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

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As of 3 / 2 / 2 0 1 8 , 1 9 5 onsite review s have been conducted.

NURSING FACILITY TOP 10 COMMENT ERRORS

3/ 13/ 2018 5 5 10 15 20 25 30

FY 1 8 Top 1 0 Com m on Er r or s a s of 2 / 2 8 / 1 8

NURSING FACILITY ERROR TRENDS

3/ 13/ 2018 6

25 23 23 27 10 4 7 8 7 5 31 29 28 27 13 10 7 6 6 5 25 28 30 18 14 10 10 16 14 8 5 10 15 20 25 30 35 Signatures at Z0500 & LTCMI did not match BIMS ADLs MDS Restorative Nursing Program(RNP) LTCMI Physician Orders No HHSC MDS Training Certification Pressure Ulcer relief devices missing documentation Physician Visits Hospice Active DX Respiratory

TREN D S

FY 2016 FY 2017 FY 2018

Thank You

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