The document discusses updates to the Minimum Data Set (MDS) 3.0/Resident Assessment Instrument (RAI) from the Centers for Medicare and Medicaid Services (CMS), including new items added, clarifications provided, and changes coming in 2014. It also describes frequent coding issues seen in Texas facilities related to MDS documentation and maintenance requirements. Key changes and clarifications from CMS involve Section G coding guidelines, distinguishing leave of absence from discharge, and adjusting Medicare group classifications for standalone assessments.
Post Acute Care: Patient Assessment Instrument and Payment Reform Demonstration nashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Authors: Judith Tobin and Barbara Gage.
The management of the Minimum Data Set (MDS) 3.0 assessment schedule is complex and time consuming. Combining scheduled MDS assessments with unscheduled Prospective Payment System (PPS) Other Medicare Required Assessments (OMRAs) correctly will lead to accurate reimbursement and can ease the MDS workflow burden on the entire team, and save the facility costly mistakes due to noncompliance. Practitioners need to know what to do if the MDS schedule is not followed correctly, and how to regain compliance with the schedule as quickly as possible. This presentation reviews the scheduled and unscheduled PPS assessment requirements and describe how to select and set Assessment Reference Dates (ARDs) strategically and accurately. The presentation also discusses implications of not following the assessment schedule correctly, and how to regain compliance once an error in assessment scheduling is discovered. The Correction Process of existing MDS assessments, including modification, inactivation, and manual correction request will be discussed. This all-important information will help the MDS coordinator to maintain and regain federal compliance with the PPS assessment schedule.
1. Learn to outline the scheduled PPS assessment schedule and unscheduled PPS assessment requirements and explain the correct Assessment Reference Date selection for each assessment type.
2. Learn to state the correct application of default or provider liable days for an early, late, or missed scheduled or unscheduled assessment.
3. Learn to identify the appropriate use of the Start of Therapy OMRA, End of Therapy OMRA, End of Therapy-Resumption OMRA, and Change of Therapy OMRA.
4. Learn the eight criteria for a Medicare Short-Stay assessment.
5. Learn to identify the difference between a MDS modification and a MDS inactivation and recognize when to choose modification or inactivation.
A presentation given at the 2016 Traffic Safety Conference during Breakout Session 10: CRIS Program Update and Dashboards. By Kellie Pierce, Crash Data and Analysis Director, Texas Department of Transportation
Post Acute Care: Patient Assessment Instrument and Payment Reform Demonstration nashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Authors: Judith Tobin and Barbara Gage.
The management of the Minimum Data Set (MDS) 3.0 assessment schedule is complex and time consuming. Combining scheduled MDS assessments with unscheduled Prospective Payment System (PPS) Other Medicare Required Assessments (OMRAs) correctly will lead to accurate reimbursement and can ease the MDS workflow burden on the entire team, and save the facility costly mistakes due to noncompliance. Practitioners need to know what to do if the MDS schedule is not followed correctly, and how to regain compliance with the schedule as quickly as possible. This presentation reviews the scheduled and unscheduled PPS assessment requirements and describe how to select and set Assessment Reference Dates (ARDs) strategically and accurately. The presentation also discusses implications of not following the assessment schedule correctly, and how to regain compliance once an error in assessment scheduling is discovered. The Correction Process of existing MDS assessments, including modification, inactivation, and manual correction request will be discussed. This all-important information will help the MDS coordinator to maintain and regain federal compliance with the PPS assessment schedule.
1. Learn to outline the scheduled PPS assessment schedule and unscheduled PPS assessment requirements and explain the correct Assessment Reference Date selection for each assessment type.
2. Learn to state the correct application of default or provider liable days for an early, late, or missed scheduled or unscheduled assessment.
3. Learn to identify the appropriate use of the Start of Therapy OMRA, End of Therapy OMRA, End of Therapy-Resumption OMRA, and Change of Therapy OMRA.
4. Learn the eight criteria for a Medicare Short-Stay assessment.
5. Learn to identify the difference between a MDS modification and a MDS inactivation and recognize when to choose modification or inactivation.
A presentation given at the 2016 Traffic Safety Conference during Breakout Session 10: CRIS Program Update and Dashboards. By Kellie Pierce, Crash Data and Analysis Director, Texas Department of Transportation
The Auditing Standards Board issued an updated Statement on Standards for Attestation Engagements (SSAE 18) effective May 1, 2017. Why the changes? What’s different? Join us to learn more about how these new standards will impact your next SOC review and report.
Remote administration of bms through android applicationeSAT Journals
Abstract SAN (Storage Area Network) is a committed high-speed network that interconnects data storage devices and multiple servers. It allows the device to appear like locally attached device to the operating system by enhancing storage devices which are accessible to server and consequently secures the manner in which the database connects with the server. Thus enabling design of portable devices that allow the user to control the building constants from remote places.[1][2][3] By gaining the access to control of building constants application like BMS (Building Management System) can be easily configured. BMS in actual is a microprocessor based electronic module or device which can be installed in a building to allow the user to operate, manage and measure real time data of various parameters. Data of the building can be accessed and modified through android app. The protocol used for communication between the app and web server is GPRS.[4][5] BMS is used to securely store and configure rules and parameters of an intelligent building like secured access-control, lighting and temperature etc. Key Words: GPRS, SAN, Microcontroller, Industrial Appliance, Android, Smart building.
Service based / modeled IT operations demands that Infrastructure needs are catered to with minimal disruptions and loss of user experience. Demand and capacity management for a critical cog in IT / service design to ensure that the service / infrastructure is fully available to users through its lifecycle
An efficient data pre processing frame work for loan credibility prediction s...eSAT Journals
Abstract
In today's world data mining have increasingly become very interesting and popular in terms of all applications especially in the
banking industry. We have too much data and too much technology but don't have useful information. This is why we need data
mining process. The importance of data mining is increasing and studies have been done in many domains to solve tons of
problems using various data mining techniques. The art of preparing data for data mining is the most important and time
consuming phase. In developing countries like India, bankers should vigilant to fraudsters because they will create more problems
to the banking organization. Applying data mining techniques, it is very effective to build a successful predictive model that helps
the bankers to take the proper decision. This paper covers the set of techniques under the umbrella of data preprocessing based
on a case study of bank loan transaction data. The proposed model will help to distinguish borrowers who repay loans promptly
from those who do not. The frame work helps the organizations to implement better CRM by applying better prediction ability.
Keywords: Data preprocessing, Customer behavior, Input columns, Outlier columns, Target column, Dataset, CRM
The Impact of Metro 2 on Credit Repair.pptxcreditletter
Understanding the nuances of Metro 2 credit letter software is crucial for anyone embarking on the journey of credit repair, as it plays a pivotal role in shaping your credit profile.
The Connection Code shall undergo thorough revision and harmonization process by Member States aiming at setting values/ranges of parameters – as specified in Chapter CC 10 ANNEX B – Reference parameters – and aiming at fine-tuning the necessary procedures. The subjects of this Code include:
a) the operational characteristics and performance of the Grids at the Connection Points (Chapter CC 2);
b) the procedure for the connection of Power-Generating Facilities, HVDC Systems, and Demand Facilities to the Grids (Chapter CC 3);
c) the connection requirements that are common for all Power-Generating Facilities, HVDC Systems and Demand Facilities (Chapter CC 4);
d) the minimum necessary technical requirements for the design criteria and operational capabilities of:
i. Power-Generating Facilities (Chapter CC 5);
ii. HVDC systems (Chapter CC 6);
iii. Demand Facilities (Chapter CC 7)
e) a set of guidelines for the definition of connection requirements for Distributed Generation (Chapter CC 8). Specifically, the requirements of this Code apply to the Power-Generating Facilities, HVDC Systems, and Demand Facilities that meet the following criteria:
a) systems that are not connected to the Transmission System as of the adoption date of this Connection Code;
b) existing systems, in case of significant changes or partial/total reconstruction.
The Network Code on Emergency & Restoration1 (NCER) came into force on
18 December 2017. Pursuant to the provisions in Chapter 3 below is the
proposed System Restoration Plan on behalf of the GB National Electricity
Transmission System Operator (NETSO).2
As provided for in the NCER Article 23, this System Restoration Plan will be
designed in consultation with relevant Distribution System Operators (DSOs),
Significant Grid Users (SGUs), National Regulatory authorities, neighbouring
Transmission System Operators (TSOs) and other TSOs in the GB
synchronous area.
This Plan is not intended to replace any provisions currently in place in the GB
Codes nor to amend the Operational Security Limits3, it is a summary of how
the requirements for System Restoration specified in NCER will be satisfied.
Many of the provisions contained within this System Defence Plan are already
described in the GB national codes (Grid Code, CUSC, BSC, etc.).Where there
are new mandatory requirements for GB Parties then these will be included in
relevant GB Codes as appropriate.
This System Restoration Plan will impact all TSOs, and DSOs in Great Britain,
SGUs identified in Appendices A to B and Restoration Service Providers
(RSPs) identified in Appendix D, who have obligations under this plan.
This System Restoration Plan has been developed taking the following into
account:
The behaviour and capabilities of load and generation
The specific needs of the high priority significant grid users detailed in
Appendix C
The characteristics of the National Electricity Transmission System and of
the underlying DSO systems.
CONDITION-BASED MAINTENANCE USING SENSOR ARRAYS AND TELEMATICSijmnct
Emergence of uniquely addressable embeddable devices has raised the bar on Telematics capabilities.
Though the technology itself is not new, its application has been quite limited until now. Sensor based
telematics technologies generate volumes of data that are orders of magnitude larger than what operators
have dealt with previously. Real-time big data computation capabilities have opened the flood gates for
creating new predictive analytics capabilities into an otherwise simple data log systems, enabling real-time
control and monitoring to take preventive action in case of any anomalies. Condition-based-maintenance,
usage-based-insurance, smart metering and demand-based load generation etc. are some of the predictive analytics use cases for Telematics. This paper presents the approach of condition-based maintenance using
real-time sensor monitoring, Telematics and predictive data analytics.
Gsm or x10 based scada system for industrial automationeSAT Journals
Abstract Power systems are important and expensive components in the electric power system. The knowledge of the actual status of the system insulation behavior, load tap changer performance, temperature, and load condition is necessary in order to evaluate the service performance concerning reliability, availability and safety. Systems abnormalities, loading, switching and ambient condition normally contribute towards accelerated aging and sudden failure. The paper presents the causes which lead to the internal faults appearance in the power system. The production mechanisms of the faults and the on-line monitoring are also analyzed. A monitoring procedure is proposed for the diagnosis and forecasting strategy of the functioning state of the power system.
Keywords: GSM standard reference manual, Universal IC programmer
The Auditing Standards Board issued an updated Statement on Standards for Attestation Engagements (SSAE 18) effective May 1, 2017. Why the changes? What’s different? Join us to learn more about how these new standards will impact your next SOC review and report.
Remote administration of bms through android applicationeSAT Journals
Abstract SAN (Storage Area Network) is a committed high-speed network that interconnects data storage devices and multiple servers. It allows the device to appear like locally attached device to the operating system by enhancing storage devices which are accessible to server and consequently secures the manner in which the database connects with the server. Thus enabling design of portable devices that allow the user to control the building constants from remote places.[1][2][3] By gaining the access to control of building constants application like BMS (Building Management System) can be easily configured. BMS in actual is a microprocessor based electronic module or device which can be installed in a building to allow the user to operate, manage and measure real time data of various parameters. Data of the building can be accessed and modified through android app. The protocol used for communication between the app and web server is GPRS.[4][5] BMS is used to securely store and configure rules and parameters of an intelligent building like secured access-control, lighting and temperature etc. Key Words: GPRS, SAN, Microcontroller, Industrial Appliance, Android, Smart building.
Service based / modeled IT operations demands that Infrastructure needs are catered to with minimal disruptions and loss of user experience. Demand and capacity management for a critical cog in IT / service design to ensure that the service / infrastructure is fully available to users through its lifecycle
An efficient data pre processing frame work for loan credibility prediction s...eSAT Journals
Abstract
In today's world data mining have increasingly become very interesting and popular in terms of all applications especially in the
banking industry. We have too much data and too much technology but don't have useful information. This is why we need data
mining process. The importance of data mining is increasing and studies have been done in many domains to solve tons of
problems using various data mining techniques. The art of preparing data for data mining is the most important and time
consuming phase. In developing countries like India, bankers should vigilant to fraudsters because they will create more problems
to the banking organization. Applying data mining techniques, it is very effective to build a successful predictive model that helps
the bankers to take the proper decision. This paper covers the set of techniques under the umbrella of data preprocessing based
on a case study of bank loan transaction data. The proposed model will help to distinguish borrowers who repay loans promptly
from those who do not. The frame work helps the organizations to implement better CRM by applying better prediction ability.
Keywords: Data preprocessing, Customer behavior, Input columns, Outlier columns, Target column, Dataset, CRM
The Impact of Metro 2 on Credit Repair.pptxcreditletter
Understanding the nuances of Metro 2 credit letter software is crucial for anyone embarking on the journey of credit repair, as it plays a pivotal role in shaping your credit profile.
The Connection Code shall undergo thorough revision and harmonization process by Member States aiming at setting values/ranges of parameters – as specified in Chapter CC 10 ANNEX B – Reference parameters – and aiming at fine-tuning the necessary procedures. The subjects of this Code include:
a) the operational characteristics and performance of the Grids at the Connection Points (Chapter CC 2);
b) the procedure for the connection of Power-Generating Facilities, HVDC Systems, and Demand Facilities to the Grids (Chapter CC 3);
c) the connection requirements that are common for all Power-Generating Facilities, HVDC Systems and Demand Facilities (Chapter CC 4);
d) the minimum necessary technical requirements for the design criteria and operational capabilities of:
i. Power-Generating Facilities (Chapter CC 5);
ii. HVDC systems (Chapter CC 6);
iii. Demand Facilities (Chapter CC 7)
e) a set of guidelines for the definition of connection requirements for Distributed Generation (Chapter CC 8). Specifically, the requirements of this Code apply to the Power-Generating Facilities, HVDC Systems, and Demand Facilities that meet the following criteria:
a) systems that are not connected to the Transmission System as of the adoption date of this Connection Code;
b) existing systems, in case of significant changes or partial/total reconstruction.
The Network Code on Emergency & Restoration1 (NCER) came into force on
18 December 2017. Pursuant to the provisions in Chapter 3 below is the
proposed System Restoration Plan on behalf of the GB National Electricity
Transmission System Operator (NETSO).2
As provided for in the NCER Article 23, this System Restoration Plan will be
designed in consultation with relevant Distribution System Operators (DSOs),
Significant Grid Users (SGUs), National Regulatory authorities, neighbouring
Transmission System Operators (TSOs) and other TSOs in the GB
synchronous area.
This Plan is not intended to replace any provisions currently in place in the GB
Codes nor to amend the Operational Security Limits3, it is a summary of how
the requirements for System Restoration specified in NCER will be satisfied.
Many of the provisions contained within this System Defence Plan are already
described in the GB national codes (Grid Code, CUSC, BSC, etc.).Where there
are new mandatory requirements for GB Parties then these will be included in
relevant GB Codes as appropriate.
This System Restoration Plan will impact all TSOs, and DSOs in Great Britain,
SGUs identified in Appendices A to B and Restoration Service Providers
(RSPs) identified in Appendix D, who have obligations under this plan.
This System Restoration Plan has been developed taking the following into
account:
The behaviour and capabilities of load and generation
The specific needs of the high priority significant grid users detailed in
Appendix C
The characteristics of the National Electricity Transmission System and of
the underlying DSO systems.
CONDITION-BASED MAINTENANCE USING SENSOR ARRAYS AND TELEMATICSijmnct
Emergence of uniquely addressable embeddable devices has raised the bar on Telematics capabilities.
Though the technology itself is not new, its application has been quite limited until now. Sensor based
telematics technologies generate volumes of data that are orders of magnitude larger than what operators
have dealt with previously. Real-time big data computation capabilities have opened the flood gates for
creating new predictive analytics capabilities into an otherwise simple data log systems, enabling real-time
control and monitoring to take preventive action in case of any anomalies. Condition-based-maintenance,
usage-based-insurance, smart metering and demand-based load generation etc. are some of the predictive analytics use cases for Telematics. This paper presents the approach of condition-based maintenance using
real-time sensor monitoring, Telematics and predictive data analytics.
Gsm or x10 based scada system for industrial automationeSAT Journals
Abstract Power systems are important and expensive components in the electric power system. The knowledge of the actual status of the system insulation behavior, load tap changer performance, temperature, and load condition is necessary in order to evaluate the service performance concerning reliability, availability and safety. Systems abnormalities, loading, switching and ambient condition normally contribute towards accelerated aging and sudden failure. The paper presents the causes which lead to the internal faults appearance in the power system. The production mechanisms of the faults and the on-line monitoring are also analyzed. A monitoring procedure is proposed for the diagnosis and forecasting strategy of the functioning state of the power system.
Keywords: GSM standard reference manual, Universal IC programmer
Similar to ATX34 - "MDS 3.0/RAI: CMS Updates, Frequent Coding Issues in Texas and Changes Coming in 2014!" (20)
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
CDSCO and Phamacovigilance {Regulatory body in India}
ATX34 - "MDS 3.0/RAI: CMS Updates, Frequent Coding Issues in Texas and Changes Coming in 2014!"
1. MINIMUM DATA SET (MDS) 3.0/
RESIDENT ASSESSMENT INSTRUMENT (RAI):
CMS UPDATES, FREQUENT CODING ISSUES
IN TEXAS AND CHANGES COMING IN
2014!
Cheryl Shiffer, RN, BSN, RAC-CT
Center for Policy and Innovation
Texas Department of Aging and Disability
Services (DADS)
RAI Panel, Center for Medicare & Medicaid
Services (CMS)
Fall 2013
1
2. MDS 3.0 OBJECTIVES
• List three or more significant changes that
CMS recently made to the MDS 3.0 RAI
Manual
• Describe three or more MDS 3.0 items that
are frequent coding issues for Texas.
2
3. MDS 3.0 OBJECTIVES
• Apply key clarifications and scenarios to
ensure accurate coding of Section G of the
MDS
I
• Identify at least three changes affecting the
MDS 3.0 process in 2014
3
4. CMS UPDATES
CMS updates listed are based on the MDS
3.0 RAI Manual (RAIM3), v1.11
Effective Date: October 1, 2013
4
5. CMS UPDATES
Along with the new version of the RAIM3 is
a new version of the data specifications
(v1.13.2).
The new specifications removed the “T”
(test) value for PRODN_TEST_CD. Test
records are no longer accepted by the
system.
5
6. CMS UPDATES
New items for the MDS item sets include:
•Items O0400A3A, O0400B3A, and
O0400C3A. Co-treatment minutes
Added for reporting co-treatment minutes
Only for Part A, does not apply to Part B
6
7. CMS UPDATES
• Item O0420. Distinct Calendar Days of
Therapy
Added to record the number of calendar days
The resident received Speech-Language
Pathology and Audiology Services,
Occupational Therapy or Physical Therapy
For at least 15 minutes a day in past 7 days
7
8. CMS UPDATES
• Items K0710A1 through K0710B3
(replaced items K0700A and K0700B)
K0710. Percent Intake by Artificial Route
Added 3 columns for coding:
1. While NOT a Resident
2. While a Resident
3. During Entire 7 Days
8
9. CMS UPDATES
Chapter 1, Section 1.8 - Protecting the
Privacy of the MDS Data – Adds:
• A revised “Privacy Act Statement – Health
Care Records” (RAIM3, pages 1-16 to
1-18)
9
10. CMS UPDATES
Chapter 2, Section 2.6 - Required Omnibus
Budget Reconciliation Act (OBRA)
Assessments for the MDS – Clarifies:
•Setting the Assessment Reference Date (ARD)
for a Discharge assessment is not set
prospectively as with other OBRA assessments.
(RAIM3, page 2-36)
10
11. CMS UPDATES
• The ARD (Item A2300) for a Discharge
assessment is always equal to the discharge
date (Item A2000).
• The ARD may be coded on the assessment
any time during the Discharge assessment
completion period (i.e., discharge date
(A2000) + 14 calendar days).
(RAIM3, page 2-36)
11
12. CMS UPDATES
Chapter 2, Section 2.9 - MDS Medicare
Assessments for SNFs – Clarifies:
•A Change of Therapy (COT) MDS is
required:
When the most recent assessment used for
Part A
Excluding an End of Therapy (EOT) MDS
Has a sufficient level of rehabilitation
therapy to qualify for:
12
13. CMS UPDATES
1. An Ultra High, Very High, High, Medium, or
Low Rehabilitation category (even if the
final classification index maximizes to a
group below Rehabilitation), and
2. The intensity of therapy changes to such a
degree it no longer reflect the Resource
Utilization Group (RUG) IV classification
assigned for a Part A resident based on the
most recent assessment used for
Medicare payment.
(RAIM3, page 2-50)
13
14. CMS UPDATES
Section 2.9 - MDS Medicare Assessments for
SNFs - Coding Tips and Special Populations
adds a Note:
•Acknowledging it may not be practicable to
conduct the resident interview items on or prior
to the ARD for a standalone unscheduled Part A
assessment, and
•Allowing facilities to conduct those resident
interview sections up to two calendar days after
the ARD (A2300).
(RAIM3, page 2-52)
14
15. CMS UPDATES
Section 2.13 - Factors Impacting the SNF
Medicare Assessment Schedule –
clarifies under Resident Takes a Leave of
Absence (LOA) from the SNF:
•An unscheduled Prospective Payment
System (PPS) MDS which meets the
appropriate standards may have an ARD
(A2300) that falls on a LOA day, but…
(RAIM3, page 2-72)
15
16. CMS UPDATES
•Only if the unscheduled PPS MDS is not
combined with a scheduled PPS MDS.
Scheduled PPS MDS must have an ARD
that falls on a Medicare Part A benefit day.
(RAIM3, page 2-72)
16
17. CMS UPDATES
Chapter 3, Section G - Item G0110
Activities of Daily Living (ADL)
Assistance – extensively revises:
•The “Rule of 3”, and
•The ADL Self-Performance Algorithm, and
•Adds several resident scenarios and
rationales for correctly coding those
situations.
(RAIM3, pages G-1 to G-22)
22
18. CMS UPDATES
Chapter 3, Section M - Skin Conditions,
replaces:
•The MDS Item Set screen shots for several
updated items in Section M, and
•References to ‘necrotic tissue’ and instead
refers to it as ‘eschar’.
(RAIM3, Section M, throughout)
22
19. CMS UPDATES
Chapter 3, Section O – Special
Treatments, Procedures and Programs –
clarifies coding the Dates of Therapy:
•When an End of Therapy with Resumption
(EOT-R) is completed, the Therapy Start
Date (items O0400A5, O0400B5, and
O0400C5) on the next PPS assessment is
the same as the initial therapy evaluation
date.
(RAIM3, page O-17)
22
20. CMS UPDATES
Chapter 3, Section Z - Item Z0400 Signatures of Persons Completing the
Assessment – adds under Coding Tips
and Special Populations:
•If a person who completed a portion of the
MDS is not available to sign it, then the
person signing the attestation should:
Verify those portions of the MDS that may
be verified with the medical record
22
21. CMS UPDATES
The date signed should be the date the
record review was verified.
For sections requiring resident interviews,
the person signing the attestation should
interview the resident to ensure the
accuracy of the information.
The date signed should be the date the
interview was validated.
(RAIM3, page Z-7)
22
22. CMS UPDATES
Chapter 5, Section 5.2 - Timeliness
Criteria, clarifies:
•The completion timing for the Omnibus
Budget Reconciliation Act (OBRA)
Admission and Annual assessment is
corrected to match the OBRA instructions
from Chapter 2 of the RAIM3.
(RAIM3, page 5-2)
22
23. CMS UPDATES
Chapter 6, Section 6.6 - RUG-IV 66-Group
Model Calculation Worksheet for SNFs
-Situation 2 clarifies:
•If the Z0100A classification for an SOT (Item
A0310C = 1), not combined with an OBRA
assessment or other PPS assessment, is
not in a Rehabilitation Plus Extensive
Services group or a Rehabilitation group,
then the following adjustment applies:
22
24. CMS UPDATES
The Medicare Non-Therapy RUG-IV group
reported in Item Z0150A should be adjusted
to AAA (the default group).
• Situation 3 clarifies:
If the Z0100A classification for an SOT
OMRA, combined with an OBRA
assessment or other PPS assessment, is in
a Rehabilitation Plus Extensive Services
group or a Rehabilitation group, then no
adjustment is made.(RAIM3, page 6-49).
22
25. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 2-2 of the RAIM3, “If allowed by
the State, facilities may have some flexibility
in form design …or use a computer
generated printout of the RAI as long as the
state can ensure that the facility’s RAI in the
resident’s record accurately and completely
represents the CMS-approved State’s RAI.”
25
26. OTHER FREQUENT CODING ISSUES
IN TEXAS
The state of Texas allows this flexibility as
long as the printed assessments:
•Are legible/readable, and
•Display all the active items for that type of
assessment in the order they are coded,
and
•Display the answer that the facility selected.
26
27. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 2-6 of the RAIM3, there are three
options for maintaining 15 months of MDS:
•Electronically with electronic signatures
•Electronically without electronic signatures
(or signatures that do not print or are not
safeguarded)
•Hard copy
27
28. OTHER FREQUENT CODING ISSUES
IN TEXAS
If MDS are maintained electronically with
electronic signatures:
•Facilities must have written policies in place
to ensure proper security measures to
protect the use of an electronic signature by
anyone other than the person to whom the
electronic signature belongs.
28
29. OTHER FREQUENT CODING ISSUES
IN TEXAS
If MDS are maintained electronically without
electronic signatures (or signatures that do
not print or are not safeguarded):
29
30. OTHER FREQUENT CODING ISSUES
IN TEXAS
• Facilities must maintain hard copies of
signed and dated CAA(s) completion
(Items V0200B-C), correction completion
(Items X1100A-E), and assessment
completion (Items Z0400-Z0500) data that
is resident-identifiable in the resident’s
active clinical record.
• No question data is resident-identifiable if
Section A is also printed.
30
31. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 2-7 of the RAIM3, surveyors are
directed to review the MDS in the form it is
maintained. If electronic, ensure enough
terminals and “read-only” access are
available.
31
32. OTHER FREQUENT CODING ISSUES
IN TEXAS
From the RAIM3, page 2-6, after the 15month period RAI information may be
thinned from the clinical record and stored
in the medical records department,
provided that it is easily retrievable if
requested by clinical staff, State agency
surveyors, CMS, or others.
32
33. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 2-8 of the RAIM3, Item A2300 Assessment Reference Date (ARD):
•Refers to the last day of the observation (or
“look back”) period ... Since a day begins at
12:00 a.m. and ends at 11:59 p.m., the ARD
must also cover this time period.
33
34. OTHER FREQUENT CODING ISSUES
IN TEXAS
• The facility is required to set the ARD on the
MDS item set itself or in the facility software
within the appropriate timeframe of the
assessment type being completed.
• This concept of setting the ARD is used for
all assessment types (OBRA and Medicare
PPS).
34
35. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 2-12 of the RAIM3, a Leave of
Absence (LOA): Does not require completion
of either a Discharge assessment or an Entry
record and occurs when a resident has:
35
36. OTHER FREQUENT CODING ISSUES
IN TEXAS
• Temporary home visit of at least one night;
or
• Therapeutic leave of at least one night; or
• Hospital observation stay less than 24 hours
and the hospital does not admit the patient.
36
37. OTHER FREQUENT CODING ISSUES
IN TEXAS
Hospital observation stay less than
24 hours and the hospital does not
admit the patient means:
• From the time the resident left the facility
until the time the resident returned was less
than 24 hours, and
37
38. OTHER FREQUENT CODING ISSUES
IN TEXAS
• The resident remained in observation and
was not admitted, and
• Any hospital observation stay periods while
actually at the hospital are irrelevant.
38
39. OTHER FREQUENT CODING ISSUES IN
TEXAS
From page 2-22 of the RAIM3, a
Significant Change in Status (SCSA)
(A0310A=04) is required to be completed
NLT the 14th calendar day after
determining a significant change
occurred when:
39
40. OTHER FREQUENT CODING ISSUES IN
TEXAS
•The resident will not return to baseline
within 2 weeks.
•There are two or more areas of
improvement or two or more areas of
decline.
40
41. OTHER FREQUENT CODING ISSUES IN
TEXAS
•Scenario: A resident has a change in both
self-performance and staff support in Item
G0110B Transfer. The resident is newly
coded as requiring extensive assistance and
one staff member’s support. Prior coding
was independent and no staff support.
•If the only change, no SCSA is required.
41
42. OTHER FREQUENT CODING ISSUES IN
TEXAS
•Scenario: A resident has a change in both
self-performance and staff support in Item
G0110B Transfer and Item G0110H Eating.
The resident is newly coded as requiring
extensive assistance and one staff member’s
support. Prior coding was independent and
no staff support.
•This is two areas of change and a SCSA is
required.
42
43. OTHER FREQUENT CODING ISSUES IN
TEXAS
An SCSA is also required when a resident
elects or revokes Hospice:
• Unless the resident dies or discharges prior
to midnight on the 14th calendar day
• Staff should make an entry in the clinical
record to reflect why the SCSA was not
started or completed.
43
44. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 2-36 of the RAIM3, a Discharge
assessment (A0310F=10 or 11):
•ARD must be set for the day of
discharge within 14 days of the
date of discharge
•Must be completed within 14 days of the ARD
•Ensure discharge date in A2000 matches the
ARD in A2300
44
45. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page A-26 of the RAIM3, when a
resident on a Medicare Part A stay is
discharged:
•The Assessment Reference Date (ARD) of a
scheduled Medicare PPS MDS may be
adjusted to the day of discharge only when
the ARD for the scheduled PPS assessment
was set prior to the day of discharge.
45
46. OTHER FREQUENT CODING ISSUES IN
TEXAS
From page I-3 of the RAIM3, Section I
Active Diagnoses - Determining Active
Diagnoses is a Two Step Process:
1.Determine all physician-documented
diagnoses in the last 60 days.
2.Determine whether each diagnosis (except
UTI) was active in the 7 day look-back
period.
46
47. OTHER FREQUENT CODING ISSUES IN
TEXAS
• Active diagnoses have a direct relationship
to the resident’s functional status, cognitive
status, mood or behavior, medical
treatments, nursing monitoring, or risk of
death during the look-back period. (RAIM3,
page I-4)
• Item I8000 – Do not code HIV/AIDS or
related diagnosis (Texas State Law).
• Read The March 2013 The MDS Mentor!
47
48. OTHER FREQUENT CODING ISSUES IN
TEXAS
From page M-7 of the RAIM3, determining if
Pressure Ulcers were “present on admission”:
•If the pressure ulcer was unstageable on admission,
but becomes staged later, it should be considered as
“present on admission” at the stage at which it first
becomes staged.
•If it subsequently worsens to a higher stage, that
higher stage should not be considered “present
on admission.”
48
49. OTHER FREQUENT CODING ISSUES
IN TEXAS
• If a resident who has a pressure ulcer is
hospitalized and returns with that pressure ulcer
at the same stage, the pressure ulcer should not
be coded as “present on admission” because it
was present at the facility prior to the
hospitalization.
• If a current pressure ulcer worsens to a higher
stage during a hospitalization, it is coded at the
higher stage upon reentry and should be coded
as “present on admission.”
49
50. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page O-1 of the RAIM3, Item O0100.
Special Treatments, Procedures and
Programs (STPP)
•Facilities may code items the resident
performed themselves, independently or
after set-up by facility staff.
50
51. OTHER FREQUENT CODING ISSUES
IN TEXAS
Include in column 2. While a resident - the
applicable STPP items that occurred during
the 14 day look-back while the resident was
a resident of the facility.
•Remember: Column 2 includes those items
that occurred while the resident was
physically present in the facility or that
occurred during a Leave of Absence (LOA).
51
52. OTHER FREQUENT CODING ISSUES IN
TEXAS
• Do not code services that were provided
solely in conjunction with a surgical
procedure or diagnostic procedure, such
as IV medications or ventilators.
• Surgical procedures include routine preand post-operative procedures.
52
53. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page O-3 of the RAIM3, Item O0100H IV
medications - DO NOT include IV fluids (Normal
Saline, D5W, etc.)
From page O-4 of the RAIM3, Item O0100M
Isolation - DO NOT include wound infections,
UTIs or encapsulated pneumonia
53
54. OTHER FREQUENT CODING ISSUES
IN TEXAS
From pages O-4 to O-5 of the RAIM3, Item
O0100M Isolation – Code for “single room
isolation” only when all of the following
conditions are met:
•Note: Never code isolation for wound
infections, urinary tract infections or
encapsulated pneumonia.
54
55. OTHER FREQUENT CODING ISSUES
IN TEXAS
• Active infection with highly transmissible,
epidemiologically significant pathogens.
• Precautions are over and above standard
precautions… transmission-based
precautions (contact, droplet or airborne)
55
56. OTHER FREQUENT CODING ISSUES
IN TEXAS
• The resident is in a room alone because of
active infection and cannot have a
roommate.
• The resident must remain in his/her room.
All services available in the facility are
brought to the resident (e.g. rehab,
activities, dining, etc.).
56
57. OTHER FREQUENT CODING ISSUES
IN TEXAS
From Appendix A, page A-19, Item O0400D
Respiratory Therapy: Following the state
Nursing Practice Act, this therapy must be
provided by a respiratory therapist (RT) or
a trained nurse.
•The March 2011 issue of
The MDS Mentor explains all the
requirements for coding Item O0400D.
57
58. OTHER FREQUENT CODING ISSUES
IN TEXAS
Item Z0400 Signatures of Persons
Completing the Assessment or Entry/Death
Reporting:
•Date for completing interview items is on the
ARD or before the ARD (except stand alone
unscheduled PPS)
•Date for gathering information for other MDS
items is usually after the ARD
58
59. OTHER FREQUENT CODING ISSUES
IN TEXAS
Item Z0400 Signatures of Persons
Completing the Assessment or Entry/Death
Reporting:
•From page Z-7 of the RAIM3, “All staff who
completed any part of the MDS must enter
their signatures, titles, sections or portion(s)
of section(s) they completed, and the date
completed.”
•Read the attestation
59
60. OTHER FREQUENT CODING ISSUES
IN TEXAS
From page 5-10 to 5-11 of the RAIM3, a
modification request is used to modify most MDS
items, including the Target Date:
•Entry Date (Item A1600) on an Entry tracking
record (Item A0310F = 1)
•Discharge Date (Item A2000) on a
Discharge/Death in Facility record (Item A0310F =
10, 11, 12),
•Assessment Reference Date (Item A2300) on an
OBRA or PPS assessment.*
60
61. OTHER FREQUENT CODING ISSUES
IN TEXAS
*
: Only correct the ARD when:
•There was a typographical error, and
•The ARD does not reflect the look-back period
used to determine the coding of the MDS.
•Monitoring will occur to determine if an ARD is
changed and clinical data is also changed (at the
same time or in a subsequent modification).
61
62. OTHER FREQUENT CODING ISSUES
IN TEXAS
A Modification Request is also used to
correct:
•Type of Assessment (Item A0310)
•Clinical Items (Items B0100-V0200C),
including Section O items
Note: Item A0310 can only be modified when
the Item Set Code (ISC) of that assessment
does not change.
62
63. ACCURATE CODING OF SECTION G
To code ADLs in Item G0110:
•Read Section G of the RAIM3
•Apply the ADL Algorithm and Rule of 3 on page G7
•Code 4, total dependence: only if there was full
staff performance of an activity with no participation
by resident for any aspect of the ADL activity. The
resident must be unwilling or unable to perform any
part of the activity over the entire 7-day look-back
period.
63
64. ACCURATE CODING OF SECTION G
• Scenario: During the entire 7-day lookback period, the resident required total
assistance (4) of two staff (3) to transfer
during the day and evening shift. On the
night shift, staff coded that the activity did
not occur (8).
• G0110B Transfer would reflect the resident
required total assistance of two staff every
time the activity occurred.
64
65. ACCURATE CODING OF SECTION G
• Scenario: During the entire 7-day look-back
period, the resident required total assistance
(4) three times, extensive assistance (3) two
times and limited assistance (2) six times in
dressing.
• G0110G Dressing would reflect the resident’s
self performance was extensive assistance.
Total dependence occurred three times but not
every time. Staff code extensive.
(RAIM3, page G-4)
65
66. ACCURATE CODING OF SECTION G
• Code 8, activity did not occur: if, over the 7-day
look-back period, the ADL activity (or any part of
the ADL) was not performed by the resident or
staff at all.
Scenario: ADL self performance is coded as 8 if
the ADL was performed only by family or friends,
or those either directly or indirectly paid by family
or friends, during the entire look-back period.
66
67. ACCURATE CODING OF SECTION G
From page G-6 and again on page G-7 of
the RAIM3, Instructions for the Rule of 3:
•When an ADL activity has occurred three
or more times, apply the four steps of the
“Rule of 3” (keeping the ADL coding level
definitions and the exceptions on page G-5
in mind) to determine the code to enter in
Column 1, ADL Self-Performance.
67
68. ACCURATE CODING OF SECTION G
• These steps must be used in sequence.
• Use the first instruction encountered that
meets the coding scenario (e.g., if Step 1
applies, stop and code that level).
• Also, if sub step 3b applies, stop and code
that level. Do not apply 3c.
68
69. ACCURATE CODING OF SECTION G
Instructions for the Rule of 3:
•1. When an activity occurs three or more
times at any one level, code that level.
•2. When an activity occurs three or more
times at multiple levels, code the most
dependent level that occurred three or
more times.
69
70. ACCURATE CODING OF SECTION G
• 3. When an activity occurs three or more
times and at multiple levels, but not
three times at any one level, apply the
following:
a. Convert episodes of full staff
performance to weight-bearing assistance
when applying the third Rule of 3.
70
71. ACCURATE CODING OF SECTION G
b. When there is a combination of full staff
performance and weight-bearing assistance that
total three or more times—code extensive
assistance (3).
c. When there is a combination of full staff
performance/weight-bearing assistance, and/or
non-weight-bearing assistance that total three or
more times—code limited assistance (2).
• 4. If none of the above are met, code
supervision.
71
72. ACCURATE CODING OF SECTION G
Definition of facility staff whose assistance is
coded in ADL support provided in Section G:
•Facility employees, agency staff, therapy (PT, OT,
ST) whether they are employees or contract staff
Scenario: CNAs provide full staff support but
Therapy staff only provides extensive assistance
for transfers during the look-back period. Staff
would code extensive assistance on the MDS.
72
73. ACCURATE CODING OF SECTION G
Definition of non-facility staff whose assistance
is NOT coded in ADL support provided in
Section G:
•Family, friends, sitters, visitors, personal care
aides
•EMS/Ambulance, Hospice, Lab, Diagnostic
Imaging (X-Ray, Ultrasound, etc.) personnel
•Nursing students/CNA students*
73
74. CHANGES COMING IN 2014
International Classification of Diseases, Tenth
Revision, Clinical Modification (ICD-10-CM)
•ICD-10-CM will be used by all providers in
every health care setting.
•ICD-10-PCS (Procedure Coding System)
will be used only for hospital claims for
inpatient hospital procedures.
74
75. CHANGES COMING IN 2014
• ICD-10-CM and ICD-10-PCS implement
October 1, 2014.
• Making the transition to ICD-10 is not
optional.
• This transition will affect all covered entities
as defined by the Health Insurance Portability
and Accountability Act of 1996 (HIPAA).
75
76. CHANGES COMING IN 2014
• Covered entities are required to adopt ICD10 codes for services provided on or after
the October 1, 2014, compliance date.
• For inpatient hospital claims, ICD-10
diagnosis and procedure codes are required
for all stays with discharge dates on or after
October 1, 2014.
76
77. CHANGES COMING IN 2014
• Note: The transition to ICD-10 does not
directly affect provider use of the Current
Procedural Terminology (CPT) and
Healthcare Common Procedure Coding
System (HCPCS) codes.
77
78. CHANGES COMING IN 2014
The CMS ICD-10 website is at
http://www.cms.gov/icd10
• Each ICD-10-CM code is 3 to 7 characters.
• The first must be an alpha character (all letters
except U are used).
• The second character is numeric.
• Characters 3-7 are either alpha or numeric (alpha
characters are not case sensitive),
• With a decimal after the third character.
78
79. CHANGES COMING IN 2014
Other changes expected in 2014:
• Updated RAIM3 – traditionally April (May)
and October
• Updated FY2015 SNF PPS Rules? – Too
early to know
79
80. TEXAS MDS RESOURCES
Call Cheryl Shiffer for Clinical Questions:
• 210-619-8010
Call Brian Johnson for Technical Questions:
• 512-438-2396
• Visit the state MDS web site:
http://www.dads.state.tx.us/providers/MDS/
(Check out The MDS Mentor! & Sign up for emails)
80
81. FINAL THOUGHTS
“When All Else Fails, Read The Instructions”
Ralph Waldo Emerson, Poet, 1803-1882
“If you don't have time to do it right, when will you
have time to do it over?”
John Wooden, American Coach, 1910-2010
81
Editor's Notes
3.
Page O-21 “Co-treatment
For Part A:
When two clinicians (therapists or therapy assistants), each from a different discipline, treat one resident at the same time with different treatments, both disciplines may code the treatment session in full. All policies regarding mode, modalities and student supervision must be followed as well as all other federal, state, practice and facility policies. For example, if two therapists (from different disciplines) were conducting a group treatment session, the group must be comprised of four participants who were doing the same or similar activities in each discipline. The decision to co-treat should be made on a case by case basis and the need for co-treatment should be well documented for each patient. Because co-treatment is appropriate for specific clinical circumstances and would not be suitable for all residents, its use should be limited.
For Part B:
Therapists, or therapy assistants, working together as a "team" to treat one or more patients cannot each bill separately for the same or different service provided at the same time to the same patient.”
Including the ARD.
Complete K0710 only if Column 1 and/or Column 2 are checked for K0510A and/or K0510B. (Parenteral/IV and/or Feeding Tube)
K0710A. Proportion of total calories the resident received through parenteral or tube feeding. 1. 25% or less. 2. 26-50%. 3. 51% or more.
K0710B. Average fluid intake per day by IV or tube feeding. 1. 500 cc/day or less. 2. 501 cc/day or more.
NOTE: Providers may request to have the Resident or his or her Representative sign a copy of this notice as a means to document that notice was provided. Signature is NOT required. If the Resident or his or her Representative agrees to sign the form it merely acknowledges that they have been advised of the foregoing information. Residents or their Representative must be supplied with a copy of the notice. This notice may be included in the admission packet for all new nursing home admissions.
Also, reiterates the requirement that a change in the provision of therapy services continues to be evaluated in successive 7-day COT observation periods until a new assessment used for PPS occurs.
Therapy qualifiers – page 2-50 “the intensity of therapy (as indicated by the total reimbursable therapy minutes (RTM) delivered, and other therapy qualifiers such as number of therapy days and disciplines providing therapy)
Also, reiterates the requirement that a change in the provision of therapy services continues to be evaluated in successive 7-day COT observation periods until a new assessment used for PPS occurs.
Makes crystal clear that a COT cannot be the first MDS to qualify a resident for a Rehab RUG.
Note: In limited circumstances, it may not be practicable to conduct the resident interview portions of the MDS (Sections C, D, F, J) on or prior to the ARD for a standalone unscheduled PPS assessment. In such cases where the resident interviews (and not the staff assessment) are to be completed and the assessment is a standalone unscheduled assessment, providers may conduct the resident interview portions of that assessment up to two calendar days after the ARD (Item A2300).
Moreover, a SNF may use a date outside the SNF Part A Medicare Benefit (i.e., 100 days) as the ARD for an unscheduled PPS assessment, but only in the case where the ARD for the unscheduled assessment falls on a day that is not counted among the beneficiary’s 100 days due to a leave of absence (LOA), as defined above, and the resident returns to the facility from the LOA on Medicare Part A.
Finally, there may be cases in which a SNF plans to combine a scheduled and unscheduled assessment on a given day, but then that day becomes an LOA day for the resident. In such cases, while that day may still be used as the ARD of the unscheduled assessment, this day cannot be used as the ARD of the scheduled assessment.
However, unless the assessment is a standalone PPS OMRA, interviews may NOT be conducted after the ARD has passed.
However, unless the assessment is a standalone PPS OMRA, interviews may NOT be conducted after the ARD has passed.
However, unless the assessment is a standalone PPS OMRA, interviews may NOT be conducted after the ARD has passed.
ARD Outside the Medicare Part A SNF Benefit
Clarifies a Skilled Nursing Facility (SNF) may use a date outside the SNF Part A Medicare Benefit period (i.e., 100 days) as the ARD for an unscheduled PPS assessment, but only in the case where the ARD for the unscheduled assessment falls on a day that is not counted among the beneficiary’s 100 days due to a LOA.
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Page 2-7 NF must “ensure that clinical records, regardless of form, are easily and readily accessible to staff (including consultants), State agencies (including surveyors), CMS, and others who are authorized by law and need to review the information in order to provide care to the resident.”
Exception: Demographic information (Items A0500-A1600) from the most recent Admission assessment must be maintained in the active clinical record until the resident is discharged return not anticipated.
CMS clarified that a LOA of less than one night (a few hours, less than a full day) is also allowed.
Discuss Medicare and Medicaid (TAC 19.2603) considerations.
CMS clarified that a LOA of less than one night (a few hours, less than a full day) is also allowed.
*Hospital observation stay less than 24 hours means the resident requires a discharge assessment if they are out greater than 24 hours from the time they leave the facility, even if the hospital does not admit.
From page 2-17 to 2-18:
If a resident is discharged prior to the completion deadline for the assessment, completion of the assessment is not required. Whatever portions of the RAI that have been completed must be maintained in the resident’s medical record.3In closing the record, the nursing home should note why the RAI was not completed.
• If a resident dies prior to the completion deadline for the assessment, completion of the assessment is not
required. Whatever portions of the RAI that have been completed must be maintained in the resident’s medical
record.4 In closing the record, the nursing home should note why the RAI was not completed.
Also not required if the resident elects Hospice upon Admission or any time prior to the ARD of the OBRA Admission MDS, because the Admission would reflect the resident was on Hospice.
May be combined with other assessments – when the ARD of the day of discharge is appropriate for other reasons for assessment
From page A-26 of the MDS 3.0 RAI Manual "When the resident dies or is discharged prior to the end of the look-back period for a required assessment, the ARD must be adjusted to equal the discharge date."
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Services available in the facility must be provided in the facility and in the resident’s room. However, page O-5 “If a facility transports a resident who meets the criteria for strict isolation to another healthcare setting to receive medically needed services (e.g. dialysis, chemotherapy, blood transfusions, etc.) which the facility does not or cannot provide, they should follow CDC guidelines for transport of patients with communicable disease, and may still code O0100M for strict isolation since it is still being maintained while the resident is in the facility.
Finally, when coding for isolation, the facility should review the resident’s status and determine if the criteria for a Significant Change of Status Assessment (SCSA) is met based on the effect the infection has on the resident’s function and plan of care. The definition and criteria of “significant change of status” is found in Chapter 2, page 20. Regardless of whether the resident meets the criteria for an SCSA, a modification of the resident’s plan of care will likely need to be completed.”
Services available in the facility must be provided in the facility and in the resident’s room. However, “If a facility transports a resident who meets the criteria for strict isolation to another healthcare setting to receive medically needed services (e.g. dialysis, chemotherapy, blood transfusions, etc.) which the facility does not or cannot provide, they should follow CDC guidelines for transport of patients with communicable disease, and may still code O0100M for strict isolation since it is still being maintained while the resident is in the facility.
Finally, when coding for isolation, the facility should review the resident’s status and determine if the criteria for a Significant Change of Status Assessment (SCSA) is met based on the effect the infection has on the resident’s function and plan of care. The definition and criteria of “significant change of status” is found in Chapter 2, page 20. Regardless of whether the resident meets the criteria for an SCSA, a modification of the resident’s plan of care will likely need to be completed.”
Services available in the facility must be provided in the facility and in the resident’s room. However, “If a facility transports a resident who meets the criteria for strict isolation to another healthcare setting to receive medically needed services (e.g. dialysis, chemotherapy, blood transfusions, etc.) which the facility does not or cannot provide, they should follow CDC guidelines for transport of patients with communicable disease, and may still code O0100M for strict isolation since it is still being maintained while the resident is in the facility.
Finally, when coding for isolation, the facility should review the resident’s status and determine if the criteria for a Significant Change of Status Assessment (SCSA) is met based on the effect the infection has on the resident’s function and plan of care. The definition and criteria of “significant change of status” is found in Chapter 2, page 20. Regardless of whether the resident meets the criteria for an SCSA, a modification of the resident’s plan of care will likely need to be completed.”
A-19 Respiratory Therapy Services that are provided by a qualified professional (respiratory therapists, respiratory nurse). Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function. Respiratory therapy services include coughing, deep breathing, heated nebulizers, aerosol treatments, assessing breath sounds and mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse. A respiratory nurse must be proficient in the modalities listed above either through formal nursing or specific training and may deliver these modalities as allowed under the state Nurse Practice Act and under applicable state laws.
In other words, if the Item Subset (full list can be found in Chapter 2, Section 2.5) would change, the modification cannot be done.
G-3 “Code 3, extensive assistance: if resident performed part of the activity over the last 7 days and help of the following type(s) was provided three or more times:
— Weight-bearing support provided three or more times, OR
— Full staff performance of activity three or more times during part but not all of the last 7 days”.
Meanwhile we still use ICD-9. No more changes to ICD 9 after the last changes which were effective October 1, 2013.
Meanwhile we still use ICD-9. No more changes to ICD 9 after the last changes which were effective October 1, 2013.