Summary
Accountable for all aspects of the Centers for Medicare and Medicaid (CMS) Resident Assessment Instrument (RAI), including the Minimum Data Set (MDS), Resident Assessment Protocols (RAPs), and Utilization Guidelines in accordance with the requirements of the State of Massachusetts, Federal regulations, Medicare Guidelines and the policies and procedures of the facility. Complete timely transmission of all MDS' in the facility.
Key Responsibilities
• Accurate completion of the MDS is coordinated in accordance with State, Federal and Medicare PPS guidelines.
• Audits are developed and performed to evaluate the quality, completeness and accuracy of the MDS process and any deficiencies are identified.
• All regulations related to MDS, Medicare PPS and managed care are monitored and supported to ensure compliance.
• Accurate classification of patients in a covered Part A stay according to the Patient Driven Payment Model (PDPM).
• Resident's condition and pertinent medical data is evaluated to determine the need for other Medicare required assessments.
• Patients who are near to not meeting the skilled requirement are identified and action plans are addressed with the team.
• Coordination with administration and the billing department is provided to establish systems that ensure accuracy of information on face sheets, therapy logs and billing records (UB 04s) to support the MDS and RUG's classification, including methods for updating ICD-10 coding.
• Completion of individualized care plans is coordinated in accordance with regulatory requirements.
• Additional department, organization, or network activities are completed per established objectives.
• Organizational Values of Innovation, Collaboration, Accountability, Respect, and Excellence are upheld.
Qualifications
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