June 2, 2016

Nursing Summary Tips:Top 10 Management Minutes Questionnaire

Kris B. Harmony, OTR/L, LNHA, MBA

Kris B. Harmony, OTR/L, LNHA, MBA

Discussions of a MDS based Massachusetts Medicaid Reimbursement System seem to wax and wane every year.   The MMQ (Management Minutes Questionnaire) system remains with fewer experts available to help providers navigate through the nuances of accurate and appropriate levels of compensation.

Through our state wide audits, Kris B Harmony is sharing tips that may be useful for your staff.  Nursing summaries have opportunity to better depict the amount of assistance provided by staff along with more support for resident diagnosis and resident dysfunction.  

Nursing summaries must be completed prior to the 5th of the month following the documentation month.  The nursing summary, in conjunction with all of the other narratives in the medical record, must contain supporting documentation to support the final MMQ level of reimbursement. 

The following list provides you with the Top 10 areas of nursing summary errors or conflicts that result in a loss of reimbursement on audit:

1.  Late Completion/Missing:  Nursing summary must be completed within 5 days of the end of the month.

2.  Alterations:  Any changes to entries in the medical record must be initialed and dated leaving the original entry legible. Only the Nurse who made the original entry may change that entry. Late entries, for the purpose of correction, must be made within 15 days of the original entry. All corrections must be complete prior to submission of the MMQ.

3.  Level of Care Discrepancy:  Summary does not reflect the level of care provided (Nursing Aid ADL Flowsheets, Nursing Treatment Sheets and Behavior Sheets etc.) Skilled observation should include date of last episode within 60 days. Exact dates and description of skilled procedures must be recorded for greater than 15 days. Behaviors must include the number of times.

4.  Care Not Received for 15 Days:  A resident's condition and care requirements must be documented for at least 15 days of the documentation month in order to justify a claim for services.

5.  Conflicting Documentation:  The resident's score and category are based upon the services rendered and recorded through Nurse and Nurse Aide documentation. When conflicting documentation exists between the Licensed Nurse and the Nurse's Aide, the lesser point value will be applied.

Common Conflicts that lead to point reductions on audit: 
•  Fifteen days of care must be provided in order to capture points for MMQ.
 The nursing summary must support the care provided.
•  Early completion of the nursing summary may not support 15 or more days of care provided if the additional care was provided after the completion of the Nursing Summary.

For example, a patient that received 2 assist for positioning episodes for 15 days the entire time in bed or chair in the month of July between the 15th and the 30th, may not be supported in the documentation if the summary was completed on July 18th.

6.  Reason/Diagnosis Clarification:  Documentation for assistance and or dependence with ADLs must be associated with resident dysfunction, and the reason given must relate to this dysfunction. The reason given must support the level of care provided. Diagnosis must support reason and level of care.

7.  Skin Risk Assessment:  The Braden, Norton, or Norton Plus Scale must have been completed within the previous 90 days. The score must be recorded on the Nursing Summary. The skin risk assessment must not conflict with any other documentation. Previous skin breakdown or risk assessment of less than 15 must be present to support decubitus prevention.

8.  Signature:  Nursing Summaries must be signed by the Nurse completing the summary. Only Nurses involved in the patient’s care can complete a nursing summary. The MMQ Nurse must not complete nursing summaries. An unsigned nursing summary is considered not complete and will result in loss of all points on audit.

9.  Date:  The Nursing Summary must be signed and dated by the Nurse completing the nursing summary. Incorrect months or years will not be accepted. An undated nursing summary is considered not complete and will result in loss of all points on audit.

10.  Corrections may be made to the nursing summary.  However, they must be made prior to submission of the MMQ.  All corrections must be crossed out with a single line. The original entry must be legible. The error must be initialed and dated. Only the original writer can correct the original entry 

Kris B Harmony recommends that the MMQ Nurse review each Nursing Summary every month, not just the documentation month, to allow time for corrections prior to submission, as well as to assist in the identification of ADL changes that can be a potential MDS Significant Change in Status. 

We hope you find these tips useful! If you have questions about MMQ, please contact Kris B Harmony by clicking here or calling our office at (617) 595-6032. 

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