Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.10 - Nursing Facility Services
Section 10.09.10.14-2 - MDS Validation and Ventilator Care Validation for Rates Effective January 1, 2015
Universal Citation: MD Code Reg 10.09.10.14-2
Current through Register Vol. 51, No. 19, September 20, 2024
A. MDS Validation.
(1) In order to validate that the
Nursing Service rate is supported by medical record documentation, accurately
coded and submitted, the Department shall conduct periodic MDS validation
reviews, which shall:
(a) Compare the MDS
assessment coding with the corresponding medical record documentation to
determine unsupported MDS assessments;
(b) Determine the completeness, timeliness,
and accuracy of resident MDS assessments identified on the resident roster;
and
(c) Determine the completeness
and accuracy of the resident payment source listed on the resident
roster.
(2) Findings
from the MDS validation may be used to adjust a nursing facility's per diem
payment rate to reflect the validated case mix index used in the rate setting
process.
B. Ventilator Care Validation.
(1) In order to validate
that days paid for residents that meet the requirements for ventilator care are
supported by medical record documentation of the need for ventilator care
services, the Department shall conduct a periodic ventilator care
validation.
(2) Findings from the
ventilator care validation shall be used to recoup payments for days not
supported by medical record documentation.
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