Will MDS 3.0 and RUG-IV Continue to Be Moving Targets? Yep…

As October 1, 2010, is approaching, we are learning how the Centers for Medicare & Medicaid Services (CMS) will handle the RUG-IV delay resulting from the passage of the Health Care Reform Act. During the May 3-4 American Association of Nurse Assessment Coordinators (AANAC) Conference in Las Vegas, Nevada, CMS announced they will pay claims beginning October 1, 2010, utilizing the RUG-IV grouper until they have completed and tested a new, hybrid RUG-III grouper. At such time, the Medicare Administrative Contractors (MACs) and Fiscal Intermediaries (FIs) will be expected to reprocess all claims using this new RUG-III grouper and pay providers accordingly. (CMS has been phasing in MACs to eventually replace the FIs. Right now, both exist.) Presently, there is no prescriptive formula to forecast the financial impact of the new, hybrid grouper.

CMS continues to make changes to the draft MDS 3.0 RAI Manual which is expected to be released in late May or early June of this year. Such changes include adding another condition to the Short Stay Assessment that looks very similar to one of the documented existing conditions. Also, in section I of the MDS 3.0, CMS has changed the definition of a Urinary Tract Infection (UTI). It has become necessary for current trainers to simply provide as much information as possible while still letting recipients know we continue to expect more changes. It will be imperative that providers who are now going to training read the MDS 3.0 RAI Manual closely for any and all changes when the new version is published in May/June.

By Lisa Hohlbein RN, RAC-CT, MSCN; Manager – Clinical Consulting Email: LHohlbein@vcpi.com