Guilt-free getaways for MDS coordinators: just because the MDS never takes a vacation doesn't mean you can't

Nursing Homes, June, 2004 by Jennifer Gross, Steven B. Littlehale

Medicare assessments. You may find this to be the area offering the least flexibility. Given the higher frequency of required assessments, as well as the pressure from your billing office to provide them with RUG scores, it may be more difficult to adjust the schedule. However, if your facility uses a team approach to managing your PPS system, you could plan ahead with your coworkers to project which residents will be in their assessment window while you are away. In many cases it is necessary to wait until the end of the assessment window to choose the optimal ARD for your residents. If the PPS team is knowledgeable about the RUG-III system and ARD selection, this process will go much more smoothly. Remember, the ARD should be chosen so that the greatest acuity is assessed. This is not "gaming the system," but one way to ensure that you are reimbursed for the excellent care provided.

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Remember, however, that the routine, nonjudicious use of the grace days available at the end of each assessment window may come under review by surveyors or fiscal intermediaries, so use these days sparingly. Once an ARD is selected, the MDS must be completed within 14 days. Any member of your team should be able to complete the MDS, so cross-training can come in handy when the MDS coordinator is away. As long as the MDS is completed in a timely fashion, you have up to 31 days from the completion date to transmit the assessment.

OBRA assessments. Traditional long-term care assessments (OBRA) offer more flexibility in scheduling your assessments. As we stated above, there are explicit rules for the maximum number of days between MDS assessments, and late assessments may put your facility at risk for survey deficiencies (for a look at how close some MDS coordinators come, see figure). However, what is not spelled out in the RAI Manual is that there is no minimum time limit between assessments. (You see this in action all the time!) A significant-change assessment satisfies the requirements of a quarterly assessment and a comprehensive assessment. The next quarterly would be due 92 days from the R2b date, which means you can schedule assessments to be done early to clear the schedule for your vacation week (or to spread out assessments if you have too many of them due at the same time). You may want to schedule your annual MDSs earlier, especially if you have many of them to do, to give you more time to complete the RAP and care plan process. Once you have scheduled the assessments, the regulatory standards for completion and transmission can be complied with while allowing for time off.

Leave a Wake Behind You

Now that you have an "MDS team" to work with and have adjusted your assessment schedule to fit your needs, you can do a few more things to make your vacation guilt-free:

* Distribute the MDS schedule to the team well in advance of your vacation to be certain that everyone is "on the same page" and understands what needs to be done while you are away.

* Make sure you transmit all the assessments you have completed before you leave. You never know if an MDS will "fall through the cracks" because it was left to be transmitted when you return.