Types of Reviews Retrospective Medical Record Review which compares the medical record to the MDS assessment Two-Staged Verification which is a re-assessment.

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Presentation transcript:

Types of Reviews Retrospective Medical Record Review which compares the medical record to the MDS assessment Two-Staged Verification which is a re-assessment of a resident, which includes a reconciliation process with the facility staff

Review Types Offsite Onsite Retrospective X Two-Staged

Clinical Team Qualifications Registered professional nurses Extensive long-term care experience Highly skilled and proficient in all aspects of the MDS Technical expert panel members Physical therapist Occupational therapist Speech therapist Registered professional nurse

Training MDS coding knowledge Claims review Medicare regulation Coverage guidelines Long-term care knowledge Retrospective medical record review (RMRR) Two-staged verification protocol Health and safety concerns

Facility Information Packet Introductory letter from CMS Letter outlining the onsite review process An onsite agenda for the 3 days Information Request Checklist A DAVE Information Sheet

Benefits of Offsite Review Medicare claims data and detect discrepancies between billing data and assessment data Identifies discrepancies between the assessment and the supporting medical record documentation Provides specific information Fiscal Intermediaries can use to ensure accurate payment of claims Enables a much higher volume of assessment reviews than the onsite reviews in the same time period