once a long term care case mix, Resource Utilization Group (RUG)-related reimbursement system is implemented, the next logical step is to develop a verification process to review Minimum Data Set (MDS) elements directly related to the RUG calculation for each nursing facility resident. The verification process assists in protecting states’ fiscal interests by ensuring integrity in the data that drives payments. Myers and Stauffer has extensive experience in MDS verification reviews, including:
- Designing on-site MDS verification reviews to meet state-specific goals and objectives taking into consideration:
- Supportive documentation guidelines.
- Facility selection.
- Sample selection of assessments for review.
- Sample assessment size, both initial and expanded.
- Definition of unsupported assessment and unsupported threshold.
- Application of the review results.
- Developing reasonable sanction remedies and phase-in schedules.
- Developing an automated electronic review system (ERS) to be used in the on-site MDS verification review process.
- Providing clinical staff to perform on-site MDS verification reviews.
- Providing clinical staff to perform training and ongoing education to state staff and providers.
- Assisting with state plan, Medicaid reimbursement regulations and provider handbooks.
- Preparing fiscal analyses.
- Establishing a comprehensive and effective appeal process.
We look forward to speaking with you about an MDS verification/review program for your Medicaid nursing facility case mix system.