Failure to Submit Required MDS Assessments Due to Incorrect Unit Certification Entry
Penalty
Summary
The facility failed to submit six completed Minimum Data Set (MDS) assessments for one resident, despite being dually certified for Medicare and Medicaid for all beds. Review of the electronic health record and MDS detail listing showed that multiple assessments, including annual, quarterly, and admission assessments, were completed but not submitted to the Centers for Medicare and Medicaid Services (CMS). Staff interviews revealed that the MDS Coordinator incorrectly identified the unit as neither Medicare nor Medicaid certified in section A0410 of the MDS, which led to the system indicating that MDS data submission was not required. This error resulted in the assessments not being transmitted to the state or CMS as required. Further interviews with facility staff, including the Business Office Manager and Director of Nursing, confirmed that the facility is certified to participate in both Medicare and Medicaid programs and that the RAI manual is followed for MDS completion and submission. However, the MDS Coordinator acknowledged the mistake in the certification designation and confirmed that six of the seven required MDS assessments for the resident had not been submitted. The RAI manual specifies that all required MDS records for residents in Medicare- or Medicaid-certified beds must be submitted, regardless of payer source, which was not followed in this instance.