What’s New in LTC Version 8.7ahtltc.goodbaitdev.com/~aht/general-release/WhatsNew_875.pdf · 60, and 90 day PPS assessments. • CMS Transition Policy: ARDs on or after October

Version 8.7.5

Copyright © 2011, American HealthTech, Inc., Jackson, MS Page 1 of 83

What’s New in LTC Version 8.7.5 September 15, 2011

Technical Note: These release notes describe version 8.7.5 of the LTC product from American HealthTech, Inc. This version supersedes LTC Version 8.7.4 CMU 2b. Read all release notes and instructions before beginning any installation or upgrade.

ALL RIGHTS RESERVED

This documentation contains confidential, proprietary information and is protected under the copyright laws of the United States. It is the responsibility of the recipient to protect the

confidentiality of its contents. Therefore, it may not be reproduced in any form or transferred to another party without the express written permission of American HealthTech, Inc.

Version 8.7.5 Copyright © 2011, American HealthTech, Inc., Jackson, MS

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CONTENTS Version 8.7.5 (September 15, 2011) ................................................................................................... 3

New Features & Enhancements Highlights Version 8.7.5 (September 15, 2011) ................................................................................................. 11

New Features and Enhancements Resident Accounting & Clinical Management Suites ................................................................... 11 Clinical Management Suite .......................................................................................................... 44 Resident Accounting Suite ........................................................................................................... 63

Maintenance Issues Clinical Management Suite .......................................................................................................... 64 Resident Accounting Suite ........................................................................................................... 64 Financial Accounting Suite ........................................................................................................... 65

Version 8.7.4 CMU 2b (August 31, 2011) ......................................................................................... 65 New Features and Enhancements

Clinical Management Suite .......................................................................................................... 65 Maintenance Issues

Resident Accounting Suite ........................................................................................................... 66 Version 8.7.4 CMU 2 (August 15, 2011) ........................................................................................... 66

New Features and Enhancements Clinical Management & Resident Accounting Suites .................................................................. 66 Clinical Management Suite ......................................................................................................... 70 Resident Accounting Suite ........................................................................................................... 70 Financial Accounting Suite ........................................................................................................... 74

Maintenance Issues Clinical Management Suite ......................................................................................................... 75 Resident Accounting Suite ........................................................................................................... 76 Financial Accounting Suite ........................................................................................................... 77

Version 8.7.4 CMU 1 (July 15, 2011) ................................................................................................ 78 New Features and Enhancements

Resident Accounting Suite ........................................................................................................... 78 Financial Accounting Suite ........................................................................................................... 80

Maintenance Issues Clinical Management Suite .......................................................................................................... 80 Resident Accounting Suite ........................................................................................................... 82 Financial Accounting Suite ........................................................................................................... 83 Enterprise Management Suite ..................................................................................................... 83


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Version 8.7.5 (September 15, 2011) New Features & Enhancements Highlights

CMS FY2012 Final Rule effective October 1, 2011 New features to address the CMS FY2012 Final Rule provide you with new tools that exceed the requirements and help your team effectively navigate and manage these new challenges including the Final Rule transition period. The CMS FY2012 Final Rule effective October 1, 2011 impacts Skilled Nursing Facilities key areas of operation through: → Shorter PPS Assessment Windows → Medicare RUG Payment Changes → Group Therapy Minutes Divided by 4 in RUG Calculations → End of Therapy – 3 Day Rule Revisions & New Resumption Option → New Change of Therapy Assessment Type and Schedule

Installation of this update by September 18th is recommended for maximum transition automation in LTC!

Pages 5 through10

• Summarize each of the major impacts listed above with • The corresponding CMS transition plan and • Highlights LTC software features to address each requirement.

Step by step instructions for using the corresponding LTC features and additional CMS MDS 3.0 requirements effective October 1st begin on page 11. Online Education Available! The following on-demand webinars explaining the Final Rule and how to use the features included in this release are available on our website at http://new.myhealthtech.net/webinar-archive.php.

→ Understanding the Final Rule → The CMS Final Rule in LTC – Part 1: What Changed? → The CMS Final Rule in LTC – Part 2: How it Works! (Note: The original live broadcast for

the LTC QuickLinks “The CMS Final Rule in LTC - Part 2: How it Works!” webinar is September 16th. It will be available on-demand at the link above after September 19th. To attend the live event, register at: https://www2.gotomeeting.com/register/745525618.)

http://new.myhealthtech.net/webinar-archive.php�

https://www2.gotomeeting.com/register/745525618�


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New! Outcomes Reporting Outcome measures are indicators for evaluating quality of care and provide organizations direction for enhancing quality procedures and, as a result, outcomes are vitally important in today’s skilled nursing care environment. The are so important in fact, that provider reimbursement may be based on them in the future. NEW Outcomes Reporting features prepare your data for this evolving reimbursement landscape providing you the ability to easily identify and monitor key outcomes data. Outcomes Reporting enables you to improve the provision and scope of services, promote early intervention, better manage complex health conditions, respond to community market profiles and partner more effectively with chosen affiliates. See page 45 for details! Coming Soon! This is just the beginning - later this Fall more features are coming your way to further expand Outcomes Reporting!

New 837i Claims Default option New Claims Default options provides ability to auto-populate the “00” in the cents field for non-dollar value codes on the printed UB04 and in Review Claims. Though this is not a Medicare requirement, some states and insurance payers do require the “00” entry. Automating the “00” through claim defaults will be particularly helpful for facilities using those payers. For example, this is a requirement with Louisiana Medicaid and with a Medicare replacement plan in Hawaii. See page 65 for details.

Data Collection History Reports Data Collection History Reports in Smart Charting have new display options. Visit the online version of the ‘What’s New’ notes on MyHealthTech for the latest details at: http://new.myhealthtech.net/whats-new.php.

Team TSI Customers Only Direct access to the MDS 3.0 portal – see page 64 for details.

Maintenance Items begin on page 66.

http://new.myhealthtech.net/whats-new.php�


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CMS FY2012 Final Rule Effective October 1, 2011 The CMS FY2012 Final Rule effective October 1, 2011 impacts key areas of operation in Skilled Nursing Facilities. The following summarizes the major impacts with the corresponding CMS transition plan and highlights the software features that accommodate the new Final Rule requirements. Page 11 begins the step-by-step instructions for using new features incorporated throughout the LTC software.

→ Shorter MDS PPS Schedule Windows PPS schedule windows are shorter under the FY2012 Final Rule for all Medicare assessments except the 5 day/readmit. The intent is to eliminate duplicate MDS information due to overlapping 7 day look-back periods. The changes result in shorter windows for the 14, 30, 60, and 90 day PPS assessments.

• CMS Transition Policy: ARDs on or after October 1, 2011 must follow the updated assessment schedule. "Note: When October 1, 2011 is Day 19, 34, 64, 94 of the stay, assessments should be completed by September 30 or the assessments will be considered late and payment penalties will apply." -- CMS Transition Policy

• Changes to the LTC software…

o The MDS Scheduler recalculates the MDS PPS Schedule for all Medicare PPS assessments automatically upon installing this release to reflect the new FY2012 mandated scheduling rules. The MDS Scheduler includes all new scheduling rules effective October 1st and accounts for the transition policy timeframe for assessments with coverage spanning from September to October. If an assessment should be completed on September 30th per the transition policy, it will be reflected in the updated schedule in the MDS Command Center and the MDS Schedule reports.

o Smart Charting questions based on the MDS schedule fire according to the new assessment schedule windows after the release is installed.

o Details begin on page 13.

• Your Next Steps to Meet this Requirement… Install this release as soon as possible and follow the revised MDS Schedule. Keep in mind the new schedule affects assessment windows that span both September and October. For example, if an assessment window previously included 3 days in September and 4 days in October, under the new shorter PPS windows, you may only have 2 days in October which will be reflected in the MDS schedule after installing this release.

http://r20.rs6.net/tn.jsp?llr=ed4nveeab&et=1107047642975&s=1&e=001R2FLng5vZngBAC-C_0lcIRwHqGAUh3pexvt8k5i7Wjxy-FtVY-RvLgg5MilhC3rpGhK8AS4CiOVlqGQXauXqOcZDotCtdfozwIfN7RzfloqR0mVzZnI2VWMa91MpbwjK8X9W_ngD5lo943fFCyqYleh4hmP1PMf-�


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→ New Case Mix Index Affects RUG Category The Medicare rural and urban Case Mix Index table values have been adjusted causing a change to the hierarchy of some RUG values.

• Changes to the LTC software…

o The Case Mix Weight tables for Medicare Rural and Urban are automatically updated to reflect the new CMI. The new Case Mix Weight tables will be used automatically by the RUG calculator in the Assessment Manager for assessments with an ARD on or after October 1, 2011.

o On transition assessments (assessments with coverage dates in both September and October), an additional RUG with an effective date of October 1st populates Resident Status Changes for October billing purposes. This only occurs for PPS transitions assessments closed after installing this release. See page 11 for details.

• Your Next Steps to Meet this Requirement… Install this release by September 18th or as soon as possible so that the RUG calculator can utilize the new CMI hierarchy when calculating RUG levels for billing effective dates on or after October 1st including RUG levels for transition assessments (i.e., PPS assessments that cover both September and October dates of service.) If transition assessments are closed prior to installing this release, manual entry of the RUG for October billing purposes may be required. See page 15 for details.

→ Group Therapy Minutes Divided by 4 in RUG Calculations Total group therapy minutes are divided by 4 when calculating the RUG level. The 25% cap to group therapy still applies. The new calculation is effective on assessments with an ARD on or after October 1st and on transition assessments with October coverage dates. CMS also stresses the importance of therapy documentation requirements.

Changes to the LTC software… The MDS RUG calculator divides the resident’s total group therapy minutes by 4 when calculating the RUG levels on PPS assessments with an ARD on or after October 1, 2011, transition assessments, and all other areas in LTC where the RUG is calculated or estimated.

Your Next Steps to Meet this Requirement… Install this release by September 18th or as soon as possible. The RUG calculations are handled ‘behind the scenes’ in the software. Continue entering the total raw therapy minutes as you have done in the past - the RUG calculator automatically divides the minutes entered. The therapy documentation features in Ancillary Tracking-Therapy may be used to help you meet the CMS therapy documentation requirements. See page 15 for details.


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→ New Change of Therapy Assessment Change of Therapy assessments are required when reimbursable therapy minutes change significantly enough to cause a change to another RUG level. This is based on a rolling 7 day observation window (aka look-back window). The COT establishes a new RUG that remains in effect until the next scheduled assessment or next COT whichever comes first.

• CMS Transition Policy: Effective for all assessments with an ARD on or after October 1, 2011.

• Changes to the LTC software… The new Change of Therapy (COT) assessment is available in the Assessment Manager for entry and completion. PLUS! Features to help you meet the new COT requirements are incorporated throughout the MDS Command Center, Clinical Reports, and Ancillary Tracking Therapy tools. For example, the therapy 7-Day Look Back includes the COT scheduled reviews for therapists’ reference; new tools enable review of therapy minutes to determine COT completion necessity in the MDS Command Center and the 7-Day Look Back; and a new report for tracking COT assessments is available. Details for these features and several additional COT related features begin on page 20.

• Your Next Steps to Meet this Requirement…

o Monitor the COT schedule and perform COT reviews to evaluate whether the COT must be completed.

o Complete the required COT assessments when residents meet the requirements. o Use the COT tools in LTC to help MDS Coordinators and Therapists communicate daily

regarding therapy completed and scheduled for residents. o Grant LTC Security rights to the new COT Summary Report to the appropriate User

Groups. o Instructions for creating COT assessments in the Assessment Manager and other COT

related features begin on page 20.


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→ End of Therapy – The 3 Day Rule The 3 day rule regarding therapy administered over the weekend and/or holidays applies regardless of holidays, weekends, whether your facility administers therapy on the weekend, therapist's schedule, and/or resident illness. If a resident does not receive therapy for 3 days, therapy has ended. If the resident resumes therapy after the 3 days, an EOT-R (End of Therapy - Resumption) may be completed if therapy resumes by day 5 at the previous therapy level. The basic rules surrounding therapy assessments still apply.

CMS Transition Policy: October 1st is a Saturday. If the resident does not receive therapy on October 1st, it is considered the first day of missed therapy. "Effective October 1, 2011, facilities will be considered 7-day facilities for the purposes of setting the ARD for an EOT OMRA. As October 1, 2011 is a Saturday, this day should be counted as a day of missed therapy if a patient does not receive any therapy services on that day."

Changes in the LTC software… No programming changes were necessary to meet this requirement.

Your Next Steps to Meet this Requirement… Complete EOT assessments when appropriate per the FY2012 Final Rule & RAI requirements.

→ New End of Therapy Resumption Option New optional therapy resumption on EOT/SEOT assessments is intended to reduce the burden on facilities to re-establish a RUG level when a resident resumes therapy. Section O, items O0450A (Resumption) and O0450B (Resumption Date) indicate a resumption of therapy and should be completed, when applicable, to re-establish the resident’s previous RUG level. Per the RAI, a new assessment should not be created to indicate a resumption. Instead, the resumption should be indicated on the EOT/SEOT that ended the therapy being resumed. If the EOT/SEOT has already been accepted, then a modification request is necessary.

CMS Transition Policy: Available for EOT/SEOT OMRA assessments with an ARD on or after October 1, 2011.

Changes to the LTC software… Therapy resumption questions are now available in Section O of the EOT/SEOT MDS and all MDS affected areas in LTC reflect the use of the resumption option. For example, Resident Status Case Mix and the MDS Assessment Summary report - details regarding the use of the resumption in LTC including the new Section O items and Billing impact begin on page 33.

Your Next Steps to Meet this Requirement… Complete resumption items as appropriate for qualifying residents. Instructions regarding EOT-R/SEOT-R in the Assessment Manager begin on page 33.


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→ FY2012 RUG Rates = Payment CMS chose to implement the full parity adjustment to correct FY2011 over payments affecting mostly therapy rugs in FY2012. CMS attributes the FY2011 over payments to forecasting errors regarding RUG utilization assumptions with the implementation of MDS 3.0. The payment adjustment reduces therapy rug rates and applies the market basket increase. The parity adjustment is an 11.3% decrease to urban facilities and 10.3% decrease for rural facilities. The FY2012 rates are on average 3.4% higher than the FY2010 rates. FY2012 rates are effective October 1, 2011. • Changes to the LTC software…

No programming changes were necessary to meet this requirement. The Medicare Part A RUG rates typically change every year and are effective October 1st. Updating Medicare RUG rates should be part of your routine LTC rate setup maintenance procedures.

• Your Next Steps to Meet this Requirement…

Enter your new Medicare Part A rug rates in Billing > Setup > Case Mix Rates.

Online LTC Tutorial Available! For an instructor led tutorial & detailed instruction guide on maintaining Billing setups which includes Case Mix Rate entry, visit us online at http://new.myhealthtech.net/webinar-archive.php for the on-demand webinar titled “QL: Keeping Your Billing Setups on Track” – located in the Resident Accounting Suite curriculum.

FY2012 Final Rule Online Resources

→ American HealthTech LTC QuickLinks On-Demand Webinars Instructor led tutorials on the new features and the CMS requirements visit us online at http://new.myhealthtech.net/webinar-archive.php for the following on-demand webinars: • Understanding the Final Rule • The CMS Final Rule in LTC – Part 1: What Changed? • The CMS Final Rule in LTC – Part 2: How it Works!

Note: The original live broadcast for the LTC QuickLinks “The CMS Final Rule in LTC - Part 2: How it Works!” webinar is September 16th. It will be available on-demand at the link above after September 19th.




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→ COT & EOT-R Calendar Examples: http://new.myhealthtech.net/support-resources.php → CMS Final Rule: http://www.ofr.gov/OFRUpload/OFRData/2011-19544_PI.pdf → CMS Transition Policy: https://www.cms.gov/SNFPPS/Downloads/fy12transpolicymemo.pdf → CMS Open Door Forum Schedule:

http://www.cms.gov/OpenDoorForums/25_ODF_SNFLTC.asp → CMS MDS 3.0 RAI Manual:

http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#TopOfPage

The CMS changes effective October 1st are incorporated throughout LTC and are described in detail in the following pages as per the checklist below.

□ Transition Assessments – Page 11 Billing Scheduling

□ PPS MDS Schedule – Page 13 □ RUG Calculations – Page 15

Group Therapy Case Mix Index

□ Therapy Minutes in Ancillary Tracking – Page 17 Admission Analysis – Page 19

□ Change of Therapy Scheduling Reviews – Page 20 Performing Reviews – Page 23 Assessment Entry – Page 29 Monitor & Tracking - Page 30

□ End of Therapy – Page 33 □ CMS MDS Edits – Page 36 □ Section S – Page 38 □ Billing Specifics Notated on

Pages 11, 16, 29, 33, 34, & 39-43 □ Appendix A:

Billing Examples for COT & EOT-R/SEOT-R – Page 39

Important! Upon installing this release, as users close entry and discharge assessments, they will be reminded to enter Outcomes Reporting ORA/ORD data but will not be required to do so. The new OR MDS section is NOT a new CMS section, does not transmit with the MDS, and is in no way related to the FY2012 CMS changes described in the previous pages. The OR section in the Assessment Manager simply provides an efficient method for collecting additional outcomes related admission and discharge information. To change the reminder to a requirement or to remove the reminder, see Clinical Facility Preferences setup instructions below on page 59.

http://new.myhealthtech.net/support-resources.php�

http://www.ofr.gov/OFRUpload/OFRData/2011-19544_PI.pdf�

https://www.cms.gov/SNFPPS/Downloads/fy12transpolicymemo.pdf�

http://www.cms.gov/OpenDoorForums/25_ODF_SNFLTC.asp�

http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#TopOfPage�


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Version 8.7.5 (September 15, 2011) New Features and Enhancements Resident Accounting & Clinical Management Suites

Transition Assessments – Billing September & October Dates of Service Transition assessments are PPS assessments with coverage dates in both September and October. Two Medicare RUGs must be calculated on transition assessments – 1) Effective for September following the RUG calculations in place prior to 10/1 and 2) Effective for October following the new RUG calculations effective October 1st. Following PPS scheduling, transition assessments will most likely be closed on or after September 18th. In LTC, when a transition MDS is closed, the transition RUG is notated as “Transition” in the RUG calculator as seen below:

All transition assessments will populate Resident Status Changes with two MCR RUG levels as seen in the following example:

Effective for October dates

of service

Effective for September

dates of service


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The system will bill September dates of service per the September effective date and October dates of service per the October effective date appropriately. No manual intervention is required to bill transition assessments appropriately if the release is installed before closing transition MDS assessments.

IMPORTANT! If a transition assessment is closed prior to installing this release and the RUG for October is different than the RUG for September, manual entry the MCR RUG effective October 1, 2011 is required in Resident Status Changes.

1. Determine if the October RUG value differs from the September RUG value. Consult the CMS validation report for the transition RUG effective October 1. Per CMS, the validation reports will include both the September and October RUG for transition assessments starting on or about September 18, 2011. If the RUG differs from the RUG in September, proceed to the next step.

2. Enter the October MCR RUG value in Resident Status Changes. In Resident Status Changes > Change History enter case mix information with an October 1, 2011 billing effective date. Facility protocol for making changes to resident’s historical information in Resident Status Changes should be followed.

To minimize or avoid this manual entry process altogether, install this update as soon as possible.

Transition – Assessment Schedule The OMRA MDS schedule for transition assessments affects PPS assessment due dates in the latter part of September - not just assessments due in October. Installing this release recalculates the MDS schedule so that PPS assessments are scheduled according to the new MDS windows and CMS transition policy. Follow the new PPS schedule to avoid late transmissions. Current assessment windows may be shorter in September during the transition! For example, PPS assessments meeting the following CMS transition criteria reflect September 30th as the last day for the assessment on the MDS Schedule. Per the CMS Transition Policy: “When October 1, 2011 is Day 19, 34, 64, 94 of the stay, assessments should be completed by September 30 or the assessments will be considered late and payment penalties will apply."


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PPS Assessment Windows PPS Assessment Windows changed to a shorter timeframe for all scheduled PPS assessments except the 5 day per the FY2012 Final Rule. The new scheduling rules are built into the LTC Assessment Scheduler. Upon installing this release, all PPS assessments will be rescheduled to follow the new, shorter schedule windows. All MDS schedule related areas of the system are updated to reflect the new PPS schedule including:

• Clinical MDS Command Center

Example of New PPS Schedule in the MDS Command Center

• MDS schedule related Clinical reports as follows: o MDS Schedule o MDS 3.0 Assessment Summary o Medicare Default RUGs Alert o Assessment Summary


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• Ancillary Tracking – Therapy features as follows: • 7 Day Look-back • 7 Day Look-back Worksheet • Therapy Appointment Monitor

• Smart Charting questions based on the MDS schedule fire according to the new assessment schedule windows.

For reference, the new PPS schedule windows & previous schedule windows are as follows: PPS Assessment

Prior to 10/01/2011 Window

Prior to 10/01/2011 Grace Days

Effective 10/01/2011 Window

Effective 10/1/2011 Grace Days

Payment Start

5 Day/ Re-Admit

1-5 (5 days)

6-8 (3 days)

1-5 (5 days)

6-8 (3 days)

1

14 Day 11-14 (4 days)

15-19 (5 days)

13-14 (2 days)

15-18 (4 days)

15

30 Day 21-29 (9 days)

30-34 (5 days)

27-29 (3 days)

30-33 (4 days)

31

60 Day 50-59 (10 days)

60-64 (5 days)

57-59 (3 days)

60-63 (4 days)

61

90 Day 80-89 (10 days)

90-94 (5 days)

87-89 (3 days)

90-93 (4 days)

91

For more information regarding CMS OMRA scheduling rules, refer to the MDS 3.0 RAI effective October 1st available online at: http://www.cms.gov/NursingHomeQualityInits/45_NHQIMDS30TrainingMaterials.asp#TopOfPage




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Medicare RUG Calculation

• Group Therapy Minutes The LTC RUG calculator incorporates the new group therapy regulation mandated by the FY2012 Final Rule stating that group therapy minutes must be divided by 4 for the purposes of the RUG calculation. The system automatically divides the group therapy minutes by 4 during the RUG calculation within the MDS when calculating a RUG value effective on or after October 1, 2011.

Important! When entering group therapy minutes, do NOT divide the minutes for entry. Enter the raw group therapy minutes provided. The system divides the group minutes by 4 during the RUG calculation. For example, if the resident received 60 minutes of group therapy, enter 60 minutes. The system will divide 60 by 4 & use 15 minutes in the calculation. Following this same example, if you divided the therapy and then entered 15 minute instead of 60, the system will divide 15 by 4 and use 3.75 minutes in the calculation which would not be an accurate reflection of the number of minutes provided to the resident. Admission Analysis Note: In the Candidate Pre-Admission Assessment (MDS 3.0 Assessment/Analysis), therapy minutes may now be entered separately for each mode of therapy (individual, concurrent, & group) for the purposes of the RUG estimation calculation. Instructions for therapy minute entry in Admission Analysis available on page 19.

• Case Mix Index CMS published a new Case Mix Index effective 10/1/2011. The hierarchy of the Case Mix Weights is a major determinant of the RUG level in the RUG calculation. The hierarchy order is slightly different with the new CMI effective 10/1/11 than it has been prior to 10/1/11. In some instances, this may cause a non-therapy RUG assignment when a rehab assignment may have been expected. For example, ES3 has a higher hierarchy priority than RHX causing ES3 to be the assigned RUG in certain scenarios. For detailed RUG calculation formulas, refer to the CMS RAI manual. The Case Mix Index is located in Clinical > Setup > Case Mix Weights in LTC and is used by the RUG calculator to maximize the RUG value. Installing this update automatically updates the Case Mix Weight tables in LTC – no manual setup steps are necessary. Do not change the Medicare Case Mix table assignment in


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Clinical > Setup > Facility Preferences as it will cause errors in the case mix calculations during the transition period. After the transition period, in a future update, we will automatically update Facility Preferences to reflect the new Case Mix Weight table effective on or after October 1, 2011.

New Tables Automatically Loaded in Case Mix Weights as seen above The two new case mix weight tables automatically loaded in Case Mix Weights are titled – “IV Version 1.1 Medicare 66 Urban” and “IV Version 1.1 Medicare 66 Rural.” The RUG calculator will use the new tables on PPS assessments with an ARD on or after October 1, 2011.

The new RUG calculations are incorporated throughout LTC and apply to RUGs effective on or after 10/1/11 which includes the following areas:

• Clinical > MDS Assessments and ARD Optimizer • Ancillary Tracking > Therapy Reports & 7-Day Look back • Admission Analysis > Candidate Assessment Analysis - Cost Calculator

Utilized by RUG Calculator for

RUGs Effective on or after

10/1/11

Utilized by RUG Calculator for RUGs Effective Prior to 10/1/11

Billing Note: Transition assessments and PPS assessments with an ARD on or after October 1st generate a RUG for October following the new RUG calculations effective October 1st which includes the group therapy division and new case mix weights discussed above.


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Ancillary Tracking – Therapy & RUG Minutes Therapists can review therapy minute totals based on the information available in Scheduled and Completed therapy quickly within several areas of Ancillary Tracking. With therapy being a major component of determining a resident’s RUG level and their COT review (detailed below), it is important for the Therapists to monitor and communicate therapy information frequently with the MDS Team.

Though the following therapy areas are not new with this release, the RUG calculations included in them are revised to incorporate the new group therapy and CMI requirements detailed above. These same areas also display MDS RUG minutes as “RTM” (Reimbursable Therapy Minutes) rather than “RUG-IV” minutes as displayed previously.

• 7-Day Lookback • 7-Day Lookback Worksheet • Therapy Appointment Monitor – Completed Therapy • 7 Day Therapy Recap • Therapist Productivity Report

Example of 7-Day Look back

RTM


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Example of Completed Therapy

Example of 7 Day Therapy Recap

RTM

RTM


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Admission Analysis – Therapy Entry in Candidate Assessment/Analysis Entering therapy in the MDS 3.0 Assessment/Analysis per mode (individual, concurrent, and group) is simple with new on-screen steps – pictured below.

Example of Therapy Estimator in Candidate MDS 3.0 Assessment/Analysis

1. In Admission Analysis > Main > MDS 3.0 Assessment/Analysis, select the Candidate. 2. On the Therapy Estimator screen, as per “Step1,” click the colored square beside the type

of therapy to enter. 3. Click on the days of the month to enter therapy minutes as per “Step 2.” 4. Per “Step 3,” enter the minutes by mode for the days selected on the calendar and click

apply. 5. Repeat the above steps until all estimated therapy is entered. 6. Click Save to save your changes. Click Exit if ready to return to the Admission Analysis

Main menu.

Step 1: Select Therapy Type

Step 2: Click on the days of the week

Step 3: Enter minutes per mode • Enter raw minutes estimated • Do not divide them for group

nor concurrent therapy


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Change of Therapy (COT) Assessments The new COT assessment type is included in LTC like all other PPS assessment types; however, unlike other assessments, the COT assessment has a unique 7 day rolling look back window and specific rules surrounding whether the COT should be completed. The 7 day rolling look back dictates that residents qualifying for a rehab RUG on their last Medicare PPS assessment must be reviewed for a change of therapy every 7 days from the ARD of the scheduled assessment. Note: The change of therapy review must be performed if the resident qualified for a rehab RUG on the last PPS assessment and not whether the actual RUG score on the last PPS assessment (Z0100) was a rehab RUG. The change of therapy review is when you determine if the resident has had enough of an increase or decrease to therapy provided in the 7 day look back to meet the COT assessment necessity requirements. During the change of therapy review, if the resident meets the specific criteria for the completion of a COT assessment, the COT assessment MUST be completed and transmitted. If the resident does not meet the COT criteria during the review, then the COT assessment is NOT required. The new COT Review tool automates the review process and reduces the manual burden substantially!

Change of Therapy (COT) MDS Review Schedule

The MDS Scheduler automatically schedules COT reviews for residents who qualified for a rehab RUG on their last scheduled PPS assessment with an ARD on or after October 1, 2011. Upon closing the PPS assessment, COT reviews are automatically scheduled through the end of the 100 day stay. Conversely, if a resident does not qualify for a rehab RUG on a PPS assessment, COT reviews are not scheduled & future COT reviews previously scheduled are removed from the schedule. Each time a PPS assessment is closed, the system evaluates whether the resident qualified for a rehab RUG and schedules the COT reviews accordingly.

→ Example #1 - If a resident qualifies for an RHC on their 14 day assessment, the system automatically schedules COT reviews every 7 days starting with 7 days from the 14 day ARD all the way through the end of the 100 day stay. When the resident’s 30 day assessment is completed, if the resident does not qualify for a rehab RUG, then all of the COT reviews are automatically removed from the schedule when the assessment is closed.


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→ Example #2 - If a resident qualifies for an RHC on their 14 day assessment, the system automatically schedules COT reviews every 7 days starting with 7 days from the 14 day ARD all the way through the end of the 100 day stay. When the resident’s 30 day assessment is completed, if the resident again qualifies for a rehab RUG, then all of the COT reviews are automatically scheduled again every 7 days starting with the 30 day ARD all the way through the end of the 100 day stay.

→ Example #3 – If during a resident’s COT review, it is determined that the resident’s therapy minutes have decreased substantially in the last 7 days and a COT assessment is necessary. The COT assessment is completed and closed and the resident did not qualify for a rehab RUG in the COT assessment. When the COT is closed, all subsequent COT reviews are no longer necessary at that point and are automatically removed from the schedule.

COT Review Scheduling Tips! • It is very important to close PPS assessments on a timely basis to keep the COT

review schedule current. COT reviews are scheduled/rescheduled every time a PPS assessment is closed and is subject to change frequently.

• If a Medicare resident’s PPS assessment does not qualify for a rehab RUG, there is no need to perform a COT review and no COT reviews are scheduled for the resident.

• COT reviews are also scheduled automatically in LTC when 5-day assessments are opened due to short MDS schedule windows – scheduling COT reviews upon opening an assessment only occurs with the 5-day assessment. COT reviews for all other PPS assessments are scheduled/rescheduled only when the assessment is closed. When the 5-day is closed, if the resident did not qualify for a rehab RUG, the COT reviews are removed from the schedule.


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The COT review schedule is available in several key areas of for quick reference including the MDS Command Center in Clinical and the 7 Day Look-back in Ancillary Tracking giving both Clinicians and Therapists access. The new, time saving COT review tool is also available and is detailed below in the “Performing Change of Therapy (COT) Reviews” section.

• MDS Command Center in Clinical is the primary source of the COT review schedule. The following is an example of a resident’s OMRA schedule in the MDS Command Center who qualified for a rehab RUG on their last PPS assessment.

• The MDS Schedule in Clinical, Reports, includes the COT schedule. Under ‘Assessment

Due’, the ‘Earliest’ and ‘Last Grace’ dates will always be blank for COT assessments since there is not a scheduling window for COT assessments. If a COT assessment is necessary after performing a COT review and is added in the Assessment Manager, the scheduled review date is the same as due date and the ARD.

• Ancillary Tracking –Therapy > 7-Day Look back includes the COT reviews with the assessment schedule and are color coded green for quick reference.


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Performing Change of Therapy (COT) Reviews

The COT review determines whether the resident’s therapy has increased/decreased enough to warrant completion and transmission a COT MDS assessment. The factors to evaluate are:

• Total Reimbursable Therapy Minutes (RTM) • Number of Therapy Days • Number of Therapy Disciplines • Restorative Nursing for residents in a Rehab Low category – This factor should only be

considered if the Grand Total Adjusted Minutes are >= 45.

The new COT Review tool available in the MDS Command Center evaluates for you whether the COT is necessary based on therapy provided during the 7 day look back window and the factors cited above. For convenience, the COT Review Tool is also accessible in the Ancillary Tracking – Therapy 7-Day Look back. This provides multiple points of entry for interdisciplinary workflow flexibility.


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Using the NEW COT Review Tool!

The COT Review tool indicates whether a COT assessment is required based on residents therapy information. It automatically calculates estimated RUG category and recommends whether or not to proceed with completing the COT assessment per comparison of the estimated RUG to the previous RUG.

1. In the MDS Command Center, right click on the COT Review directly from the calendar or grid view. It is also accessible under ‘Tools’ in the MDS Command Center. Or, in Ancillary Tracking-Therapy in the 7 Day Look-back select ‘Tools’ to access the COT Review.

MDS Command Center – COT Therapy Review

Right click on COT Review

COT Review Also available under ‘Tools’


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2. Select “Open COT Review” and the Reportable Therapy Minutes screen opens (pictured below).

Example of Change of Therapy Review Tool

3. The COT Reportable Therapy Minutes screen pre-populates with therapy minute information available in Ancillary Tracking-Therapy and provides a manual entry screen for entering minutes not documented in Ancillary Tracking-Therapy.

• If all of your resident’s therapy minutes are populated based on Ancillary Tracking-Therapy, the totals are displayed on the screen for reference and no further manual entry of minutes is required. Note: It is necessary for therapy minutes to be recorded in Ancillary Tracking-Therapy frequently for the resident’s most recent therapy minutes to be available for population. Skip to Step 8 since manual therapy entry is not required when Ancillary Tracking-Therapy reflects all therapy provided for residents.

• If therapy minutes are not recorded in Ancillary Tracking-Therapy or if the pre-populated minutes should be adjusted, then manual minute entry is necessary for the COT review process. Proceed with the next step to manually enter therapy minutes.


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4. To enter the therapy minutes, click on the ‘Enter Daily Minutes’ button under the

appropriate discipline. The following is an example of the Daily Reportable Therapy Minutes minute entry screen for ST.

5. Enter each day’s minutes per mode. If you click ‘Refresh’, the system re-populates the minute information per the minutes entered in Ancillary Tracking-Therapy. If you are not licensed for Ancillary Tracking-Therapy, the ‘Refresh’ button is not available. Caution! If you are licensed for Ancillary Tracking-Therapy; however, you do not use it for recording therapy minute information, the minutes available are zero. In this case, if you click ‘Refresh’ to populate the minutes available, they will populate with zero removing any manual entry you may have made. If this occurs, you will need to re-enter the therapy minute information.

6. Click ‘Ok’ to return to the COT Reportable Therapy Minutes screen. 7. Repeat steps 4-6 until all therapy minutes have been entered and click ‘Save’ at the top of

the COT Review screen to save the therapy minute information entered. Tip! You may enter the minutes as frequently as you wish allowing your organization flexibility in developing COT review procedures.

Enter Minutes per

day, per mode

Only click “Refresh” if all minutes should be replaced with the minutes currently in Ancillary Tracking-Therapy


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8. The system totals the minutes entered & displays the Grand Total Adjusted Minutes in the COT Review screen. If the Grand Total Adjusted Minutes are >= 45, check the applicable items under Restorative Nursing Services.

9. Click ‘Save’ to save the information. Upon ‘Save’, the RUG calculator uses the therapy minutes, disciplines, and days provided; and restorative information (if applicable) to calculate an estimated RUG category which is displayed in the lower left corner of the screen. The estimated RUG categories are: RU – Ultra High; RV – Very High; RH – High; RM – Medium; and RL – Low.

Minutes total Automatically Enter

Restorative only if

Grand Total Adjusted

Minutes are =>45 or <150

Calculates estimated RUG

category Automatically

Proceed with COT or COT Not

Required Notation

Click to Open New COT Assessment & Access Assessment Manager


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10. The system compares the previous PPS assessment RUG level to the estimated RUG category and notates whether it is appropriate to proceed with the COT assessment above the “Open New COT Assessment” button, per the following criteria:

• If the previous and estimated RUG categories ARE NOT the same, then a COT assessment is required. The notation displays in red as: “RUG Category has changed. COT assessment may be required.”

• If the previous and estimated RUG categories ARE the same, then a COT assessment is not required. The notation displays: “RUG Category has not changed. COT assessment not required.”

• If the Previous RUG Category is “Incomplete”, the notation displays in red as: “The last PPS assessment hasn’t been completed. Unable to compare RUG.”

• If the Previous RUG Category is “Non-Therapy” or “Not Available”, the notation displays: “Non-Therapy RUG. COT Assessment not required.”

• If the Previous RUG Category is NOT “Non-Therapy”, but the Estimated RUG Category IS “Non-Therapy”, the notation displays: “Non-Therapy Category. EOT may be required.”

11. If it is appropriate to proceed with entering a COT MDS, click the “Open New COT Assessment” button to add a COT MDS Assessment. Directions for adding the COT MDS are below. If it is not appropriate to proceed with entering a COT MDS at this time, click ‘Save’ at the top and ‘Exit’. Note: The “Open New COT Assessment” button is only enable for users with LTC security access to add an MDS.

Tips! → New Change of Therapy Summary report detailed below under “Additional Change of

Therapy Assessment Tools” provides a quick reference to COT reviews performed in the facility for a specified time frame and includes the user id and date/time for the last user to save the COT review.

→ For more information regarding the circumstances for performing COT assessments, refer to the MDS 3.0 RAI manual.

→ Customers whose Therapists utilize Ancillary Tracking-Therapy to administer and schedule therapy save the most time completing COT reviews since all therapy minutes are automatically pre-populated. And those who utilize the automated Casamba interface at frequent intervals throughout the day share in this same time saving benefit. If you are not currently licensed for Ancillary Tracking-Therapy and would like more information about the features and benefits available, contact our Sales Team at 1-888-810-9586, ext. 1051.


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Coming Soon! In a release later this Fall, a new option to prevent minute entry on the days populated by therapy administered in Ancillary Tracking will be available. For those who choose to use the new option, if the previously administered therapy minutes are incorrect, they would be corrected at their source - Ancillary Tracking. The updated minutes could then be reflected in the COT review. Adding Change of Therapy (COT) MDS Assessments Once a COT review is performed and it is determined that a COT assessment is necessary:

1. Add the COT assessment & complete the answers to A0310. Indicate the assessment is a COT by answering A0310C = “Change of Therapy” as seen below:

2. Continue with answering, completing, and transmitting the assessment as usual for any other PPS assessment. The ‘Next COT Review’ date displays in the Assessment Profile pane on the right side of the Assessment Manager for your reference. Since the ARD Optimizer is not applicable to COT assessments, the “Re-Optimize” feature is not available under Tools when a COT assessment is displayed in the Assessment Manager. For more information regarding how to add, enter and transmit assessments, refer to LTC Help.

Billing Note: The COT MDS establishes a new RUG and HIPPS modifier that remains in effect until the next scheduled MDS or next COT whichever comes first. When the COT assessment is closed, the RUG replaces the previous PPS assessment RUG effective the first day of the 7 day look back. See Appendix A on page 39 for examples in Resident Status Changes and information about new COT HIPPS modifiers.

Select Change of Therapy for A0310C


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Additional Change of Therapy Assessment Tools COT assessments are incorporated throughout several areas including a new Clinical COT Summary report. New monitoring tools in Ancillary Tracking-Therapy keep the Therapists informed of COT information as well improving interdepartmental communication. Keep these reporting tools in mind as COT processes and procedures are developed in your organization.

• New! Change of Therapy Summary Report Quickly reference COT reviews and who performed them with the new Change of Therapy Summary report. It includes:

o An overview of COT reviews per resident within a specified timeframe giving you an additional tool to monitor COT reviews performed.

o Scheduled PPS assessments with the corresponding COT Reviews including the ARD, reimbursable therapy minutes (RTM), and COT review estimated RUG.

o Monitor COT assessment completion requirements, if the COT was completed, and who performed the review.

The following is an example:

Coming Soon! This report will include skipped COT Reviews as well in the October 2011 LTC software update.

Important Security Note: Access to the new COT Summary report is based on security access rights. When the release is installed, no one will have security rights to access the new report. Follow your internal LTC security procedures for granting rights to the appropriate User Groups.

COT Assessment Required

and Completed

Last user to Save

COT Review

Last Assessment Prior to Current COT

RTM


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Printing the New COT Summary Report

1. Select Clinical > Reports > Change of Therapy Summary. Or, in Ancillary Tracking select Ancillary Tracking > Therapy Reports > Change of Therapy Summary.

2. Select to view a specific resident, all, active, or discharged residents under ‘Status’. 3. Specify the date range to include on the report. 4. Click ‘Print’ to print the report or ‘Preview’ to view the report on screen.


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• RUGs Analysis Worksheet Includes a C as a RUG superscript indicating the RUG was generated on a COT assessment.

A legend for the new superscript is displayed at the bottom of the RUGs Analysis Worksheet as pictured the footer example below:


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End of Therapy-Resumption (EOT-R & SEOT-R) The addition of Section O assessment items, O0450A (EOT Resumption) and O0450B (EOT Resumption date) indicate whether or not an EOT/SEOT assessment includes a resumption of therapy. These new Section O items are available for entry on EOT and SEOT assessments with an ARD on or after October 1, 2011. EOT/SEOT assessments end the therapy RUG in effect from the last PPS assessment. Indicating resumption in O0450A and O0450B resumes the therapy RUG from the last PPS assessment.

Adding End of Therapy-Resumption (EOT-R) 1. In the Assessment Manager, add an EOT or SEOT assessment. 2. Answer items O0450A and O0450B. The following is an example of the new questions in

the MDS Assessment Manager for an EOT or SEOT assessment:

Assessment Manager – Section O, item O0450

3. When O0450A is answered as ‘yes’, the assessment becomes an EOT-R instead of an EOT or SEOT. Once Section Complete is selected, “EOT-R” is reflected as the assessment type rather than “EOT” or “SEOT” in both the prior assessment and the assessment profile panes within the Assessment Manager. The “Resumption Effective Date” (item O0450B) also displays in the assessment profile pane.

4. Proceed with the rest of the assessment following routine MDS completion and submission procedures. It is important to close PPS assessments in a timely fashion. Therapy resumption resumes the RUG for Billing purposes based on closed assessments.

Billing Note: The EOT MDS ends the therapy RUG established by the previous PPS assessment. The EOT-R re-establishes or “resumes” the prior therapy RUG from the prior closed PPS assessment. New HIPPS modifiers are utilized with the EOT-R & SEOT-R as well. When an EOT-R/SEOT-R is closed, multiple RUG lines populate Resident Status Changes each with the appropriate MCR RUG level for the corresponding billing effective dates. See Appendix A on page 39 for examples in Resident Status Changes and information about new EOT-R/SEOT-R HIPPS modifiers.


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Modification Request for EOT/SEOT Assessments for Resumption To indicate a resumption of therapy for an EOT/SEOT, items O0450A and O0450B must be completed on the EOT/SEOT that ended the therapy being resumed. Per the RAI, If the EOT/SEOT has already been accepted, then a modification request is necessary. When performing the Correction Request, select item X0900E “End of Therapy - Resumption (EOT-R) date” and proceed with the modification request. The example below includes the new option to select X0900E as a reason for modification.

Tip! Make sure to answer Section O, items O0450A and O0450B and complete Section O as part of the correction request process. For more information on performing Correction Requests in the Assessment Manager, refer to LTC Help.

MDS 3.0 Assessment Summary The MDS 3.0 Assessment Summary Report includes the new EOT/SEOT with resumption and identifies them as EOT-R/SEOT-R assessments.

Billing Note: EOT/SEOT assessments that include therapy resumptions reflect multiple billing lines just as those same assessments do in Resident Status Changes. The Payment Effective Date section displays the date therapy ended with the non-therapy RUG (Z0150) for the EOT-R assessment. And displays the Payment Effective Date for the resumption with the therapy RUG (Z0100) from the last PPS assessment. Therapy resumption should always resume the RUG from the last PPS assessment for billing and not the therapy RUG calculated on the EOT-R assessment.


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RUGs Analysis Worksheet – Resumption RUG Notation The RUGs Analysis Worksheet displays the therapy resumption date and notates therapy resumption RUG levels in the grid.

• The resumption date is a new column at the top of the report. The new column is pictured in the example below:

• The resumption RUG levels are notated with an “R” superscript as seen in the following example:

• A legend for the new superscript is displayed at the bottom of the RUGs Analysis Worksheet as pictured the footer example below:


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CMS MDS Edits

CMS MDS Edit revisions per the CMS data specification Version 1.02.0 effective October 1st are incorporated throughout the MDS assessments in the Assessment Manager:

• The following edits are effective on or about September 18, 2011, when CMS updates the edits in the ASAP system and allow for completion of therapy start and end dates when the sum of the therapy minutes is equal to zero: #-3557, -3558, and -3559.

• Section O Therapy Minute and Date Entry Edit – In the event a date is needed in MDS Section O, items O0400A5, O0400A6, O0400B5, O0400B6, O0400C5, and O0400C6, are available for entry when the minutes and days items in Section O are blank. Prior to this release, those fields were unavailable for entry when the minutes and days were blank. Important! If there is no need to enter date(s) in the referenced items, leaving them blank is valid. Since it is valid to leave them blank, you will be allowed to Section Complete. When the electronic transmission file is created, if those date items are blank, they will be treated properly as skipped. Do not enter dashes for those date items unless that is your intended answer. Therapy end dates are utilized by billing – if dashes are entered in those date items and should not be it can cause erroneous billing. For more information on the appropriate use of dashes and coding items in MDS assessments, refer to the CMS MDS RAI manual.

• Edit #-3676 & -3815 applies to O0450A and X0900E. • Edit #-3677 applies to O0450B. • Edit #-3812, -3814, applies to O0450A and O0450B • Edit #-3813 – Skip pattern applies to O0450A and O0450B • Edit #-3746, -3779, & -3795 – Skip pattern applies to X0900E.

For a complete list of CMS MDS edits, refer to the data specifications available on the CMS website at: http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp#TopOfPage

http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp#TopOfPage�

http://www.cms.gov/NursingHomeQualityInits/30_NHQIMDS30TechnicalInformation.asp#TopOfPage�


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Printed MDS Assessment Versioning & Copyright Printed MDS Assessments display the current item listing version at the bottom of each page and the MDS copyright notice on the last page as pictured below:


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MDS Electronic Transmission File Version MDS Electronic Transmission File creation in the MDS Command Center automatically utilizes the correct version of the CMS data specifications based on the ARD of the assessments included file. CMS data specification versions utilized in the transmission files are as follows:

• Assessments with an ARD prior to 4/1/2011 utilize CMS data specification version 1.00. • Assessments with an ARD on or after 4/1/2011 and prior to 10/1/2011 utilize CMS data

specification version 1.01 • Assessments with an ARD on or after 10/1/2011 utilize CMS data specification version

1.02.

Section S – State Specific Item Changes

• California – The following Section S items are included on NC, NQ, NT, and ND assessments with an ARD on or after October 1, 2011 per the CMS data specifications effective October 1st: S9040A, S9040B, S9040C, S9040D, S9040E, S9040F, S9040G, and S9040H.

• Connecticut - The following Section S items are included on both NC and NQ assessments with an ARD on or after October 1, 2011 per the CMS data specifications effective October 1st: S0102, S0501, S8010F, S8010G, S8020C3, and S9120. The items listed are no longer included on NT assessments.

• Nebraska – Section S, item S0183 is no longer included on NP, NT, ND, NSD, and NOD assessments per the CMS data specifications effective October 1st.

• Ohio - Section S, item S8520C is included on ND, NSD, and NOD assessments with an ARD on or after October 1, 2011 per the CMS data specifications effective October 1st.

• West Virginia – The following Section S items were removed from NC and NQ assessments with an ARD on or after October 1, 2011 per the CMS data specifications effective October 1st: S1100F1, S1100F2, S1100G, S1100H, S1100I, S1100Z, S2016, S5010D1, S5010D2, S5010E1, S5010E2, S5010F1, S5010F2, S5010G1, S5010G2, S5010H1, S5010H2, S5010I1, S5010I2, S6050, S6051A, S6051B, S6051C, S6051D, S8510A, S8510B, S8512A, and S8512B. The following were removed from NC assessments: S6100A, S6100B, S6100C, S6100D, S6100E, S6100F1, S6100F2, and S6100F3.


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Appendix A – Billing Examples for COT & EOT-R/SEOT-R

RUG & HIPPS modifiers in Resident Status Changes

The FY2012 Final Rule introduced four new HIPPS codes effective October 1, 2011. The new codes were created to accommodate Change of Therapy assessments and End of Therapy Resumptions or combinations including the COT and EOT-R/SEOT-R. The new HIPPS codes are alpha additions to the numerical HIPPS modifiers. EOT-R/SEOT-R assessments utilize A, B, and C in the HIPPS. COT assessments utilize D in the HIPPS.

In turn, Billing effective dates for Medicare RUG levels are impacted. For example, one assessment can generate multiple billing effective dates. Billing impacts are noted above on pages 11, 16, 29, 33, & 34. The following examples provide billing scenarios reflecting the use of the new HIPPS modifiers and corresponding billing effective dates.

As you review the examples, keep in mind each line in status changes generates a different charge in Room Charges & Census for the month representing the new billing effective dates and are reflected in Billing reports populated by Room Charges & Census. For example, the Daily Census Reconciliation may be longer due to the inclusion of the additional charge information.


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Example #1

Sandra admitted to facility as Medicare A on 10/1/11 and immediately began therapy on 10/01/11. She wasn’t feeling well enough to go to therapy for a few days. When she was feeling better, she was able to resume her therapy. The details are as follows:

• Medicare 5-Day Admission MDS ARD = 10/05/11 • End of Therapy Assessment ARD = 10/10/11

→ Therapy ended on 10/7/11 → Therapy resumed on 10/10/11 (resumption date entered in Section O, item O0450B)

When the assessments noted above are closed (5-day admit & EOT-R), they populate Resident Status Changes with the following Billing effective dates, Medicare RUGs, and HIPPS modifiers:

5-Day Admit Assessment billing effective date is 10/1/2011

EOT-R populates 2 RUG lines. Non-Therapy RUG effective 10/8/11. Therapy RUG from 5-Day resumed on 10/10/11.


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Example #2

Roger was admitted to facility as Medicare A on 10/1/11 and was too sick to begin therapy on admission. Soon, he was feeling better and began his therapy. He was able to tolerate it for a short time, needed a break, and then resumed therapy. The details are as follows:

• Medicare 5-Day Admission MDS ARD = 10/05/11 • Start and End of Therapy Assessment ARD = 10/13/11

→ Therapy started 10/07/11 → Therapy ended 10/10/11 → Therapy resumed on 10/12/11 (resumption date entered in Section O, item O0450B)

When the assessments noted above are closed (5-day admit & SEOT-R), they populate Resident Status Changes with the following Billing effective dates, Medicare RUGs, and HIPPS modifiers:


SEOT-R populates 3 RUG lines:

• SOT Therapy RUG effective 10/7/11

• EOT Non-Therapy RUG effective 10/11/11

• Therapy RUG from Start of Therapy resumed on 10/12/11.


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Example #3

George was admitted to facility as Medicare A on 10/1/11 and was too sick to begin therapy on admission. He started therapy 10/07, but it ended on 10/10. He resumed therapy on 10/12 and had a significant change of status combined with a start/end therapy. The details are as follows:

• Medicare 5-Day Admission MDS ARD = 10/05/11 • Start and End of Therapy Assessment combined with Significant Change ARD = 10/13/11

→ Therapy started 10/07/11 → Therapy ended 10/10/11 → Therapy resumed on 10/12/11 (resumption date entered in Section O, item O0450B)

When the assessments noted above are closed, they populate Resident Status Changes with the following Billing effective dates, Medicare RUGs, and HIPPS modifiers:


Populates 3 RUG lines:

• SOT Therapy RUG effective 10/7/11

• EOT Non-Therapy RUG effective 10/11/11

• Therapy RUG based on this assessment rather than resumption of 5-day on 10/12/11.


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Example #4

Suzanne was admitted to facility as Medicare A on 10/1/11. Her first COT Review indicated that a change of therapy assessment should be done. Her condition changed so much that it was also necessary to do a significant change assessment which was combined with the COT. The details are as follows:

• Medicare 5-Day Admission MDS ARD = 10/05/11 • First COT Review Scheduled for 10/12/2011 (7 Days after 5-day ARD) and review indicated

COT assessment should be completed • COT assessment combined with Significant Change assessment ARD = 10/12/11

When the assessments noted above are closed, they populate Resident Status Changes with the following Billing effective dates, Medicare RUGs, and HIPPS modifiers:


COT combined with Significant Change billing effective date is 10/6/2011


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Clinical Management Suite

Outcomes Reporting

“Outcomes Reporting enables you to improve the provision and scope of services, promote early intervention, better manage complex health conditions, respond to community market profiles and partner more effectively with chosen affiliates.” Outcome measures are indicators for evaluating quality of care and provide organizations direction for enhancing quality procedures and, as a result, outcomes are vitally important in today’s skilled nursing care environment. They are so important in fact, that provider reimbursement may be based on them in the future. Outcomes Reporting prepares your data for this evolving reimbursement landscape providing you the ability to easily identify and monitor key outcomes data.

The new Outcomes Reports available in the Quality Assurance module are fully customizable reports analyzing outcome measures specific to your facility’s residents presented in both a high level facility summary view and resident level details. You decide the outcome measures to include and how you want to see it! Outcomes Reports include the options to display outcome measure data in pie charts and/or trend graphs.

As you define your Outcomes Reports, pre-defined lists of Resident Status and Discharge Reporting measures are available now to include in the reports. Options to limit data to specific physicians, A/R Types, hospitals available on demand when printing. You can even plot results over time for residents discharged within a selected reporting period. The reporting possibilities are endless!

For more information on Outcomes and the Changing Industry Landscape and for a detailed, instructor led tutorial on using the new features, visit us online at http://new.myhealthtech.net/webinar-archive.php for a 2-part on-demand webinar series:

• “How Come Outcomes? Part I: The need for Outcomes Reporting in Skilled Nursing Facilities”

• “How Come Outcomes? Part II: Using New Outcome Reporting in LTC” (Note: The original live broadcast for the LTC QuickLinks “How Come Outcomes? – Part II: Using New Outcomes Reporting in LTC” webinar is September 20th. It will be available on-demand at the link above after September 23rd. To attend the live event, register at: https://www2.gotomeeting.com/register/771498522.)


https://www2.gotomeeting.com/register/771498522�


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Outcomes Reports Sample Outcomes Reports are fully customizable for your facility's reporting needs. The following is just one example of an Outcomes Report:

Example of Pie Graph Included in Sample Discharge Tracking Report for Decline in ADL’s


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Outcomes Reports Sample (Continued)

Example Continued - Trend Graph and Resident Detail Pictured


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Outcomes Reporting Data Outcome measures reflected in the new Outcomes Reports are based on resident data recorded in various areas of the system including the MDS, Incident Entry (measures related to falls) and Resident Information with the majority of the information based on the MDS. Several additional key pieces of information are needed to fully populate outcome measures for the new Outcomes Reports. To capture this vital admit and discharge information, a new Outcomes Reporting-OR section is now included in Entry and Discharge MDS assessments. New Outcomes Reporting MDS section entry instructions are below under “Capturing Outcomes Data in the Assessment Manager.”

Best Practice! Always complete the new ORA and ORD in all entry and discharge assessments. This ensures accurate data is available for your Outcomes Reports. Even if you don’t plan to use the vital new Outcomes Reporting features in the near future, begin collecting the data now! Remember, outcomes data is based on historical information – so begin capturing the history! If the ORA and ORD data is not entered for all entry and discharge assessments, the report data may be skewed. To make the ORA and ORD required on all entry and discharge assessments, see Clinical Facility Preferences setup instructions on page 59.

The new OR MDS section is not a new CMS section, does not transmit with the MDS, and is in no way related to the FY2012 CMS changes described in the previous pages. The OR section in the Assessment Manager simply provides an efficient method for collecting additional outcomes related admission and discharge information. Just a few entries in the OR section of each admit and discharge MDS provides a wealth of outcomes data!

Getting Started – “Get Ready, Get Set, Go!” □ Setups

• One time Facility Preferences setup for ORA/ORD entry options – Page 59 • Required! Grant Security access rights for the appropriate user groups to Quality

Assurance > Outcomes Reporting Setup and Print – Page 59 □ Create customized Outcomes Reports for printing – Page 48 □ Begin answering the new OR MDS section in the Clinical Assessment Manager to build

outcomes data – Page 55

Outcomes ready to print!


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Printing Customized Outcomes Reports New Outcomes Reports have a variety of print selection options available at the time of printing to further customize the report on-demand. In order to print/preview Outcomes Reports, they must first be created in Outcomes Reporting Setup (instructions below) to establish the report title and the specific outcome measures to include in the report. Once an Outcomes Report format is created, it’s ready to print! The resident data included in the report is based on the residents who were active for the reporting period and meet the report selection criteria and does not include outpatient residents.

1. In Quality Assurance > Outcomes Reporting > Outcomes Reporting Print, select the report you wish to print from the ‘Report Name’ drop box.

Outcomes Reporting Print Selection Screen


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2. Enter the appropriate selection criteria. Tip! The default selection criteria entered in the setup for the report are automatically displayed and may be changed if you choose. • The Date Range limits the data in the report to the date range specified. The date

displayed is based on the reporting period defined in the report setup. If you would like to change the date range, enter the preferred date range. Tip! You may enter up to one year prior to the current date. However, no MDS 3.0 data is available prior to the MDS 3.0 implementation date of October 1, 2010.

• A/R Type – To change the A/R Type(s) included in the report, click on the binoculars

button and select the preferred A/R Type(s). Data for residents with the selected A/R Type(s) during the reporting period will be included in the report.

• Report Content - Indicate whether they Include Detail Grid and/or Trends over time graph should be included.

• Select a Sort Order to indicate whether you want to sort your results alphabetically by Resident name, Admit Date or Discharge Date.

• Location (From and Thru) – Indicate the area of the facility to include or leave blank to include the entire facility.

• Physician – To limit the report data to residents assigned a specific primary physician(s), click the binoculars button and select the physicians(s) if not already displayed.

• Admit Hospital – To limit the report data to residents admitted from a specific hospital(s), click the binoculars button and select the hospital(s) if not already displayed.

• Discharge Hospital - To limit the report data to residents discharged to a specific hospital(s), click the binoculars button and select the hospital(s) if not already displayed.

3. Check the "Printer Friendly" checkbox to produce a version of the report suitable for printing on a black and white printer.

4. Click ‘Print’ or ‘Preview’ at the top of the screen to print/preview the report. Tip! Due to the large amount of data included in the report, it may take a moment for the report to display/print. While the report is generating, a processing message displays on screen. Other work can be done in LTC while the report is generating; the length of time the report takes to generate depends on the amount of information being collected from the system.

Tip! Want to e-mail the report? Just save an electronic copy and attach to your e-mail! When previewing the report, select the ‘Export’ and save the report as a PDF file.

Note: The data represented in the report is as current as the information available in LTC at the time. Some outcomes report data may be distorted until sufficient entries for the selected reporting period have been made in the new Outcomes Reporting data entry section available in Entry and Discharge MDS assessments.


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Defining and Customizing Outcomes Reports Formats Outcomes Reports provide over 45 different resident status and discharge reporting measures, such as, ‘Falls with major injury’, ‘Medicare A and ADL decline’, and ‘Admitted and discharged back to the hospital with high risk diagnosis…’ Various scenarios present a wide variety of outcome reporting needs for facilities. Using Outcomes Reporting Setup, you define the various outcomes reports applicable to your organization. Define as many different reports as you like at any time – report setup is quick and simple. For example, after visiting with a local hospital you may identify a new reporting need – no problem! Just define a new report per the steps below and it’s ready for you to print/preview.

Creating a New Outcomes Report Format

The Outcomes Reporting Setup Screen (below) enables you to select from a pre-defined list of Resident Status and Discharge Reporting Outcome measures to create your customized reports.

1. Select Quality Assurance > Outcomes Reporting > Outcomes Reporting Setup and the following Outcomes Reporting Setup screen displays:

2. Click New and the following screen appears:


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3. Enter the Outcomes Report name under ‘Report Name’. 4. If you created a report format previously that you would like to copy and customize

differently, select it from the "Template Report" drop box. Tip! The template drop box is not facility specific and provides you the ability to copy a format defined for another facility. This is especially helpful for multi-facility organizations when setting up similar reports across multiple facilities.

5. Click ‘Ok’ to begin selecting the outcome measures to include in the report.

Report Criteria

Content Selection Choose the

Outcome Measures to include!

Content Order Choose the Display/Print

Order of the selected Outcome Measures


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6. Under ‘Report Criteria’ select the report defaults that will apply most frequently when printing/previewing the report. ‘Report Criteria’ selected here may be changed as needed when actually printing/previewing the report. Select the following as applicable: • Reporting Period is a required field that defines the period of time displayed on the

report. Select either Previous Month, Previous Quarter, or Previous Year. • A/R Type – To limit the report to specific A/R Types by default, click on the binoculars

button and select the A/R Type(s) to include. Data for residents with the selected A/R Type(s) during the reporting period will be included in the report.

• Location (From and Thru) – To limit the report to a specific area of the facility by default, select the range of rooms.

• Report Content o Check the “Include Detail Grid” checkbox to display a data grid on the report by

default (see Outcomes Reporting Report examples above for an example). o Check the “Include Trends over time graph” checkbox to display resident trends

on the report by default (see Outcomes Reporting Report examples above for an example).

If “Include Trends over time graph” is checked, select the "Graph Interval" from the following display choices: Previous Month Weekly, Previous Quarter Monthly, Previous Year Quarterly

• Select a Sort Order to indicate whether you want to sort your results alphabetically by Resident name, Admit Date or Discharge Date.

• Physician – To limit the report data to a specific physician(s) residents by default, click the binoculars button and select the physician(s).

• Admit Hospital – To limit the report data to residents admitted from a specific hospital(s) by default, click the binoculars button and select the hospital(s).

• Discharge Hospital - To limit the report data to residents discharged to a specific hospital(s), click the binoculars button and select the hospital(s).


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7. Under ‘Content Selection’ select the specific outcome measures to include in the report – you may choose from both the Discharge Tracking and Resident Status measures.

Discharge Tracking Content Selection

a) Click on the Discharge Tracking measure from the list (pictured above) on the left to

highlight it and to display the full description of the measure under Details. Use the arrow pointing to the right located in the middle of the screen to move the highlighted measure(s) to the right under Selected Reporting. Tip! To select more than one measure, click the first one you wish to select, hold down the CTRL key on your keyboard, and click each additional measure you want to add.

Resident Status Content Selection

b) Click Resident Status (pictured above) to view the resident status measures. Click on the measure to highlight it and display the full description under Details. Use the arrow pointing to the right located in the middle of the screen to move the highlighted


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measure(s) to the right under Selected Reporting. Tip! To select more than one measure, click the first one you wish to select, hold down the CTRL key on your keyboard, and click each additional measure you want to add. If multiple items are selected, the ‘Details’ area is blank.

You may select up to 15 different measures between Discharge Tracking and Resident Status measures to include in the report and may add/remove the reporting measures listed under Selected Reporting at any time using the arrows in the middle of the screen.

Tip! When creating an outcomes report, keep in mind the outcome measures selected will all be on the same report. Create different reports for different needs rather than including more than you need on one report. For example, if you wish to report on ‘Falls with major injury’ and ‘Average Length of Medicare A stay’ you may not want those measures included on the same report. In that case, create separate reports selecting just the relevant measures for the purpose of that report.

8. Under ‘Content Order’ you may rearrange the order in which the selected reporting measures display on the report. To do so, click on the measure to highlight the item(s) you want to move and click the up or down arrow buttons located on the left-hand side of the Content Order list box. Tip! When a measure is highlighted under Content Order, the full description displays under ‘Details.’ If multiple measures are highlighted, the ‘Details’ are blank.

9. Click ‘Save’ to save the report. If you would like to define additional Outcomes Report formats, repeat the above steps. At this point, clicking the File > Print or the Print button at the top of the screen opens the Outcomes Reporting print screen so that reports can be printed directly from the Setup screen. See the Printing Customized Outcomes Reports for printing details.

10. Click ‘Exit’ to return to the Outcomes Reporting menu.

Modifying an Existing Outcomes Report Format

An existing Outcomes Report format can be modified at any time to change the Outcome Measures included in a report, the order of the measures displayed on the report, or the default report criteria. If you would prefer to create a copy of the report first and then modify the copy, refer to steps 2 through 9 above under ‘Creating a New Outcomes Report Format’ and utilize the template option.

1. In Quality Assurance > Outcomes Reporting > Outcomes Reporting Setup, select the facility.

2. Select the report to change from the ‘Report Name’ drop box.


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3. Modify the report selections to meet your needs. 4. Click ‘Save’ to save your changes. 5. Proceed with printing/previewing the report by clicking ‘Print’ at the top or click ‘Exit’ to

return to the Outcomes Reporting menu.

Once the modifications are saved, the report is ready to print again!


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Capturing Outcomes Data in the Assessment Manager Admission & discharge statistical information is a vital component in determining outcomes for your residents. To capture this information at the point of entry and discharge, a new Outcomes Reporting section is now available on all entry and discharge assessments within the Assessment Manager. Most of the outcome measures available in Outcomes Reporting rely heavily on the data collected in the new OR-Outcomes Reporting section – ORA on entry assessments and ORD on discharge assessments.

Best Practice! Always complete the ORA and ORD in all entry and discharge assessments. This ensures accurate data is available for your Outcomes Reports. Even if you don’t plan to use the vital new Outcomes Reporting features in the near future, begin collecting the data now! Remember, outcomes data is based on historical information – so begin capturing the history! If the ORA and ORD data is not entered for all entry and discharge assessments, the report data may be skewed. To make the ORA and ORD required on all entry and discharge assessments, see Facility Preferences setup instructions on page 59.

OR - Outcomes Reporting Data Entry

When entering an entry or discharge assessment, the Outcomes Reporting data entry section is available in the Assessment Manager in the left pane as seen in the entry assessment example below. Complete the ORA/ORD sections per the following steps:

1. When entering an admit or discharge assessment in the Assessment Manager, click ‘Outcomes Reporting’ in the left pane to display the ORA/ORD section. Since the data collected here is for the purposes of admit and discharge data, the Outcomes Reporting section is only available on entry and discharge assessments.


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Outcomes Assessment with ORA Questions loaded

2. Answer each of the ORA/ORD questions. The ORA available on entry assessments consists of 7 questions. The ORD available on discharge assessments consists of 9 questions.

3. Once the questions have been answered, click ‘Section Complete’ and proceed with completing the entry or discharge assessment per your routine procedures. Note: The ORA/ORD section is not included in the MDS electronic transmission file. The information entered in the Outcomes Reporting section is specific to use in LTC only.

Notes: • Upon installing this release, as users close entry and discharge assessments, they will

be reminded to enter ORA/ORD data but will not be required to do so. To change the reminder to a requirement or to remove the reminder, see Facility Preferences setup instructions below on page 59.

• Users with read/write security access to any section of the MDS will have access to enter ORA and ORD information automatically.


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OR Section in Print MDS Assessment

When printing entry and discharge assessments, the new OR section is available for print as well. If you would like to print blank copies of the OR section as part of your data collection procedures, you may do so by selecting the ‘print blank assessment’ option and choosing the OR section to print. For more information on printing MDS assessments, refer to LTC Help.

Example of Print Assessment Screen

Note: If your policy is to keep a printed copy of the MDS, it is not necessary to include the OR section. The OR section is not part of the CMS MDS form.

New OR Section on an

Admit record


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OR Section in Assessment History

Track outcomes reporting data entry details with the Assessment History under View in the Assessment Manager. The new Outcomes Reporting history report provides a detailed listing of data entry activity by date, time, and user surrounding the section. Information such as, when and who opened the section; when and who made entries; and when and who section completed the OR section as pictured below:

Example of Assessment History Report for OR-Outcomes Reporting section

To print/preview the new OR-Outcomes Reporting section history:

1. Click View at the top of the Assessment Manager and select Assessment History.

2. Click on OR-Outcomes Reporting to highlight it & use the arrows to move it to the right side under ‘Selected Assessment Detail’.

3. Click print/preview.


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Setup Security – Required!

Upon installing this release, the new Outcomes Reporting features in Quality Assurance default to ‘no access’. Follow your organization’s security setup protocols to grant access to the appropriate user groups for the following menu items:

• Quality Assurance > Outcomes Reporting > Outcomes Reporting Setup • Quality Assurance > Outcomes Reporting > Outcomes Reporting Print

Facility Preferences

Options for requiring the new OR section in entry and discharge assessments are available in Clinical Setups. Determine the option that best corresponds to your organization’s policies regarding the collection of outcomes data. The following options are available:

o Display reminder on close of MDS when no entries have been made on Sections ORA or ORD - A warning message displays at the close of entry and discharge MDS assessments if no data has been entered in the ORA/ORD section. This is a reminder to users to enter the information but does not require them to enter data.

o Require completion of Section ORA and ORD items when Section Complete – An error message displays at the close of entry and discharge MDS assessments if the ORA/ORD section has not been section completed. This option requires the ORA/ORD to be section completed in order to close the assessment.

o No reminders or required fields for section ORA and ORD – No messages related to ORA or ORD display when an assessment is Closed and ORA/ORD completion is not required.

Important! Upon installing this release the first option is automatically selected. As users close entry and discharge assessments, they will be reminded to enter ORA/ORD data but will not be required to do so.

To change the OR MDS option to make the data entry required or to not display any outcomes related messages at all during MDS entry, do the following:

1. In Clinical > Setup > Facility Preferences (pictured below), locate the Outcomes Reporting section on the General screen.


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Clinical > Setup > Facility Preferences Screen

2. Select the best option for the facility as described above. 3. Click ‘Save’ to save your selection. If setting this option for multiple facilities, select the next

facility and repeat the above steps. 4. Click ‘Exit’ to return to the Setup menu.

Select appropriate

option


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Clinical Management Suite (continued)

Clinical

• Admission & discharge statistical information is a vital component in determining outcomes for your residents. To capture this information at the point of entry and discharge, a new Outcomes Reporting section is now available on all entry and discharge assessments within the Assessment Manager. Most of the outcome measures available in Outcomes Reporting rely heavily on the data collected in the new OR-Outcomes Reporting section – ORA on entry assessments and ORD on discharge assessments. For more information on the new Outcomes Reporting ORA and ORD sections in the Assessment Manager, see “Capturing Outcomes Data in the Assessment Manager” on page 55.

Best Practice! Always complete the ORA and ORD in all entry and discharge assessments. This ensures accurate data is available for your Outcomes Reports. Even if you don’t plan to use the vital new Outcomes Reporting features soon, begin collecting the data now! Remember, outcomes data is based on historical information – so begin capturing the history! If the ORA and ORD data is not entered for all entry and discharge assessments, the report data may be skewed.

Important! Upon installing this release, as users close entry and discharge assessments, they will be reminded to enter Outcomes Reporting ORA/ORD data but will not be required to do so. To change the reminder to a requirement or to remove the reminder, see Facility Preferences setup instructions below on page 59. The new OR MDS section is NOT a new CMS section, does not transmit with the MDS, and is in no way related to the FY2012 CMS changes described in the previous pages. The OR section in the Assessment Manager simply provides an efficient method for collecting additional outcomes related admission and discharge information.

To print Outcomes Reports, you must be licensed for the Quality Assurance module. If you are not currently licensed for Quality Assurance and would like more information about the features and benefits available, contact our Sales Team at 1-888-810-9586, ext. 1051.

• Team TSI Customers Only – In the MDS Command Center, selecting the Team TSI button provides direct access to the MDS 3.0 portal rather than the 2.0 portal.


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Resident Accounting Suite

Claims

• New Claim Default options provides ability to auto-populate the “00” in the cents field for non-dollar value codes on the printed UB04 and in Review Claims. Non-dollar value codes are typically 45-53, 60-61, 67-68, and 80-83. Though this is not a Medicare requirement, some states and insurance payers do require the “00” entry. Automating the “00” through claim defaults will be particularly helpful for facilities using those payers. For example, this is a requirement with Louisiana Medicaid and with a Medicare replacement plan in Hawaii. If you are submitting paper claims and the “00” described above is a requirement with your fiscal intermediary, do the following to utilize the new claim default: 1. In Resident Information > Setup > FI/Insurance Carriers, select the intermediary. 2. Select the 837 ECS tab to display the 837 ECS screen. 3. Check the box beside “Print ‘00’ cents for non-dollar value codes on UB” 4. Click Save to save your changes and Exit to return to the Resident Information Setup

menu.

All future claims created for the selected payer will include “00” in the cents field for non-dollar value codes in Review Claims and on the printed UB04.

Note: The “00” entry is not an electronic requirement and is therefore not included in the electronic claims submission file.


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Maintenance Issues Clinical Management Suite

Clinical

• The MDS 2.0 button no longer displays above the calendar/grid schedule in the MDS Command Center. MDS 2.0 assessments remain accessible for reference and historical purposes by selecting the “Launch MDS 2.0” option available in the “I Want To” window on the left side of the MDS Command Center.

• In Care Plans, when deleting and adding an approach at the same time, the associated roles and forms on the added approach save successfully. This corrects an issue where the roles and form disappeared from the added approach if the user did not save after deleting/before adding the new approach.

• In the MDS Command Center, electronic transmission batches may be recreated successfully. • In the Assessment Manager, values entered in Section M, items M0610 A, B, and/or C with a

leading zero display correctly on the printed/previewed MDS. • California Customers Only - When the MDS is printed/previewed, Section S displays the

correct numbering scheme for questions 9040G (displays 1, 2, or 9 instead of 1, 2, or 3) & 9040H (displays 1, 2, 3, or 9 instead of 1, 2, 3, or 4).

Quality Assurance

• When entering Incident Reports, the following sporadic error no longer occurs: “Run Time Error -2147217900(80040e14) primary key constraint.”


Billing

• When printing/previewing the Monthly Census Analysis report: o If a 3 month date range selected, the A/R Type Mix section displays all three months’

worth of data. o If multiple billing periods are selected, the A/R Type Summary section displays the

correct totals. • When printing/previewing the Daily Census Analysis report, the A/R Type Summary section

displays the correct totals. • When posting batches in Ancillary Batch Entry, the following sporadic errors no longer occur:

“Can't Create Log File" and "=>Argument 'Record Number' is not a valid value."


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Claims Filing

• When creating claims in the Claims Command Center, the following sporadic error no longer occurs: “Object reference not set to an instance of an object.”

• When importing 277CA acknowledgements for 5010 version claim files, the rejection codes (located in STC01-2 of the file) display on the 277CA report. Tennessee Customers Only – When revenue code 192 and a HCPC are used in a resident’s ancillary charges, the HCPC is included with 192 in the SV2 segment of the electronic claims submission file. This is specific to intermediaries assigned the MDTN intermediary code

Financial Accounting Suite

General Ledger

• Alternate Statement of Operations report formats print/preview in portrait when formatted for portrait.

Payroll

• Indiana Customer Only - The complete State EIN populates the W2 electronic file. • Kansas Customers Only – Record S is correct in the SUTA electronic file.

Version 8.7.4 CMU 2b (August 31, 2011) New Features and Enhancements Clinical Management Suite

Clinical

• Attention Team TSI Customers! Team TSI has updated their web services to WPF and are retiring their prior web services on September 16, 2011. Both services are in operation until that date. Installation of this release enables LTC to use the new Team TSI web services. What should you do in LTC? After installing this release, update the primary web address for transmission files per the following steps:

1. In Clinical > Setup > EMS Facility screen


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2. Beside ‘Primary MDS 3.0 Web Address’ remove the e-mail address displayed and enter the following new address: https://web services.intellilogix.net/m30/MdsService.svc

3. Click Ok to save your changes and return to the Clinical > Setup screen. The setup changes are complete.

Follow your routine procedures for submitting to Team TSI from LTC. The system will now utilize the new web services address when submitting your assessments.

Maintenance Issues Resident Accounting Suite

Claims

• Medicare A MSP claims create successfully. The following error no longer occurs: "Total_visits is neither DATAColumn a nor a DATARelation for Table CMInstitutrionalcharges."

• The HI segment within 5010 electronic claims submission files includes days reported on the claim for value codes 80-83.

Version 8.7.4 CMU 2 (August 15, 2011) New Features and Enhancements Clinical Management & Resident Accounting Suites

Resident Information

• Residents’ discharge status now displays in eChart, on the Face Sheet, and on the Resident Status History List report allowing for quick reference and review. A resident’s discharge status is classified as one the following: ‘Return Anticipated’, ‘Return Not Anticipate’, and ‘Death in Facility.’ Entry of discharge status is now a new requirement in Resident Status Changes each time a resident is discharged (instructions below).

Coming Soon! In addition to the new reporting capabilities available in this release, tracking the discharge status provides the information needed for the system to automatically calculate a resident’s “clinical stay.” Clinical stay information will be a major component in the Outcomes Reporting features available in September 2011 and additional future features including Wound Management, scheduled for release early next year.

https://webservices.intellilogix.net/m30/MdsService.svc�


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Discharge Status Reporting

o eChart – The discharge status entered in Resident Status Changes displays on the Face Sheet screen in eChart as seen in the following example:

o Face Sheet – The discharge status entered in Resident Status Changes displays on the Face Sheet as seen in the following example:

o Resident Status Changes History List – Quickly review the discharge status for multiple residents at once on the Resident Status History List. The discharge status entered in Resident Status Changes displays on the Resident Status Changes History List available in Resident Status Changes > File > Print as seen in the following example:

Discharge Status

Discharge Status


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Entering the Discharge Status

When discharging a resident in Resident Status Changes, the discharge status is now a required entry. Select the applicable discharge status from the following options: “Return Anticipated”, “Return Not Anticipate”, and “Death in Facility.”

Example of Discharge Entry in Resident Status Changes

If the discharge status is not entered, users receive the following error message upon Save indicating the discharge status must be entered in order to proceed with saving and completing the discharge.

Discharge Status

Discharge Status Entry


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Example of Error Message if Discharge Status is not Entered

Note: If the incorrect discharge status is selected and saved, the discharge status may be corrected via Resident History Maintenance in Resident Status Changes per you current history maintenance data entry correction procedures.


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Clinical Management Suite

Clinical

• New York Customers Only –Section S, item S8055 now displays "None of the Above" instead of “Other” as per New York state requirements.


Claims

• Claims updated to accommodate CMS Change Request #7339 “Manual Clarifications for Skilled Nursing Facility (SNF) Part A Billing” effective August 1, 2011. Background CMS clarified Medicare Part A claim requirements for therapy charges in the MLN Matters Article #7339 published in late March and subsequent software changes were incorporated into LTC in Version 8.7.4 available June 15, 2011. On June 21st, CMS revised the MLN Matters Article with further clarifications and changes. As a result, the following clarifications are effective for claims with dates of service on or after August 1, 2011:

1. Submission of occurrence code 16 to report the last day of therapy when an End of

Therapy – OMRA assessment is completed. (Note: Only the last EOT for the claim period should be reported.)

2. Medicare Part A PT, ST, and OT charges should include the number of billed therapy days on the claim. Per the CMS Change Request 7339: “30.4 - Coding PPS Bills for Ancillary Services... For therapy services, that is revenue codes 042x, 043x, and 044x, units represent the number of calendar days of therapy provided. For example, if the beneficiary received physical therapy, occupational therapy or speech-language pathology on May 1, that would be considered one calendar day and would be billed as one unit.”

3. Claims should be submitted in order based on FL6 from/thru dates of service* 4. Occurrence span code 74 is used to report LOA from and thru dates* 5. Physicians services provided to SNF residents are bundled into the Part A PPS payment

and are not paid separately* The changes are effective August 1, 2011 for dates of service on or after August 1, 2011. For more information, visit the CMS website:

• MLN Matters Article 7339: http://www.cms.gov/MLNMattersArticles/downloads/MM7339.pdf

http://www.cms.gov/MLNMattersArticles/downloads/MM7339.pdf�


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• Transmittal 2245 / Change Request 7339: http://www.cms.gov/transmittals/downloads/R2245CP.pdf

* Note: The items denoted by an asterisk above are already included in LTC claims and therefore no additional software changes were necessary in this software update. If the LOA is not populating your claims as referenced in #4 above, please contact the Customer Relations Support Team at 1-800-489-4248 for setup assistance. Automation in LTC Installing this update automates the population of occurrence code 16 and billed therapy days provided to the resident on the claims.

Auto-population of Occurrence Code 16 for End of Therapy

On Medicare Part A claims, occurrence code 16 will automatically populate with the end of therapy date when applicable to the dates of service on the claim. The end of therapy date is based on information entered in MDS assessments. The methodology used by LTC to determine the end of therapy date to report on the claim is as follows:

1. LTC first reviews all End of Therapy OMRA assessments that cover the RUGS/days billed for

the claim period. The therapy end dates in Section O on the last EOT OMRA assessment for the claim period is reported on the claim. Note: Prior to installing this update, per the original CMS instruction the system referenced all assessments rather than EOT-OMRA assessments only.

2. The system evaluates the therapy end dates in Section O. If a therapy end date is provided on all three therapies, the latest date populates the claim. The following examples indicate how the system populates a combination of blanks, dashes, and dates reported in Section O: Example #1 – Therapy end date entered for PT, but OT & ST are blank. In this case, the PT date would populate the end of therapy date on the claim. Example #2 – Therapy end date entered for PT, but OT & ST are dashes. In this case, there is no end date to report since therapy is ongoing as indicated by the dashes. Example #3 – Therapy end date entered for PT, OT is dashes, and ST is blank. In this case, there is no end date to report since OT is still ongoing. Example #4 – The PT end date is 8/19/2011, the OT end date is 8/30/2011, and the ST end date is 7/25/2011. In this case, the last end date reported, 8/30/2011, populates the claim.

Note: If you are not currently entering MDS assessments in the Clinical module of LTC, occurrence code 16 and the therapy end dates must be entered manually on all applicable claims in Review Claims. Assessment entry in the Clinical module is required for the end of therapy automatic population on the claim to occur.

http://www.cms.gov/transmittals/downloads/R2245CP.pdf�


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Auto-population of Number of Therapy Sessions/Visits – Billed Therapy Days The number of sessions populate the claim based on the number of billed therapy days associated with Medicare Part A therapy charge(s) in Ancillary Charges. Medicare Part A therapy charges must be detailed by day in Ancillary Charges in order for the billed therapy units to automatically populate Medicare A claims with the correct number of therapy days after installing this release. However, if your current Medicare Part A therapy charge entry practice reflects Medicare Part A charges in Billing > Main > Ancillary Charges as a single summed charge per discipline for the month, the number of therapy days will not automatically populate the claim. In order for your claims to auto-populate the number of billed therapy units on claims for dates of service on or after August 1st, you will need to enter the Medicare Part A charges in detail. If this is not your current practice, Charge Code setup may also be required to accommodate the new entry method. Visit AHT’s online Support Center at http://new.myhealthtech.net/support- resources.php for step-by-step processing and charge code setup review/change instructions. If you are unsure if your charges are entered in detail or summary, see the examples below. If you need login information to access Support Resources, please e-mail us at [email protected] contact the Customer Relations team at 1-800-489-4248. Example #1 - Detailed Medicare A charge that will populate therapy days billed on the claims

http://r20.rs6.net/tn.jsp?llr=ed4nveeab&et=1106453695667&s=1&e=001HnJ_cW962yXuJ0RbjdTwmzxhDjlbZK8cprSUblctHv5ImROzNLwLuRoeJgZuX0AEZHnLJkML0QCS_Vl6lrM1dUi2WE73mVF5UmhncEC_mmHwGdfPFmi4O8fETZHyXtEjxHcNcA-yEIW1S6eL7GK0fg==�

http://r20.rs6.net/tn.jsp?llr=ed4nveeab&et=1106453695667&s=1&e=001HnJ_cW962yXuJ0RbjdTwmzxhDjlbZK8cprSUblctHv5ImROzNLwLuRoeJgZuX0AEZHnLJkML0QCS_Vl6lrM1dUi2WE73mVF5UmhncEC_mmHwGdfPFmi4O8fETZHyXtEjxHcNcA-yEIW1S6eL7GK0fg==�

mailto:[email protected]�


Page 73 of 83

Example #2 - Medicare Part A Ancillary Charge NOT entered in detail and is summed for the discipline:

In example #2 above, a “generic” charge code representing all physical therapy charges was utilized. This data entry process does not provide the daily detail & will not populate billed therapy days on Medicare Part A claims.

New Medicare A Review Claims Edit #398 evaluates the days billed on the claim. If therapy charges are not detailed by day in Billing > Main > Ancillary Charges, FL46 for revenue codes 420-449 is blank and the following message displays in Review Claims: ‘Medicare A – Service Units (FL46) on the claim will be blank if therapy charges are not entered by day.’ FL46 can be entered manually on the claim in Review Claims.

Note: Prior to installing this update, per the original CMS instruction the therapy/visits populated the claim based on the number of therapy visits associated with the Medicare Part A therapy charges. Once this release is installed, claims on or after August 1st are populated by the total billed therapy days as per the revised CMS instructions.


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General Ledger & Corporate Office

New reporting setup option allows you to override the A/R Type description display on several General Ledger and Corporate Office reports and display the description best suited to your reporting needs. General Ledger reports utilizing the new display option are: Operating Budget, Resident Mix Analysis, and Trend Analysis. Corporate Office reports utilizing the new display option are: Consolidated Operating Budget, Consolidated Resident Mix Analysis, and Consolidated Trend Analysis.

To override the current A/R Type description which is based on the A/R Type description entered in Resident Information > Setup > A/R Types, do the following:

1. In General Ledger > Setup > Modify Days for PPD Calculation, select the A/R Type whose description you would like to override.

2. Enter the new description for report display beside ‘Override Description.’ 3. Click Save and then Exit to return to the General Ledger Setup menu. 4. In Budget Days, select the same A/R Type selected above. 5. Enter the new description for report display beside ‘Override Description.’ 6. Click Save and then Exit.

New Override

Description Option in

Modify Days for PPD

New Override

Description Option in Budget Days


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Payroll

• Optional Social Security Number edit provides ability to require users to enter employee social security numbers in Employee Information. If this is an option you would like to take advantage of in your organization, it will be necessary to first enable the edit. To require entry of employee SSN’s, do the following to enable the new edit:

1. From the main menu, go to Setup > User Defined Edits > VB6. 2. Open the drop box of Edit Numbers. 3. Select “Edit number 701038” (new SSN error edit). When enabled, users will not be

allowed to save employee information if the SSN field is blank. Important Note: “Edit number 701025” is also specific to SSN data capture. Released previously, edit number 701025 is a warning advising (not requiring) users to enter a valid SSN and can be bypassed. If this edit is currently enabled, it will be necessary to disable it prior to proceeding. To disable 701025, select it from the drop box of edit numbers, uncheck ‘Enabled’, and click Save.

4. On Edit Number 701038, click ‘Enabled’ and then click Save. The edit is now enabled.


Ancillary Tracking – Therapy

• The Therapy Appointment Monitor no longer sporadically displays completed therapy on the scheduled therapy screen.

Clinical

• Care Area Assessments (CAA) and Care Area Triggers (CAT) - o When information is changed in a completed worksheet, the CAA is no longer checked

as complete. The CAT remains open until the Worksheet Complete button is selected again.

o “Indwelling” is spelled correctly on the “06. Urinary Incontinence and Indwelling Catheter” Care Area Trigger Worksheet.


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o “Altered” is spelled correctly under “Intrinsic Risk Factors” on the “16. Pressure Ulcer” Care Area Trigger Worksheet.

o Care Area Assessments no longer sporadically trigger twice on MDS Assessments. • Section O, items O0400E and O0400F do not print/preview on 5-day NP, 30-day NP, and NQ

MDS assessments when printing/previewing the full assessment. O400E and O0400F are not applicable to the referenced assessment types.

• When printing MDS assessments using the quick print format option, unchecked MDS assessment items are not included in the print/preview if the “Do not include blank/unchecked items” box is checked.

• All information entered in MDS Sections V and Z including signatures/dates displays on printed/previewed assessments when printing/previewing the full assessment form for all sections of the MDS.

• When printing/previewing Section S only for non-comprehensive assessments, only Section S items are displayed.

• In the MDS Command Center, the Z0500B date is no longer displayed for open discharge assessments.


Resident Information

• The Admit/Discharge Summary Report includes admit and readmit data for the specified date range only.

• When changing A/R Types in Resident Status Changes, the following error no longer occurs: “COM object that has been separated from its underlying RCW cannot be used.”

Billing

• Fee Schedule Rate import files containing duplicate HCPCs import without error in Billing > Setup > Fee Schedule Rates.

• When MPPR affected charges are recalculated in Prior Month Adjustments, the balances on the Payment Reconciliation and Interim Aged Analysis reports remain accurate.

Claims Filing

• The No-Pay Skilled section of Resident Status Changes populates Resume Skilled Care for readmitted residents when appropriate and includes those residents as needed in the No Pay/Benefit Exhaust claims.


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• Ancillary Charges deleted in Prior Month Adjustments do not populate claims. Prior to installing this release, when charges were deleted in Prior Month Adjustments, they would continue to populate the claims until the current billing month was closed.

• 5010 version 999 and 277CA files consistently import without error. • Florida Medicaid Customers Only – 5010 electronic claims submission files populate the

admit date, admit hour or discharge hour whether the admit/re-admit falls within the claim period or not.


Payroll

• When time is imported for facilities not set up to do intercompany transfers and the import file includes expense allocations for intercompany transfers, the import stops, no information is imported, and the user receives a message indicating the import has aborted. The following is an example of the warning message:


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Version 8.7.4 CMU 1 (July 15, 2011) New Features and Enhancements Resident Accounting Suite

Billing

• The Fee Schedule Charge Code Wizard provides a new option to select the charge code adjust to fixed fee effective date (as pictured below) for the system to assign automatically to the selected charge codes when running the Charge Code Wizard. Selecting the month and year when utilizing the Charge Code Wizard assigns the first day of that month and year to the appropriate A/R Type and Charge Code as the adjust to fixed fee effective date. Note: Prior to installing this release, the Charge Code Wizard auto-assigned the current billing month as the fixed fee effective date.

Background – The Fee Schedule Charge Code Wizard is a time saving feature available since 2008 in Billing > Setup > Fee Schedule Rates. Anytime a newly named Fee Schedule Table is added in Fee Schedule Rates, the Charge Code Wizard may be utilized to automatically assign the new Fee Schedule Table to the appropriate A/R Type in all affected charge codes. For more information on using Fee Schedule Rates and the Charge Code Wizard, refer to LTC Help.

• Prior month adjustment wizard is now available for use with all imported Fee Schedule Rate tables. When importing a Fee Schedule Rate table for any A/R Type with a prior month effective date, you will be prompted to implement the adjustment wizard for all affected charges.

Charge Code Wizard

New Effective Date Option


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If you wish to let the system auto-adjust all affected charges, proceed with the adjustment. If you would rather not let the system auto-adjust the affected charges, choose not to proceed with the adjustment when prompted. Note: Prior to installing this release, only Medicare Part B MPPR impacted HCPC charges were adjusted via the prior month adjustment wizard within Fee Schedule Rates. For more information on MPPR and/or importing fee schedule rates, refer to LTC Help.

• North Carolina and Georgia Customers Only – North Carolina and Georgia

Medicaid/Medicare Part A crossover calculations are as follows per state regulations: 1. The number of Medicare/Medicaid crossover coinsurance days X The coinsurance rate in

the month = Total coinsurance amount due for the month 2. Net Medicare rate = The RUG contractual amount minus the coinsurance rate Note: When

multiple RUGs are present for the resident during the month, a weighted average is used for the net Medicare rate. The following is an example of a weighted average calculation:

Weighted Average Example for Net Medicare Rate Dates of Service = 7/1 – 7/31 RMB = 278.80 X 1 Day = 278.80 RHB = 300.39 X 13 Days = 3905.07 SSA = 207.18 X 17 Days = 3522.06 Total Amount of 7705.93 \ 31Days in Month = 248.578 (RUG amount) 248.58 - 137.50 (Co-insurance rate) = 111.08 Net Medicare rate

3. Compare the net Medicare rate (determined in step 2 above) to the facility Medicaid rate. 4. If the net Medicare rate is more than the Medicaid rate, Medicaid does not make any

payment and no resources are collected. The entire coinsurance rate in step 1 above is written off.

5. If the net Medicare rate is less than the Medicaid rate, Medicaid will pay the excess of the Medicaid rate over the net Medicare rate LESS the patient resources. The balance is written off.


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Medicare/Medicaid Crossover A/R Type Setup Verification for GA and NC The above calculation is dependent upon the accuracy of the Medicare/Medicaid crossover A/R Type setups which are probably already in place in your Billing setups. Verify the following setups to ensure accuracy:

In Billing > Setup > A/R Type Rates, select the Medicare/Medicaid Crossover A/R Type (commonly referred to as ‘MXA’).

o On the General screen Verify the ‘MCD State’ is the appropriate state (either GA or NC) Verify the contract rate and effective date under ‘Contract Rates’ is the same

as the Medicaid A/R Type contract rate (also known as “per diem”) and effective date.

o On the MCR/MCD Crossover screen under ‘If Medicaid Crossover does NOT pay full Part A Co-insurance’, verify the effective date and G/L account are entered.


Payroll

• Colorado Customers Only – Per Colorado regulations, the Colorado SUTA file reports employees’ "Total" wages instead of "Gross" wages.


Ancillary Tracking – Therapy

• The 7 Day Therapy Recap report consistently displays eligible days correctly at the top of the report.

Departmental Notes

• The date/time displayed in Departmental Notes is based on the facility’s time zone rather than the server’s time zone when the facility and server are located in different time zones.


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Clinical – MDS

• In the MDS Assessment Manager, when a dash is entered in C0100 the skip pattern no longer disables C0600. C0600 is available for entry.

• After inactivating an MDS assessment, a new assessment can be added with the same ARD as the inactivated assessment.

• When printing/previewing the full MDS form, Question D0600 prints/displays the correct value. • On the Assessment Summary report

o The state RUGs and their corresponding effective dates display. o The state RUG effective dates no longer display prior to the billing effective date. o The 'Transmitted' date remains once the batch is marked as accepted.

• In the MDS Assessment Manager, CAT worksheets display checkmarks correctly when the ‘When auto-populating from assessment, override manual entries’ checkbox is not checked in Clinical > Setup > Facility Preferences.

• Performance improvements in the CAT Worksheets within the MDS Assessment Manager. • The number of records displayed in the MDS 3.0 Post Transmission Results grid is correct

when the same document ID is used for multiple facilities. • Assessments previously rejected due to an invalid skip pattern in Section X (CMS edit -3746)

will be updated to reflect the correct skip pattern upon installation of this release. • When two users are accessing an MDS assessment at the same time per the scenarios below,

inactivated assessments continue to display correctly. In addition, messages are displayed per the scenarios below:

o If one user is inactivating an MDS assessment while another is trying to change it, the user trying to change the assessment will receive the following message: “The assessment you are updating has been Inactivated via Correction Request since you loaded it. You will need to reload the assessment to make changes. Would you like to reload it now?"

o If the assessment has been Modified via a Correction Request, the user trying to change the assessment will receive the following message: "The assessment you are updating has been Modified via Correction Request since you loaded it. You will need to reload the assessment to make changes. Would you like to reload it now?"

o If the assessment ARD has been changed, the user trying to change the assessment will receive the following message: "The ARD of the assessment you are updating has been changed since you loaded it. You will need to reload the assessment to make changes. Would you like to reload it now?"

o If the ISC (assessment type) has been changed, the user trying to change the assessment will receive the following message: "The ISC of the assessment you are


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updating has been changed since you loaded it. You will need to reload the assessment to make changes. Would you like to reload it now?"

• The Resident Information/MDS Reconciliation Report has been removed from the Clinical Reports menu. This report was a temporary report released in October 2010 to identify potential MDS 3.0 data issues between the Assessment Manager and Resident Information, which were also corrected in October 2010.

• Team TSI Customers Only – The default web address for submitting MDS files to Team TSI has been corrected to include ‘https’ instead of ‘http.’

• Pennsylvania Customers Only – On MDS NT assessments, Question S9080E displays in Section S for Pennsylvania.

Smart Charting

• The ADL flowsheet populates properly for the shifts that span midnight. • The Data Collection History report displays when special characters (including !@#$%^&*()'")

are entered in the footer via Smart Charting > Setups > Facility Preferences. • When a resident is admitted and their A/R type is added or changed at a later date with the

admit date as the effective date, the resident’s tasks do not fire again. For example, on July 1st a resident is admitted with an admit date of July 1st. On July 3rd, the A/R type is assigned to the resident with an effective date of July 1st. The tasks do not fire again for July 1st and 2nd.


Billing

• In 5010 Medicare Part B electronic claims submission test files, when the first two digits of the type of bill are 22, the DTP 435 segment and CL101 are populating which allows for successful submission of the Medicare B test file.

• Sporadic differences in the charges/payment information on the Billing Activity, Payment Reconciliation, and Statements no longer occur. The charge and payment detail matches across all reports reflecting the residents’ accurate activity.

• In Cash Receipts, if all of the detail lines of a deposit are deleted; the deposit with no detail is saved; and then a new deposit is added using the same deposit number, a run time error no longer occurs.


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General Ledger

• When attempting to delete a Journal Entry after another user has posted it, the following error message appears: “This journal entry was posted since you last opened or saved it. Cannot delete.” This ensures the posted entry is not deleted and keeps all reports in balance.

Payroll

• A non-worked pay type (for example, sick or jury duty) does not display a shift amount on the employee check stub or a shift amount added to the base rate on the employee check stub.

• YTD deductions are reflected on the check stub when there are no deductions taken that pay period.

Enterprise Management Suite

Compliance Center

• The scheduled trigger for the timely completion of the MDS sends the notification as defined in the trigger.

Documents

What’s New in LTC Version 8.7ahtltc.goodbaitdev.com/~aht/general-release/WhatsNew_875.pdf · 60, and 90 day PPS assessments. • CMS Transition Policy: ARDs on or after October