With PDPM, there are 161 items on MDS which could impact payment. Now all the qualifiers for Nursing Component of the rate must be accurate, as well as co-morbidities. Our audit will focus on the accuracy of these items sets, which include co-morbidities for NTA and SLP component of the rate; and the qualifies for Nursing component. Polaris Group has expertise in coding of MDS, and will apply these skills to the audit. Items audited will include but not be limited to: Mood Indicators, isolation, multiple diagnosis checks, nutrition qualifiers, nursing restorative, GG, and ICD-10 selection.
- Provide an audit for MDS accuracy of Items on MDS that could impact PDPM CMGs.
- PDPM qualifiers are through-out the MDS performed by nursing, dietary, and social services.
- Identify weaknesses in supporting documentation of coded items, to prepare to MAC/RAC audits in the future.
- Identify any under-coding practices.
- Provide Training on PDPM
- Sample of discharged Part A residents 5-day MDS and claim to obtain all RUGs billed.
- Audit up to 161 items on MDS for accuracy and supporting documentation.
- Will include GG and ICD-10 Review
- Identify any under-coding of items which would impact PDPM CMGs
- Determine financial impact comparing RUG revenue to PDPM revenue for charts audited.
- Determine change in CMGs related to coding errors and PDPM revenue impact
- Share findings of audit, coding impact, and recommendations.
Benefits of Audit and Training:
- Expert analysis of current coding practices to identify areas for improvement
- Financial Impact Analysis for charts audited.
- Improved understanding of how PDPM will work
- Ability to create strategies to prepare for PDPM
- Audit findings and recommendations for coding accuracy.