2015-03 louisiana advisor - march 2015

2015-03 louisiana advisor - march 2015
Department of Health and Hospitals
ouisiana
Advisor
Vol. 14, Issue 1 - March 2015
Louisiana Advisor is a quarterly notification of policy changes on the MDS related to the case mix reimbursement system
The Louisiana Advisor
is a publication produced
under contract with The
Department of Health and
Hospitals by Myers and
Stauffer LC
9265 Counselors Row,
Suite 100
Indianapolis, IN 46240
The Louisiana Advisor is
published to keep all
interested parties current
on Louisiana Case Mix
Reimbursement. It is our
goal to provide official
information on major
issues such as:
* Clarifications/
changes to the
Supportive
Documentation
Guidelines
*Case Mix Review
Process
*Policies and
Procedures
*Upcoming Training
The reports for Medicaid rate setting used to be provided
electronically utilizing the strpts folder. The ability to access
this folder was removed by CMS in December 2014, and any
documents in this folder are no longer available. Myers and
Stauffer has now implemented web portal functionality in order
to continue providing reports electronically to Medicaid
providers in the state of Louisiana.
In order to access this new portal, users without current login access for
their facility will need to discuss their requests with facility management
and send an email request to [email protected] including their name,
facility name, facility Medicaid number and phone number. Please note
that this is not a secured email and no HIPAA information should be sent
to this address. User Forms will then be provided for completion. The
information required on the form will include a business related email address and a public
facing IP address and instructions to identify the public facing Internet Protocol (IP) address
will be provided. New forms will be required to document changes to staff, email and IP
addresses. Please note that if incomplete and inaccurate information is provided,
it will cause delays in processing and lead to delays in providers receiving their
information for Medicaid Rate setting. The number of users is limited to 2 per facility.
The web portal contains the current quarters Point In Time Report and individual reports
will be available for 180 days before being archived. If other types of information such as
newsletters, etc. are provided, they may be
archived for a shorter time frame such as 15
In This Issue
days.
Introduction to the Web Portal .......................... 1
MDS Clinical
Questions?
Health Standards
(800) 261-1318
Documentation or
Review Questions and
Medicaid CMI Report
Questions?
Myers and Stauffer LC
(800) 763-2278
Louisiana Advisor
Details of the operation of the web portal can
be found at www.mslc.com/louisiana by
clicking on “Case-Mix and Related Services”
selecting “Review Resources” and clicking on
“Web Portal” the document is titled
Louisiana Web Portal User Guide (Posted
2-3-15).
Medicaid Best Practices .................................... 2
Reflections ......................................................... 2
Web Portal User Account Update Forms ......... 3
RAI Footer Document Updated & Posted ......... 3
Transmission Timeline ...................................... 3
Web Portal FAQs ............................................ 4-5
Stay Informed .................................................... 5
Dear Vickie ....................................................... 5
Questions related to the web portal should
be directed to the Myers and Stauffer
Helpdesk at: 800-763-2278.
Note From the Louisiana RAI Coordinator ... 6-7
Use of Modified Assessments ............................ 7
How Can We Help You? .................................... 8
Page One
This is an article in the Medicaid Best Practices series to understand
the Medicaid Reports and their value to your facility in the Medicaid
rate setting process. The Medicaid Point In Time Report is generated
from a database of records that were accepted by CMS and
acknowledged on a CMS Final Validation Report. Providers should
ensure that they evaluate that the data submitted in the following fields A1700
(Type of Entry) and A0700 (Resident Medicaid number), is in accordance with the
requirements in the RAI manual shown below:
A1700: Type of Entry
Code 1, admission when one of the following occurs:
1. Resident is admitted for the first time to this facility; OR
2. Resident is readmitted after a discharged return not anticipated;
OR
3. Resident is readmitted after a discharge return anticipated when
return was not within 30 days of discharge.
Code 2, reentry every time a resident:
1. Is readmitted to this facility, and was discharged return
anticipated from the facility, AND
2. Returned within 30 days of discharge.
What could MDS stand for other than
Minimum Data Set?
M = Magic (for making it happen)
D = Determination (to make it error-free)
S = Stamina (to stick with it)
Hats off to all of the dedicated MDS nurses
out there, working hard to complete accurate
and timely MDS assessments!
A0700: Medicaid Number
1. Record this number if the resident is a Medicaid recipient.
2. Enter one number per box beginning in the leftmost box.
3. Recheck the number to make sure you have entered the digits
correctly.
4. Enter a “+” in the leftmost box if the number is pending. If you are notified later that the resident does have a
Medicaid number, just include it on the next assessment.
5. If not applicable because the resident is not a Medicaid recipient, enter “N” in the leftmost box.
Tips and Special Populations:
 To obtain the Medicaid number, check the resident’s Medicaid card, admission or transfer
records, or medical record.
 Confirm that the resident’s name on the MDS matches the resident’s name on the Medicaid
card.
Please also note that for Medicaid reimbursement purposes, accuracy of this data
in these fields is important. (Please see pages A-10-11 and A-22-23 and the flowchart
in Chapter 2 page 38 of the RAI Manual relating to the completion of these fields). These
fields are used in the determination of eligible residents and associated payer source that
would appear on the Medicaid Point In Time Report. Inaccurate data submitted in these two fields continues to cause
issues with the calculation of Medicaid CMIs on the report and the subsequent Medicaid rate. Call your state RAI
Coordinator for guidance on the completion of these fields.
Louisiana Advisor
Page Two
Medicaid reports (such as Rosters) are now only available from a secure
web portal. In order to access this new portal, users without current login
access for their facility will need to discuss their requests with facility
management and send an email request to [email protected]
including their name, facility name, facility Medicaid number and phone
number. Please note that this
is not a secured email and no HIPAA information should be sent to this address.
User Forms will then be provided for completion. The information required
on the form includes a business related email address and a public facing IP
address and instructions to identify the public facing Internet Protocol (IP)
address. It is assumed that IP addresses will not change, but if this occurs,
and the facility owns a range of IP addresses, these can be documented but
will require a technical review with IT staff from both parties in order to
With the frequent updates and
determine the best way to provide access to users. The users shown on the
footer page changes to the RAI
forms should also be employees of the facility/company.
manual, Myers and Stauffer has
New forms will be required to document changes to staff, email and IP
addresses and will be subject to review and information confirmation. Please
note that if incomplete and inaccurate information is provided, it will
cause delays in processing and lead to delays in providers receiving
their information for Medicaid rate setting. The total number of users is
limited to 2 per facility. The goal to process returned forms is 6 business
days, although technical circumstances relating to IP addresses may require
additional time to resolve.
Questions related to the web portal should be directed to the Myers and
Stauffer Helpdesk at: 800-763-2278.
created a guide that details every
page in the RAI manual and its
associated footer date. This guide
is available on-line at
www.mslc.com/louisiana by
clicking on “Case-Mix and
Related Services” selecting
“Review Resources” and clicking
on “MDS 3.0”. As CMS releases
future changes to the manual, this
footer page guide will be updated.
 May 1st, 2015 - Cut-off date for MDS transmission of the Preliminary Point In Time Report
 May 15th, 2015 - Posting of the Preliminary Point In Time Report
 June 1st, 2015 - Cut-off date for MDS transmission of the Final Point In Time Report
 June 15th, 2015 - Posting of the Final Point In Time Report
Louisiana Advisor
Page Three
General Questions
Web Portal Set-Up Form Questions, Continued
Q. Where do I now find my Medicaid Point In Time Q. Two of my staff share the same public facing IP
Reports as they used to be available to us via the address. Is that OK?
CMS State Reports Folders?
A. Yes.
A. CMS withdrew the ability to access the strpts folders
in December 2014. Myers and Stauffer has developed Q. The form requests an email address - which should
and implemented web portal functionality where these be provided?
reports are available electronically.
A. The user’s provider specific email account that is used
for business purposes, must be submitted.
Q. Where can we find out information relating to the
web portal?
Web Portal Policy Questions
A. The Web Portal User Guide can be found at
www.mslc.com/louisiana by clicking on “Case-Mix and Q. How are users modified on the web portal?
Related Services” selecting “Review Resources” and A. Requests must be made electronically via email to the
clicking on “Web Portal” the document is titled Louisiana following email address: [email protected] Please
Web Portal User Guide (Posted 2-3-15).
include in your email your Name, the facility you are
requesting access to, the previous facility you had access
Q. Will anything other than the Point In Time to (if appropriate) the facility’s Medicaid numbers and your
Reports be posted on the web portal?
phone number. A form will be returned to you for completion
A. Yes, the Louisiana Advisor quarterly newsletters, and will need to be returned via email to the appropriate
training flyers, and any other necessary correspondence state specific email address.
will also be posted on the web portal.
Q. What is the time frame to be granted access to
the web portal?
Web Portal Set-Up Form Questions
A. The processing of forms can take up to 6 business
Q. I submitted an IP address that was deemed to be days.
invalid by Myers and Stauffer. Why was that?
A. The requested IP address is the Public Facing IP
address, not the provider’s internal network address.
Please note that the invalid IP addresses would include
the following ranges:
 10.0.0.0.0 - 10.255.255.255.255
 172.16.0.0 - 172.31.255.255
 192.168.0.0 - 192.168.255.255
 Any numeric value which exceeds 255 an example
would be 150.2.54.258
 Any IP6 address format such as
2001:db8:0:1234:0:567:8:1. See the attached link for
more information https://support.google.com/
websearch/answer/1696588
Louisiana Advisor
Q. Is there a limit to the number of individuals that
can have access to a provider’s web portal account?
A. Yes, the providers web portal account is limited to 2
individuals and this limitation is enforced when changes
are requested.
Q. Who makes the determination of what type of
staff can access the web portal?
A. Ultimately facility management determines who will be
authorized to access the web portal. Keep in mind that the
web portal contains protected health information (PHI) so
facility staff authorization must be carefully determined.
Page Four
If you would like to be among the first to receive
seminar notifications, newsletters, resources, etc.,
Q. My facility has undergone a change of ownership\name please send an email to [email protected] to
change which would impact access to the web portal. Who subscribe to our notification list. When sending your
should I notify?
message, please type “subscribe” in the subject
A. An email should be sent to the Myers and Stauffer help desk line. In the body of the message, please include
your full name, title, phone number and facility/
at: [email protected]
company name.
Web Portal Policy Questions, Continued
Q. My facility has lost Medicaid certification which would
As always, MDS 3.0 coding questions are
impact access to the web portal. Who should I notify?
addressed by your state RAI Coordinator. If you
A. An email should be sent to the Myers and Stauffer help desk have general questions and/or comments pertaining
at: [email protected]
to our website that you would like to submit to the
Myers and Stauffer Help Desk, send us an email at
Q. My facility is a newly certified Medicaid provider, how [email protected] Please be sure to provide
do we gain access to the web portal?
all of your contact information to ensure a speedy
A. An email should be sent to the Myers and Stauffer help desk response.
at: [email protected]
Q. I cannot access the web portal at this time - how can I
enter my assessment information?
A. The input of MDS 3.0 assessment information is not entered
through the web portal. MDS assessments and tracking forms
are ONLY submitted to the QIES ASAP CMS web site. The
web portal is used to provide the Medicaid Point In Time Report
for Medicaid rate setting purposes.
Remember, resident information is considered
Protected Health Information (PHI). Email is
not a secure format for transmitting this type
of sensitive information. Please consult your
HIPAA Security Officer for more information. Any
question that includes specific resident information,
for example, questions relating to the Point In Time
Report must be referred by phone to our Help Desk
at 800-763-2278.
The “Dear Vickie...” column is a regular feature in each issue of the Louisiana Advisor. Vickie Rester
RN, one of Myers and Stauffer’s Health Care Consultants, will discuss questions that are frequently
referred to our staff. We welcome your questions for future issues. As always, please refer all coding/
regulatory issues to your state RAI Coordinator.
Q: Why would our facility be reviewed twice in one year?
A: There are two possible reasons for having two reviews in one calendar year: 1) Reviews are scheduled by state
fiscal year (July 1 – June 30). It is possible for a facility to be reviewed in March for State Fiscal Year (SFY) 2015
then again in October 2015 for SFY 2016; 2) A facility may receive a follow-up or second review during the same
calendar or SFY year if requested by DHH.
Louisiana Advisor
Page Five
CASPER Reports:
MDS Provider Access to Standard Reports 0003D & 0004D Effective March 5, 2015, MDS providers can generate the Provider
History Profile and Provider Full Profile reports in the CASPER
Reporting application. In brief description; the reports produce a
comprehensive summary of Program Requirements, and their
Resident Characteristics, in comparison to the State, Region, and
Nation percentages.
These reports are available in the MDS 0003D/0004D Package
Report, in the MDS 3.0 NH Provider report category. The packages
allow providers to generate one or both of the reports.
This is how it looks in CASPER:
RAI Manual:
February 2015 - CMS has issued and errata document on the Nursing Home Quality Initiatives webpage: http:/
/www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/
MDS30RAIManual.html titled: “MDS3.0RAIManualv1.12R.Errata.”
This document is available in the Downloads section, and contains revisions to pages in Chapter 2 and
Chapter 3, Section A of the MDS 3.0 RAI Manual v1.12R that clarify the meaning of entry/reentry and
the coding for MDS items A1600, A1700, A1800, and A1900. Changed manual pages are marked with the
footer “October 2014 (R)” or “October 2014 (R2)” if the page was previously revised.
Medicare Coverage Related to Pneumococcal Vaccines:
February 2015 - The Centers for Disease Control and Prevention (CDC) along with recommendations from the
Advisory Committee on Immunization Practices (ACIP) has issued new requirements for the pneumococcal
vaccine in adults over the age of 65. They recommend that providers now use two pneumococcal vaccines for
adults aged e”65. These vaccinations are 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and 23-Valent
Pneumococcal Polysaccharide Vaccine (PPSV23).
Louisiana Advisor
Page Six
CMS is updating the Medicare coverage requirements to align with the updated ACIP recommendation.
Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare
will cover:


An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine
under Medicare Part B; and
A different, second pneumococcal vaccine one year after the first vaccine was administered (that is, 11
full months have passed following the month in which the last pneumococcal vaccine was administered)
These Medicare coverage requirements are implemented on February 2, 2015 as posted in the MLN Matters
document: MM9051.
** CMS has been getting calls in reference to these new requirements and how they relate to coding
item O0300: Pneumococcal Vaccine on the MDS. The directive at this point is for Providers to
continue to code item O0300 as instructed in the current RAI User’s
Manual.
MDS Focus Survey Memo:
Note: The most recent Memo RE: MDS / Staffing Focused Surveys;
was posted by CMS on February 13, 2015. Ref: S&C: 15-25-NH.
Providers will be able to view the report of the findings from the pilot
surveys, in 2014, and get the general expansion of these surveys to all States
in 2015. This can be viewed at: CMS Medicare S & C-General InformationPolicy & Memos to States and Regions site; or the RAI State Coordinator
site.
A review period uses MDS assessments completed with an ARD on or before
the point in time date provided on the associated Point in Time Report being
reviewed. For example, an error in an assessment was identified and a
modification completed in January of 2015. For the review period of
January, February and March 2015, the associated MDS assessments
will reflect the third quarter point in time (July, August and September
assessments); a modification completed in January 2015 would not be
included on the 9/30/14 Point in Time Report. The facility rate would
have been calculated on the original assessment rather than on the modified assessment; therefore, the modified
assessment would not be included in the review sample.
Louisiana Advisor
Page Seven
The Myers and Stauffer Help Desk is able to assist with many of your questions. Below is a table of common issues and
the best resource to provide you a quick and accurate response.
Common Issues
Best Resource
Telephone
Number

Point In Time Report

Transmission deadlines related to
Point In Time Reports

Reports posted to Web Portal

Web Portal User Account Form

Medicaid RUGs

Payer Source Questions

Records with BC1 Delinquent RUGs

Medicaid Resources

Myers and Stauffer Provider Training

Medicaid Rates
Myers and Stauffer LC
800-374-6858

Casper Reports
800-261-1318

CMS Validation Reports
State RAI Coordinator,
Jonelle Thompson RN, LNC

Duplicate Residents

MDS Coding

Medicare RUGs

Medicare Stay

Modification/Inactivation Policy

QM Reports

Medicaid Case Mix Documentation
Review
Myers and Stauffer Health Care Manager, 800-763-2278
Cindy Smith RN, BA, RAC-CT

CMS User ID/Passwords
QTSO Help Desk
800-339-9313

PPS Billing Questions
Your CMS Fiscal Intermediary
Contact your
business office

CMSNET User ID/Passwords
CMSNET Helpdesk
888-238-2122
Louisiana Advisor
Myers and Stauffer Help Desk
800-763-2278
Myers and Stauffer Website,
www.mslc.com/louisiana
Page Eight
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