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MDS Coding Accuracy for PDPM  

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 and Training 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.  

Objectives:

  • Provide an audit for MDS accuracy of Items on MDS that could impact PDPM CMGs.
  • Identify any under-coding practices.  
  • Provide Training on MDS Coding Accuracy for PDPM

Audit:

  • Sample of current or discharged Part A residents 5 day MDS.
  • Audit up to 161 items on MDS for accuracy and supporting documentation.
  • Share findings of audit and recommendations.

Training Outline:

  • Review MDS Section by Section to review coding for PDPM items
  • Section A
    • Reason for Assessment
    • New Interim Payment Assessment (IPA)
    • Interrupted Stay Policy
    • Optional State Assessment
  • Section B and C with Interviews and Cognitive coding
  • Section D – Mood Interview
  • Section E – Behaviors
  • Section GG
    • Best coding practices for Function Score
    • GG for IPA
  • Section H
  • Section I – Diagnosis coding best practices
    • Selecting the Primary Reason for Admission
  • Section J – Coding Procedure codes
    • Coding other items in J impacting PDPM
  • Section K – Swallowing disorders
    • Parenteral/IV
    • Tube Feeding
    • Weight
  • Section M – Pressure Ulcer Stage and Skin Treatments
  • Section N – Diabetic Orders
  • Section O
    • Coding PDPM items
    • Coding Therapy Minutes/days at End of Stay for entire stay
    • Respiratory Services
    • Nursing Restorative Services

Benefits of Audit and Training:

  • Expert analysis of current coding practices to identify areas for improvement
  • Improved coding Accuracy

Deliverable:

  • Audit findings and recommendations for coding accuracy.
  • Training on MDS Coding Accuracy for PDPM – CECs – 2
  PDPM Training - How it works
  Full PDPM MDS Audit
  Focused ICD-10 Coding Accuracy Audit and Training
   Focused GG Audit and Training
  PDPM to RUGs Financial Impact Analysis
  Transition Services
Other PDPM Support Services:
   Medicare and PDPM Compliance Audits
  Key Indicator Trend Reports - Claim data trending services
  PDPM Manual with policies and procedures
  Billing Manual with policies and procedures
  Solution Center Hotline
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