TIP OF THE WEEK

IV fluid administration for nutrition/hydration (K5a)

 

Whether a resident receives IV fluids administered continuously or intermittently for nutrition and/or hydration during the seven-day look back period is indicated in K5a of the nursing home MDS. The options for selection include:

• IV fluids or hyperalimentation, including total parenteral nutrition (TPN)
• IV fluids running at keep vein open (KVO)
• IV fluids administered via heparin locks
• IV fluids contained in IV piggybacks (IVP)
• IV fluids used to reconstitute medications for IV administration

Here are some of the most common replacement solutions, mineral salts, and vitamins used in IV fluid therapy for nutrition and hydration:

• D5W (5% dextrose in water) D5 ½ NS (55 dextrose in 0.45% normal saline) Normal Saline (0.9% sodium chloride)
• Ringers/ Lactated Ringers (differing solutions of sodium, chloride, potassium, and calcium)
• ANY composition of TPN
• Vitamins/multivitamins (Niacin, B6,B,K, Chromium, Zinc)
• Amino Acids
• Fat emulsions

Exclusions (do not code) include:

• IV medications
• IV fluids administered during chemotherapy, dialysis or as a routine part of an operative
• Diagnostic procedures or recovery room stay
• IV fluids administered solely as flushes

According to the RAI Users Manual, an IV solution containing medication, nutrients, and/or fluids for reconstitution can only be coded in item K5a ONLY IF there is supporting documentation that reflects an identified need for additional fluid intake for nutrition and hydration. There must be supporting documentation in the resident’s record that complies with state and internal facility policies.

 

References:

• RAI Users Manual, page 3-182, item P1a (c).
• Dave 2 Data Assessment and Verification May 2007 Tip Sheet

For help interpreting MDS coding instructions, contact Patsy Strouse, Ohio RAI/MDS Coordinator. Phone: 614-752-8285. Fax: 614-564-2596. E-mail: mds@odh.ohio.gov

 

If you require further assistance, you may submit your question to: mdsquestions@cms.hhs.gov

 

 

 

 

 

IN THE NEWS

 

MEDICARE/MEDICAID REVISIT FEES OVERVIEW

The 2007 Continuing Appropriations Resolution (Pub. L. No. 110-5, H.J.Res.20, §20615(b)(2007)) directed the Department of Health and Human Services to charge user fees necessary for conducting revisit surveys on health care facilities cited for deficiencies during initial certification, recertification, or substantiated complaint surveys. Revisit surveys are performed when there are findings of deficiencies in patient care or processes that were identified in an earlier survey and are conducted to assure that the deficiencies have been corrected. The primary purpose for the user fees is to provide for the continuation of Centers for Medicare & Medicaid Services (CMS) Survey and Certification quality assurance efforts to improve patient care and safety.

 

The fees were effective on September 19, 2007 until the end of the 2007 federal fiscal year, which concludes on September 30, 2007. CMS will use the current fee schedule until such time as a new fee schedule notice is proposed and published in final form. The final fee schedule for revisit surveys in skilled nursing facilities and nursing facilities is $168 per offsite revisit survey and $2,072 per onsite revisit survey. Hospice fees are $168 per offsite survey and $1,736 for onsite revisit survey.

 

Fees are based on the cost that CMS incurs as a result of the time and effort for State surveyors to conduct follow up as a result of deficiencies found. Providers and suppliers have the right to reconsideration if they feel an error of fact has been made in the application of the user fee, such as clerical errors, billing for a fee already paid or assessment of a fee when there was no revisit scheduled. A request for reconsideration must be received by CMS within 14 calendar days from the date identified on the revisit user fee assessment notice.

 

Providers who are assessed a revisit user fee will receive a notice in the mail which will include the amount of the assessed fee. Payment must be received within 30 days or CMS could terminate the facility’s enrollment and participation in the Medicare program. If you have additional questions, contact Carla.McGregor@cms.hhs.gov.

 

AT MANY HOMES, MORE PROFIT AND LESS NURSING

September 23, 2007 -- NY Times -- Private investment groups currently own approximately 10% of nursing homes in the U.S. As such investors have acquired nursing homes, they have often reduced costs, increased profits, and quickly resold facilities for significant gains. Read more >>

 

AGING IN PLACE SOLUTIONS TO BE HIGHLIGHTED IN EVENTS AROUND THE NATION, OCT. 1-7

September 20, 2007 -- PR Newswire -- Most Americans want to age in place. Current Census Bureau data tells us that over 90 percent of seniors who move stay within their county. Survey after survey tells us that a majority of those 65 and over -- say they would like to stay where they are for as long as possible. Read more >>

 

SCHIP PLAN TO FORGO MEDICARE CUTS

September 19, 2007 -- The Washington Times -- Congressional negotiators tentatively have agreed to avoid cutting funds to a Medicare program to pay for the expansion of a federally funded health care plan for low-income children, senior Capitol Hill aides say. Read more >>

 

STRICKLAND ORDERS UP HEALTH ADVISORY BOARD

September 18, 2007 -- Dayton Daily News -- Gov. Ted Strickland created a state advisory board aimed at reducing the growth in health care costs partly by improving the exchange of health information between providers and patients. The board's mission is to bring together representatives from the public and private sectors to work on health information technology issues and to coordinate that work with the Ohio Broadband Council. Read more >>

 

OIG RELEASES A NEW RESOURCE GUIDE ON CORPORATE RESPONSIBILITY AND HEALTH CARE QUALITY

September 10, 2007 -- OIG -- The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS), in partnership with the American Health Lawyers Association (AHLA), released a resource guide on quality of care entitled “Corporate Responsibility and Health Care Quality: A Resource for Health Care Boards of Directors.” Read more (PDF) >>
Download the resource guide (PDF) >>

 

 

 

OHIO KEPRO EVENTS

 

Guidelines and Coding for Restraints Teleconference

Featuring Carla Brumby and Patsy Strouse, Ohio Department of Health

November 8, 2007 1:00 p.m. to 3:00 p.m.

Dial-in: 1.877.339.0018, Conf ID: *4477925*

Download the Flyer (PDF)

 

 

INDUSTRY EVENTS

 

Preventing Pressure Ulcers IHI Teleconference

October 4, 2007, 1:00 to 2:00 p.m.

Dial: (800) 860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.

 

Preventing Adverse Drug Events (Medication Reconciliation) IHI Teleconference

October 9, 2007, 1:00 to 2:00pm.

Dial: (800) 860-2442. No PIN code is required.

Ask the operator to connect you to the Campaign Office.

 

Improving AMI Care IHI Teleconference

October 18, 2007, 1:00 to 2:00pm.

Dial: (800) 860-2442. No PIN code is required. Ask the operator to connect you to the Campaign Office.

 

Together We Make a Difference: Solutions for Senior Care 2007
October 5-7, 2007, Columbus Ohio
The conference features plenary sessions and didactic sessions on medical direction, physician-nurse practitioner collaboration, urinary incontinence, atrial fibrillation, appropriate medication prescribing, and the latest diabetic medications (Registration ends Sept 28, 2007). Contact Catherine Austin at (216) 778-8087, Executive Assistant of OMDA, for more details.

 

The Many Facets of Pain Management: An Integrated Approach

November 7, 2007, 8:00 a.m. to 4:30 p.m., MetroHealth Medical Center, Cleveland. Call (216) 778-7707 for more information.

 

Medicare Learning Network:
Learning resources and products for the healthcare professional.

 

Alzheimer’s Association Training Events

 

AOPHA Events

 

Case Western Reserve University School of Medicine Courses

 

Ohio Department of Health, Technical Assistance Program – New Programs

 

Ohio Health Care Association Events

 

 

 

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