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HealthPRO Heritage Reports: RAI Manual Updates

The 2019 RAI Manual is here! The SNF world has been on the edge of their seat in anticipation of how the changes would impact the interdisciplinary team and coding of the MDS assessment.  CMS’ message is clear:  No longer is the manual only for MDS coordinators!  More emphasis on clinical characteristic coding for PDPM case mix group assignment means all disciplines must participate in completion of the MDS. The MDS item sets have been adapted for this shift in the Medicare classification system, requiring significant updates in the go to manual for RAI process.

The Highlights
The updated manual features PDPM coding guidance, and was posted in a user-friendly .pdf format with an interactive outline so readers can bookmark sections. HealthPRO Heritage recommends careful review of the following sections: 

Chapter 2:  A great read! This section includes details related to how the new assessment requirements for Medicare Part A will unfold.  Also, be sure to review details related to how the Interim Payment Assessment (IPA) will be scheduled. The take home message: Providers must establish a process for their IDT to collaborate on identification and completion of the IPA.  

Chapter 3:  Outlines how providers must complete training with all clinical departments on coding significant sections impacting PDPM case mix groups such as B, C, D, GG, H, I, J, K, M and O.

Pay close attention to Section C (page 138) RE: unexpected discharges and the completion of the staff assessment for determining residents’ cognitive status. 

Don’t miss!  Important details related to PDPM Readiness in the updates to Section GG (a “must-read!”) as these items will have significant impact on Quality Reporting expectations.

Chapter 6:  An explanation of how the new HIPPS codes will be assembled inclusive of the new default code of ZZZZZ. Calculation instructions for the function score derived from Section GG for both PT and OT as well as nursing can be found in this updated chapter. Additionally a comprehensive walk-through of each PDPM component (with calculations for the variable per diem adjustment and Total Case-Mix Adjusted PDPM Per Diem Rate) is provided.

More to Come!
This most recent MDS 3.0 RAI Manual update is likely not the final posting of edits, according to CMS.  Rest assured HealthPRO Heritage will post additional updates as they are published!

Click here for the full printable version. 

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Tags: PDPM, CMS Update 2019, RAI