Nursing Facility Utilization Review Stakeholder Meeting Office of - PowerPoint PPT Presentation

Nursing Facility Utilization Review Stakeholder Meeting Office of I nspector General Division of Medical Services March 12, 2018

Nursing Facility MDS 3.0 Reviews • The Utilization Review Unit is perform ing review s of MDS 3 .0 assessm ents from the FY 2 0 1 8 W ork Plan. • The FY 2 0 1 8 sam ple period is from 3 / 1 / 2 0 1 6 through 2 / 2 8 / 2 0 1 7 and contains m anaged care and fee-for-service claim s. 2

Nursing Facility MDS 3.0 Reviews FY 1 8 W ork Plan is to review approxim ately 5 0 0 nursing facilities, w hich includes 2 0 nursing facilities from the FY 1 7 W ork Plan that are associated w ith the NFUR Pilot 2 – Nursing Facility Review for Managed Care Residents w ith Hospital Adm issions. 3

Nursing Facility Onsite Reviews As of 3 / 2 / 2 0 1 8 , 1 9 5 onsite review s have been conducted. 4

N URSING F ACILITY TOP 10 COMMENT ERRORS FY 1 8 Top 1 0 Com m on Er r or s a s of 2 / 2 8 / 1 8 30 25 20 15 10 5 0 3/ 13/ 2018 5

N URSING F ACILITY E RROR TRENDS TREN D S 25 Signatures at Z0500 & LTCMI did not 31 match 25 23 BIMS 29 28 23 ADLs 28 30 27 MDS 27 18 10 Restorative Nursing Program(RNP) 13 14 4 LTCMI 10 7 Physician Orders 7 10 8 No HHSC MDS Training Certification 6 7 Pressure Ulcer relief devices missing 6 documentation 5 Physician Visits 5 10 Hospice 16 Active DX 14 Respiratory 8 0 5 10 15 20 25 30 35 3/ 13/ 2018 6 FY 2016 FY 2017 FY 2018

Thank You Linda Carlson, RN, BSN, CPC Nursing Facility Program Manager Linda.carlson@hhsc.state.tx.us 7