Think back to a time
when you were new to
the health care
field. Remember how
confusing it was to
memorize all the
abbreviations that
came along with the
new job? Was MMR a
disease, treatment
or a regulatory
process? Hopefully
you all know the
answer by now to
that one – but have
you heard of
MMRC?
You can rest easy if
you haven’t heard of
MMRC before. The
abbreviation stands
for
MDS, Medicare,
Regulatory Process
and Case Mix.
MMRC is a new
investigative system
that Pathway has
developed that gives
insight into the
oftentimes confusing
regulatory processes
of survey, Quality
Indicators and 5
Star Ratings. The
MDS system also
drives the Medicare
reimbursement and
the case mix
reimbursement in
many states.
These systems are deeply
intertwined and have monumental effects. The MDS drives the QI/QMs which are
used in the traditional survey process as well as MDS data that is downloaded in
the Quality Indicator Survey (QIS) process. Inaccuracies, late completions, and
submission errors that are not corrected lead to deficiencies and survey
investigations, which, in turn, develop into more serious situations such as
dehydration, pressure ulcers and other consequential tags.
The MDS is the means in
which the reimbursement of Medicare is determined.
Timeliness, setting the assessment reference date (ARD), accuracy of
data, and supporting documentation which confirms the data on the MDS could lead
to a potential loss of revenue if inaccuracies are found. It also reveals the
risk that a care center might face in light of a CMS audit. Recovery Audit
Contractor (RAC) reviews are happening and retrieval of funds is a reality. This
process will identify symptoms of risk for a RAC audit.
Case mix is
determined in
different ways in
different states.
Many use the data
from the MDS in some
manner. Whether it
takes the form of
Resource Utilization
Groups (RUGs) or a
state specific case
mix such as
Illinois,
accuracy and
supporting
documentation are
required.
The investigative
and diagnostic
process of
MMRC serves to
identify the areas
that place your care
center in jeopardy
and provide the
following outcomes:
ways to improve
reimbursement,
regulatory risks and
recommendations,
recommendations on
improving QI /QMs,
and potential
Medicare audit
issues and
recommendations.
If you have concerns
that your care
center might be in
danger of any of
these issues or if
you are seeing
symptoms of these
hazards such as
QI/QM’s percentiles
creeping higher,
average Medicare
rates dropping,
seeing more default
payments, or
questioning how you
will do in the next
survey process, call
your Pathway
regional office and
discuss the
possibility of this
diagnostic review.
Just as the familiarly abbreviated vaccines prevent illness, a
MMRC review can
identify and assist
in preventing an
invasive system
breakdown from
occurring.
Looking at the MDS
Process provides
insight into:
-
Regulatory
Issues
-
Quality
Indicators
and 5
Star
Ratings
-
Medicare
Process
&
Reimbursement
-
Case Mix
Process
&
Reimbursement
Process Includes:
-
QI/QM
Review
-
Chart
Review
-
Interviews
-
System
Reviews
Outcome
Recommendations on:
-
Opportunities
to
improve
reimbursement
-
Regulatory
Risks
-
Improving
QI /QMs
- Potential Medicare Audit Issues
