This bulletin should be shared with all health care practitioners and managerial members of the provider/supplier staff. 

Purpose:

The purpose of this bulletin is to provide education to the SNF provider community regarding submission of specific data into the Minimum Data Set (MDS).  PPS payments are per diem rates based on the patient's condition as determined by classification into a specific Resource Utilization Group (RUG). This classification is made by using the MDS.

Background:

Highmark Medicare Services would like to remind all providers that when entering data into the Minimum Data Sets (MDS), be sure you include both the social security number and the Health Insurance Claim (HIC) number.  The form is located on CMS' website.

When a patient is admitted to the skilled nursing facility (SNF), the nursing staff completes assessment on the patient and completes a Minimum Data Set (MDS) form. The MDS information is put into a grouper program (state system/software program) identified by CMS.  The grouper program classifies the patient into a Resource Utilization Group (RUG) which defines the patient’s level of care.  The level of care ranges from rehabilitation plus extensive services to low rehabilitation services.  The RUG’s code is a 3 digit alpha/numeric code that defines the level of care and determines the daily reimbursement rate.

If you have any questions on completion of the MDS, please direct your questions to the MDS RAI Coordinator. 

If you have questions on transmission of the MDS, please direct your questions to Meyers and Stauffer at 717- 541-5809.

Provider Action:

Ensure the information entered in the MDS is complete and accurate, and supported in the medical record documentation. 

References:

• Highmark Medicare Services FAQs
• CMS - Chapter 6 of the RAI Manual, MEDICARE SKILLED NURSING FACILITY PROSPECTIVE PAYMENT SYSTEM (SNF PPS)
• SNF Notice 06-001

Assistance:

If you have any questions regarding this bulletin, please contact the appropriate Customer Contact Center at:

Maryland/DC Providers: 1-866-488-0545
Pennsylvania Providers: 1-800-560-6170