Glossary

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Glossary

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A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Activities of Daily Living (ADLs)

Assessment Period

Assessment Reference Date (ARD)

Assessment Window

Case Mix Index (CMI)

Case Mix Reimbursement System

Center for Health Systems Research and Analysis, University of Wisconsin - Madison

Centers for Medicare and Medicaid Services

CMS MDS 2.0 Data Collection System

Code of Federal Regulations

Cognitive Performance Scale (CPS)

Comprehensive Assessment

Data Assessment and Verification

Dually Certified Facilities

Duplicate Assessment

Facility ID (FACID)

Federal Register

Final Validation Reports

Fiscal Intermediary (FI)

Health Care Finance Administration (HCFA)

Health Insurance Portability and Accountability Act of 1996

Health Insurance Prospective Payment System

Healthcare Common Procedure Coding System (HCPCS)

Index Maximizing

Initial Feedback Report

Internal Assessment ID

International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)

Look Back Period

MDS Completion Date

Medicare Data Communications Network (MDCN)

Medicare Prospective Payment Assessment Form (MPAF)

Metropolitan Statistical Area (MSA)

Minimum Data Set (MDS)

National Drug Code (NDC)

Nursing Facility (NF)

OBRA Assessments

Observation Period

Omnibus Budget Reconciliation Act of 1987 (OBRA '87)

Other Medicare Required Assessment (OMRA)

Other State Required Assessment (OSRA)

Peer Review Organization (PRO)

Post Acute Care

PPS Assessments

Program Transmittal

Prospective Payment System (PPS)

Quality Improvement and Evaluation System (QIES)

Quality Improvement Organization (QIO)

Quality Indicators (QI)

Quality Measures (QM)

RAI Coordinator

Registered Nurse Assessment Coordinator (RNAC)

Resident Assessment

Resident Assessment Instrument (RAI)

Resident Assessment Protocols (RAPs)

Resident Assessment Validation Entry System (RAVEN)

Resident Assessment Validation Entry System for Swing-Beds (RAVEN-SB)

Resource Utilization Group, Version III (RUG-III)

Significant Change in Status Assessment (SCSA)

Significant Correction Assessment

Skilled Nursing Facility (SNF)

State Operations Manual (SOM)

Submission Requirements (SUB_REQ)

Swing-Bed MDS (SB-MDS)

System of Records (SOR)

Utilization Guidelines

Validation Report

1 of 1

Resident Assessment Instrument

Overview of RAI

Components of RAI

Benefits to Facility

The Assessment Schedule for the RAI

Admission Assessments

Quarterly Assessments

Annual Assessments

Significant Change in Status Assessments (SCSA)

Significant Correction of a Prior Full Assessment (SCPA)

The Medicare PPS Assessment Form (MPAF)

Combining the RAI OBRA Schedule with the Medicare Schedule for SNFs

Factors Impacting the SNF Medicare Assessment Schedule

Item-by-Item Guide to the MDS

Coding Conventions

Background Information

Section A. MDS Identification & Background Information

Section B. Cognitive Patterns

Section C. Communication/ Hearing Patterns

Section D. Vision Patterns

Section E. Mood & Behavior Patterns

Section F. Psychosocial Well-Being

Section G. Physical Functioning & Structural Problems

Section H. Continence in Last 14 Days

Section I. Disease Diagnoses

Section J. Health Conditions

Section K. Oral/Nutritional Status

Section L. Oral/Dental Status

Section M. Skin Condition

Section N. Activity Pursuit Patterns

Section O. Medications

Section P. Special Treatments & Procedures

Section Q. Discharge Potential & Overall Status

Section R. Assessment Information

Section S. State-Defined Section

Section T. Therapy Supplement for Medicare PPS

Section U. Medications (7 Day Look Back)

Section V. Resident Assessment Protocol Summary

Section W. Supplemental Items

Completing the RAPs

What are the Resident Assessment Protocols (RAPs)

How are the RAPs Organized?

What does the RAP Process Involve?

Identifying Need for Further Resident Assessment by Triggering RAP Conditions (RAP Process – Step 1)

Assessment of the Resident Whose Condition Triggered RAPs (RAP Process – Step 2)

Decision-Making and Documentation of the RAP Findings (RAP Process – Steps 3 and 4)

Development or Revision of the Care Plan (RAP Process)

RAP Clarifications

When is the RAI Not Enough?

Case Example – MDS, RAP and Care Planning

Overview of the RAI and Care Planning

The Care Planning Process

Submission & Correction of the MDS Assessment

Transmitting MDS Data

Timeliness Criteria

Validation Edits

Additional Medicare Submission Requires that Impact Billing Under the SNF PPS

Correcting Errors in MDS Records That Have Not Yet Been Accepted Into the State MDS Database

Correcting Errors in MDS Records That Have Been Accepted Into the State MDS Database

Inactivation of Submitted Records Lacking State or Federal Authority

Medicare Skilled Nursing Facility Prospective Payment System

Utilizing the MDS in the Medicare PPS

Resource Utilization Groups Version III (RUG-III)

Relationship Between the Assessment and the Claim

SNF PPS Eligibility Criteria for SNF's

RUG-III 53 Group Model Calculation Worksheet for SNFs

Course Evaluation

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Accessibility Guidelines

Acknowledgments

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