The following notice posted by Texas DADS could prove useful to providers nationwide, Texas DADS revised the notice on Feb. 7, 2013:
Minimum Data Set (MDS) 3.0 – Item A0410 Clarification
On a Jan. 15, 2013 national conference call, the Centers for Medicare & Medicaid Services (CMS) staff reiterated that MDS 3.0 item A0410 must be coded correctly.
Coding instructions for item A0410 are on page A-9 of the MDS 3.0 RAI Manual.
In all states, item A0410 must be set to “3″ (federal required submission) when a resident is in a Medicare or Medicaid certified bed, regardless of whether or not CMS requires submission to the federal database.
In Texas, due to state reporting requirements, item A0410 must be set to “2″ if an MDS record is an OBRA assessment, entry tracking record or discharge record for a resident on a unit that is not Medicare or Medicaid certified. Otherwise, item A0410 is set to “1″ for Medicare Prospective Payment System (PPS) assessments and Other Medicare Required Assessments (OMRA) for a resident on a unit that is not Medicare or Medicaid certified.
CMS staff is aware some MDS support staff recommend setting A0410 to a “1″ when Medicare PPS MDS assessments are completed for private insurance (e.g. Medicare Advantage, Tricare, etc.). Sometimes miscoding A0410 is recommended incorrectly to comply with the requirements from page 5-1 of the MDS 3.0 RAI Manual, “Required MDS records are those assessments and tracking records that are mandated under OBRA and SNF PPS. Assessments that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted, e.g., private insurance, including but not limited to Medicare Advantage plans.” Then, if the MDS record was accidentally submitted, A0410 is set to 1 so the MDS record would be purged from the federal database.
However, CMS staff clarified that A0410 must be set based only on the bed certification status. MDS software vendors and nursing facility staff must develop a method other than miscoding A0410 to keep private insurance MDS records from being submitted to the federal MDS database.