Mds Coordinator
2 weeks ago
**VMP is looking for a part time, 3 days a week, MDS Coordinator**
**SUMMARY**
Coordinates the Resident Assessment Instrument (RAI) process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payer program requirements. Ensures assessments accurately reflect the physical, mental and psychosocial status of each resident; ensures accuracy of RAI to reflect optimal reimbursement for services provided; ensures appropriate documentation to report and support services provided and assessment accuracy. Communicates effectively with other members of the interdisciplinary team. Follows all company policies and procedures.
**ESSENTIAL DUTIES & RESPONSIBILITIES**
- RAI Process
- Participate in the pre-admission process to ensure essential information, needed for MDS/Case Mix optimization, is obtained from the referral source(s). Predicts RUG and recommends decision regarding admission.
- Works in collaboration with the facility Rehab Coordinator to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare Assessments through the use of the PPS Pathway.
- Initiates, directs and maintains the Medicare PPS/OBRA Assessment schedules to ensure timely completion of all assessments. Collaborates with the Interdisciplinary Team to set appropriate ARD for all assessments.
- Ensures all new admissions have an MDS completed timely and accurately.
- Ensures each quarterly MDS is accurate, complete and timely and is supported by clinical documentation.
- Ensures each annual assessment is accurate, complete and timely and is supported by clinical documentation.
- Collaborates with interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS.
- Initiates and completes Discharge and Re-entry tracking forms accurately and timely.
- Performs Modifications/Inactivation’s of assessment in accordance to CMS Correction Policy.
- Verifies timely transmission of MDS Assessments, including tracking forms, to the State in accordance with EHSI standards.
- Tracks, records and analyzes all defaults and rectifies if appropriate. Implements corrective action to prevent further default status.
- Reviews quarterly State CM Resident rosters for accuracy. Corrects any inaccuracies in a timely manner.
- In-services and trains current and new staff in clinical reimbursement systems and issues, as identified. Disseminates information regarding updates to the MDS, RAI, and PPS process per Medicare regulations.
- Maintains a current knowledge base regarding State and Federal Regulations, PPS and the RAI process.
- Coordinates, oversees and ensures the timely completion of the RAI process (MDS, RAPS, CAAS & Care Plan).
Case Management**
- Manages Medicare Part A and B certification/recertification process.
- Manages communication with Managed Care, VA and other payor sources.
- Performs ongoing evaluation from pre-admission through discharge to ensure an appropriate reimbursement level for each resident. Evaluates care to ensure that services and products provided match benefits available.
- Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.
- Monitors facility practice to ensure compliance with guidelines for participation in Medicare, Medicaid and other benefit programs. Initiates action needed to ensure compliance.
- Assists in preparation and timely submission of any Additional Development Requests (ADRs), Reconsiderations and Administrative Law Judge (ALJ) hearings.
- Tracks and reviews all claims denials to identify problems.
- Reviews State MDS validation reports to identify issues and/or processes to ensure accuracy of submitted MDSs.
**Nursing Administration**
- Communicates regularly with D.O.N. and V.P./Administrator to discuss identified clinical reimbursement issues.
- Treats all residents, visitors, and staff with courtesy.
- Assists in orientation and training of employees as assigned.
- Reports and documents any incidents or accidents of residents, staff or visitors to the appropriate facility personnel.
- Maintains no less than 12 hours of CEU’s. Attends training, as approved, on clinical reimbursement issues related to coverage criteria, PPS, Medicaid, VA, case mix payor systems and documentation requirements for each.
- Maintains appearance to meet department’s standards.
- Maintains acceptable record of attendance and promptness according to facility policy.
- Uses proper lines of communication.
- Maintains safety standards and institute safety precautions as appropriate.
- Supports and participates in changes involving the department.
- Stays current in professional organizations specific to subacute care.
- Attends mandatory in house education, including skills review and competency testing.
- Maintains on call for all MDS issues.
- Responsible for all Medicare denial letters and appeals
- Provides education
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