MDS Corner with Judy Bagby, RN

Hayden Parker

MDS Corner: RAI Updates

Judith A Bagby BSN, RAC-CT, C-NE, LNHA


We are ending a busy 2013 year for the world of MDS.  One step that has not changed in the world of MDS is that the opening and completion dates move along without regard for holidays or power outages.  There were several revisions to the RAI this past year, please make sure you have the most up to date documents in your RAI Manual.  The October revisions did provide additional information in section G regarding ADLs and section O with Restorative Nursing.   Both these areas need to be accurately coded as they influence your payment rate.  Items in G and O identify both resident declines and improvements and are areas of focus during the survey process.  This month (December) CMS posted drafts of the MDS Item Sets for proposed implementation in October 2014.  These were posted for review and to encourage comments on the changes.

This past year has seen the MDS used by CMS and other payment sources to monitor hospital transfers.  It is our responsibility to implement and maintain systems for accurate coding on the MDS and to evaluate the reason for changes.  Quality Assurance and Performance Improvement (QAPI) is not an option it is the way to do business on a daily basis.  SNFs are being asked to manage sicker residents.  Our challenge is to provide a safe environment with quality care.  The assessment process helps to identify needs and risks which should be reflected by the MDS coding.  The CAA process is the root cause analysis to answer the question of why regarding the MDS coding.  Frequently, the area of the CAAs is overlooked or short cuts are taken.  When we do a detailed review of a CAA often key items are noted that will help in the delivery of services to the resident.  The Care Plan is that resident specific “recipe” for the delivery of their services.   The CAAs and Care Planning are steps of the RAI process that have ongoing review to assist with identifying needed changes for improvement of resident outcomes.  Early identification of changes and implementation of approaches may avoid a hospital transfer.