MDS Nurse

ESSENTIAL JOB FUNCTIONS:

1. Prior to or at the time of admission, review resident records for skilled services meeting the guidelines for Medicare coverage, as appropriate 2. Provide Medicare Charting Guidelines to nursing staff, as appropriate 3. Manage Medicare A Certification / Re-Certification process per CMS guidelines and timeframes 4. Coordinate the Resident Assessment Instrument (RAI) process including completion of an accurate Minimum Data Set (MDS) and development of the interdisciplinary Plan of Care (CP) 5. Review records for diagnoses and complete ICD-9 Coding (ICD-10 as of 10/1/15) and sequencing for payer type, as needed 6. Prior to look-back period, meet with IDT to review resident programming and documentation requirements to maximize reimbursement and provide an accurate picture of the care being provided to the resident 7. Schedule resident for appropriate OBRA and/or Medicare PPS MDS (scheduled and unscheduled), per RAI and CMS guidelines and timeframes allowed 8. Work in collaboration with the Therapy Program Manager to ensure the most appropriate assessment date is utilized 9. Maintain Therapy Intensity Schedule COT binder and review daily with Therapy Program Manager – scheduling COT OMRA's as necessary 10. Perform ongoing evaluation from pre-admission through discharge to ensure an appropriate reimbursement level for each resident. 11. Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level. 12. Complete appropriate MDS interviews following designated script on or prior to the ARD within the window, document time/date and staff member completing the (include type) interview in the medical record on the day it occurred when indicated 13. At minimum, complete the sections assigned to the MDS Coordinator per facility processes (A, B, G (IN only), H (IN only), I, J, K0510A&B, K0700, L, M, N, O0100-O0450, , O0500 (IN only), P (IN only), S (IL only) V, X, Z) 14. Strive to complete MDS sections within 2 working days after ARD 15. MDS Nurse to complete CAA's for Delirium, Visual, ADL (IN only), Urinary Incontinence and Urinary Catheter (IN only), Falls, Feeding Tubes, Dehydration, Dental, Pressure Ulcer, Psychotropic Drug, Restraints (IN only) and Pain 16. Oversight of all disciplines involved in the MDS process to strive to complete MDS, CAA's and CP within 2 working days after the ARD, the exception is preparing for Medicare billing which may reduce completion time to day after ARD. 17. Complete other sections of the MDS when incomplete to prevent late closure 18. Conduct weekly CMI Meetings (IN) and RUG-IV 48 Meetings (IL) 19. Utilize all available tools to validate the accurateness of the MDS 20. Signs MDS sections for accurateness – RN must sign for completeness 21. Maintain supportive documentation packet for each OBRA and Medicare PPS MDS for validation of RUG 22. Audit MDS for validation of RUG – audit should not be completed by the nurse completing the MDS 23. Create submission files and transmit MDS data timely to the State / CMS repository – no later than 14 days after completion of MDS/PPS assessments and no later than 7 days after completion of Entry/Death in Facility Tracking 24. Review Validation Report for warnings and rejections, responding as appropriate, and maintain transmission Validation Reports 25. Review Assessment Due Report and PPS Assessments Due Report 2-3 times a week to track assessments that are due 26. Complete and provide MDS, PPS and CP Calendars to all disciplines involved in MDS and CP 27. Review telephone orders and update care plan problems, goals and approaches as necessary 28. Participate in Morning Meeting review to monitor for changes in resident condition 29. Perform modifications of assessments in accordance with CMS Policy 30. Participate in Claims Triple Check Procedure 31. Ensure Care Plan Conference Process is followed by all disciplines 32. Ensure Care Plan Update Process is followed by all disciplines 33. Ensure End of Month Billing Process is completed timely 34. Maintain Benefits Exhaust Log and fax to designated biller each month 35. Participates in assigned meetings as deemed necessary 36. Ensure Medicare Meeting Process is followed by all disciplines 37. Attends in-service training and other educational programs as directed or authorized. 38. Performs all job duties in a manner that ensures that confidential information and residents rights are protected at all times 39. Responsible for facilitating, preparing, implementing appropriate procedures to meet the needs ethically of the reimbursement entities surveying the facility 40. Complies with established standards described in facility policies and procedures, code of conduct, corporate compliance plan, employee handbook and other company documents and publications. 41. Performs other duties or functions as directed. 42. Monitor Point Click Care (Point of Care) documentation daily and report non-compliance to the DON and/or designee. Complete POC documentation during the ARD period and PRN. 43. Quarterly Review of the HFS Roster (IL) / Quarterly Review of the Time Weighted Report (IN) 44. Coordination of the HFS Audit Survey Process (Surveys are random at this time) IL / Coordination of the Myers and Stauffer's MDS Audit Survey Process (Surveys are Scheduled and are not random) IN 45. Coordination of the MDS Focused Surveys (IL and IN) 46. Coordinate of data collection for the ADR Process (Additional Documentation Requests) for Medicare Part A and B as well as Managed Care.

KNOWLEDGE/SKILLS & ABILITIES:

1. Must possess a current, unencumbered, active license to practice as a Registered Nurse or Licensed Practical Nurse in this state.

1. Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.

2. Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.

EDUCATION/EXPERIENCE: Must possess, as a minimum, a Nursing Degree from an accredited college or university. Optional: Certification programs for MDS Coordinators are available through the American Association of Nurse Assessment Coordinators (AANAC). The AANAC offers credentials such as Resident Assessment Coordinator – Certified and Certified Nurse Executive. In order to