Industry Insights

Important Modification Requirement for OMRA Standalone MDS Assessments

December 2016
Author:  Amy Ray

Amy Ray

Senior Managing Consultant

Consulting

Health Care

200 E. Main Street, Suite 700
Fort Wayne, IN 46802-1900

Fort Wayne
260.460.4000

Providers recently received an email alert from the Quality Improvement and Evaluation System (QIES) containing an important action required to correct recent Minimum Data Set (MDS) submissions that were inaccurately stored in the QIES Automated Submission and Processing System (ASAP) database.

Providers are instructed to create modifications for standalone Other Medicare Required Assessments (OMRA). The affected standalone OMRA records are Change of Therapy (COT), End of Therapy (EOT) and EOT combined with a Start of Therapy (EOT/SOT) assessments with target dates on or after October 1, 2016, that were transmitted from October 1, 2016, through November 4, 2016.

It’s reported that a small subset of MDS items weren’t correctly stored in the QIES ASAP system for the COT, EOT and EOT/SOT assessments that were completed as standalone assessments or not combined with any other type of scheduled assessment, e.g., five-day, 14-day, 30-day, etc. These OMRA assessments must be modified to accurately store MDS items and ensure an accurate Resource Utilization Group (RUG) score in the database. Affected MDS items are responses to Stage 2, Stage 3, Stage 4 and unstageable pressure ulcers in MDS Section M.

A modification to the original OMRA MDS transmitted to the QIES ASAP must be created and transmitted. No changes are required to the data on the MDS prior to submission. Resubmitting the original record will result in a duplicate assessment and will be rejected in the database. Therefore, a modification is required.

After transmitting the required modifications, the billing office should be notified. Any October claims that were already submitted for these assessments needs to be verified to ensure the claim is consistent with any recalculated RUG score by the QIES ASAP system. Billing adjustments should be made as appropriate.

If you have questions concerning this modification process, contact your BKD advisor.

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