Published October 4, 2018

So, your QRP Review and Correct Report shows >80% compliance but CMS is still penalizing you with a 2% reduction in APU?

Getting your arms around the QRP data, the Review and Correct Reports and figuring out what needs to be done with the MDSs flagged with incomplete data is not an easy task! A few points to make. First, don’t be misled into thinking you will escape the 2% reduction because your Review and Correct report shows >80% compliance!

Understand that QM performance score (reported on the Review and Correct Report) is not the same as the APU compliance score that CMS uses for the >80% threshold.  The QM performance score is nothing more than the number of “SNF stays” that trigger the measure. The denominator for the APU compliance score is based on qualifying PPS 5 Day and Part A PPS Discharge assessments for Medicare A stays in the collection period. The numerator is the number of those assessments in the denominator that did not supply sufficient QRP data.

So, if you can’t rely on your Review and Correct report to ensure APU Compliance that meets or exceeds the 80% threshold set by CMS, what do you do?

First, review the MDS Validation Report after each MDS submission, identify any PPS 5 Day or Part A PPS Discharge assessments that have missing data in the QRP required MDS items and take appropriate corrective actions.

Second, consider running the MDS Error Report from CASPER monthly. This will provide further details of any assessments with missing data including those items required for the QRP measures. Again, take corrective actions timely.

Some of the more common problems we are finding include:

• 5-day PPS assessments for Medicare Advantage recipients are being submitted into QIES and inappropriately being factored into the APU Compliance calculation.
• Failure to dually code a Discharge Record as a Part A PPS Discharge may result in miscoding of QRP items.
• A0310G (Type of Discharge) is coded as planned when the discharge was unplanned.
• QRP items are left blank or inappropriately “-“ filled.

This last quarter of 2018 will be especially challenging to SNF’s with the addition of new QRP items in Section GG and N.

Coretactics will be providing updates specific to the QRP Measures so please be sure to visit our blog regularly for further information. We also recognize these challenging times so please don’t hesitate to reach out to us for assistance or if you have any questions.

Visit CMS for additional references on the SNF QRP Measures.

Sarah Ragone, MSPT, RAC-CT
VP of Reimbursement & Education