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October 2011 MDS 3.0 RAI User’s Manual Back Online - Jan 31, 2012

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CMS inadvertently removed the current RAI Manual (October 2011) from the website when the April 2012 (V1.08) RAI Manual was uploaded. The current version is back online now at:

http://www.cms.gov/NursingHomeQualityInits/20_MDS30RAIManual.asp#TopOfPage

Scroll down the page where you will find V1.07 beneath Downloads.

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Billers: Upgrade Available for PC-Ace Pro32 - Jan 31, 2012

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WPS providers now have an upgrade available for PC-Ace Pro32: version 2.34.

"IF YOU ARE NOT USING THE VERSION LISTED ABOVE, IT IS VERY IMPORTANT THAT YOU UPDATE YOUR SOFTWARE IMMEDIATELY.

It is important that each user updates their software program in a timely manner, so as to avoid the software expiring. As software upgrades are received each quarter (January, April, July, and October), please download/install the upgrades to update your program.

With this version of PC-Ace, an important change has been made pertaining to 5010. When you install version 2.34 or upgrade to version 2.34, the submitter setup will automatically be changed to 5010. This means that when a file is prepared, it will be created in the 5010 version. This version of PC Ace will only allow files to be created in the 5010 format.

If you are an established PC-Ace user and have not yet tested or been approved for 5010, please contact the WPS EDI department at 866-503-9670.

If you are NOT currently using this program but you are interested in using this HIPAA-compliant software, please contact our EDI department at the above number."

The website to download this upgrade is:

http://www.wpsic.com/edi/pcacepro32.shtml

On this website, billers will find the version 2.34 upgrade as well as instructions, user guides and manuals, and a Change Summary for this version.

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CMS Releases Info on Impact of FY2012 Changes - Jan 27, 2012

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CMS posted the following today on the Spotlight Skilled Nursing Facilities PPS webpage:

“In the FY 2012 SNF PPS final rule, we committed to monitoring the impact of our FY 2012 policy changes on various aspects of the SNF PPS. Specifically, we committed to monitoring the impact of policies such as the following: the recalibration of the parity adjustment, allocation of group therapy and changes to the MDS including the introduction of the Change-of-Therapy (COT) Other Medicare Required Assessment (OMRA).”

Several of these reports are found at: http://www.cms.gov/SNFPPS/02_Spotlight.asp

Scroll down the webpage to Downloads.

“Table 4 below shows the distribution of all MDS assessment types as a percent of all MDS assessments. We note that the first part of FY 2012 quarter one included a transition period for the new policies, and therefore may not be entirely representative of all of FY 2012.

Table 4: Distribution of MDS assessment types

	FY 2011	FY 2012
Scheduled PPS assessment	95%	85%
Start-of-Therapy (SOT) assessment	2%	2%
End-of-Therapy (EOT) assessment (w/o Resumption)	3%	3%
Combined SOT/EOT	0%	0%
End-of-Therapy assessment (w/ Resumption) (EOT-R)	N/A	0%
Combined SOT/EOT-R	N/A	0%
Change-of-Therapy (COT) assessment	N/A	10%

In the FY 2012 SNF PPS final rule, we estimated that approximately 884,492 COT OMRAs would be submitted during FY 2012, based on an estimate of 62 COT OMR As per facility per year for 14,266 SNF facilities (76 FR 49534). Based on the data presented in Table 4 and assuming that the number of COT OMRAs per quarter remains constant, we will have overestimated the total number of COT OMRAs that will be necessary in a given year. We will continue to monitor the number of COT OMRAs.”

The above is excerpted from page 3 of the FY 2012 SNF PPS Monitoring Activities document. This document is found in the zip file of the SNF Monitoring. Other reports include:

SNF Monitoring [ZIP, 93KB]

Provider-Level Medicare Patient Days by RUG-III and RUG-IV - FY 2011 [ZIP, 21 MB]

SNF Baseline Expenditure Data [ZIP, KB]

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RAI Manual Updates for April 1, 2012 Released - Jan 23, 2012

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Late last Friday CMS posted the April 2012 MDS 3.0 RAI Manual. This is version 1.08 and its contents become effective April 1, 2012.

The manual can be found at:

http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#TopOfPage

You will find the link to that manual beneath Downloads (scroll down the page).

The All Change Tables and Pages is a 490-page document that contains all of the revised pages as well as 178 pages of Change Tables that begin on page 313. A good way to start reviewing this soon-to-be-implemented manual is to read the Change Tables.

As noted above, the contents of the 1.08 manual are not effective until April 1, 2012. Until that time the current (October 2011, Version 1.07) manual is the guideline to use for the RAI (Resident Assessment Instrument) process.

The MDS 3.0 Training Aids-Slides-Instructor Guides (the third link beneath Downloads) are not new for the 1.08 version of the RAI Manual.

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PAs Allowed to Certify/Recertify Skilled Care - Jan 20, 2012

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CMS has updated the online Medicare manual system to reflect that Physician Assistants (PAs) have been allowed to initially certify as well as periodically recertify skilled level of care for a Medicare beneficiary. This change took place January 1, 2011.

"A certification or recertification statement must be signed by the attending physician or a physician on the staff of the skilled nursing facility who has knowledge of the case, or by a nurse practitioner or a clinical nurse specialist (or, effective with items and services furnished on or after January 1, 2011, a physician assistant) who does not have a direct or indirect employment relationship with the facility, but who is working in collaboration with the physician."

R76GI dated January 13, 2012, can be found at:

http://www.cms.gov/transmittals/downloads/R76GI.pdf

R153BP dated January 13, 2012, can be found at:

http://www.cms.gov/Transmittals/downloads/R153BP.pdf

MLM7701 dated January 13, 2012, can be found at:

http://www.cms.gov/MLNMattersArticles/downloads/MM7701.pdf

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