“I

want to go up to be an MDS coordinator!” That is not a phrase that I have ever heard. Have you? But career paths take us many places. That is the beauty of nursing. We can pick and choose our fields and places to work as easily as changing the channels on the remote.
       Minimum Data Set (MDS) coordinators became an entity when the MDS was mandated by the Omnibus Budget Reconciliation Act of 1987. The extra time it takes to complete an MDS was delegated to a Director or Nursing (DON), registered nurse (RN), or charge nurse. The coordinator of the team made sure that the assessments were completed and care plans initiated. In many institutions, the MDS coordinator is responsible for completing the paperwork for 40–120, if not more, residents.
       Systems development is the beauty and art of the MDS coordinator, record keeping one of his or her primary responsibilities. How great it is to tweak or develop our own systems for completing all the paperwork needed to do our jobs?
       Do you have a mentor? A consultant? The previous MDS coordinator? Every building has a pulse. What was the process before, and is it working? The MDS coordinator and supervisor need to find what works in each building. Each MDS coordinator works under a different supervisor with expectations of his or her own. Although there may be one supervisor, most MDS coordinators also report indirectly to other supervisors. Many MDS coordinators have “other duties as assigned.” Make sure that priorities are set forth. First is completing the process of assessments and directing care. As one can see, working closely with nursing management for documentation and implementation of care can be seamless.
       We all know that in healthcare, and long-term care specifically, nurses and other staff members in the field move around for various reasons. What worked in one building may not work in another. Conversely, the MDS coordinator brings along new ideas that may streamline work and improve resident care.
       How does one become an MDS coordinator? The government states that the MDS coordinator must be an RN. However, many licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) assume the role, with an RN signing MDS sections R2 and VB2. The MDS coordinator’s role may be incorporated into the DON or Assistant Director of Nursing (ADON)’s role. Many see the MDS coordinator as one who is highly organized and detail-minded. It is well known that a good MDS coordinator is worth his or her weight in gold. Because this is such a valued position, it behooves the facility to treat that person well.
       How can you be the best MDS coordinator your facility has ever had? Know your job. The MDS coordinator coordinates the dates of when the next MDS is due. Have a fail-safe system. Set care plan dates appropriately. As part of Quality Assurance, make sure documentation is in place for all aspects of the assessment and resident care. Work with the DON and staff development coordinator (SDC) to make sure the nursing staff is documenting whatever they need to document.
       The MDS manual states, “Medicare and Medicaid-participating long-term care facilities are required to conduct comprehensive, accurate, standardized, and reproducible assessments of each resident’s functional capacity and health status.” Furthermore, “This system will collect the minimum amount of personal data needed to accomplish its stated purpose. MDS information may also be necessary for the nursing homes to receive reimbursement for Medicare services.”
       Meet deadlines. If you are responsible for the assessments, complete them on time. Make sure the team completes their assessments on time, too. Work with your supervisor if there is a problem regarding time management.
       Completing work without someone having to ask for it is always the best practice. If an MDS needs to go on the chart, make sure it gets there. You never know when a surveyor will come in, and you are expected to have everything in perfect order on the chart.
       How often do you get to speak to nursing students? Many nursing students complete part of their training in the nursing home. The MDS coordinator may be asked to present information about the MDS. When asked by elementary, middle, and high schools to present on career day, I will mention what I specifically do for a living, although my emphasis is clearly on being a nurse and what I get out of it. The goal here is usually to enlighten children on healthcare fields and the choice of nursing as a career.
       Are you called a resident assessment coordinator (RAC)? This term has also come into popularity. Which does your organization prefer?
       Are you certified? Several courses are offered across the country, and some even offer online information on accurately completing the MDS. Although it may be time-consuming and costly, it would behoove MDS officials to look into credentialing.
       In conclusion, the MDS coordinator is a unique individual who enjoys not only the clinical aspects of his or her job but also the technical duties of coordinating a team of professionals and completing the paperwork.

Questions and Answers

       Question: The 9 new Resource Utilization Groups (RUG) levels mean new calculations. What are the criteria for getting a higher RUG level? And what does it mean to the facility? (registered nurse, Wisconsin)
       Answer: Higher reimbursement for selected residents with rehabilitation therapy and direct nursing care, along with reimbursement for the cost of nontherapy ancillary services. There are 5 items that will bring a higher RUG level for the facility. These are intravenous (IV) fluids in the last 7 days, or, in the last 14 days, IV medications, suctioning, tracheostomy care, or ventilator/respirator. For more information, go to http://www.cms.hhs.gov/providers/SNFPPS and click on “RUG-53 Education Material.”
       Question: What is the process for selecting an admission Assessment Reference Date (ARD) for long-term residents? (registered nurse, Mississippi)
       Answer: As the MDS coordinator, you may set a standard date for any new admissions to long term care. This way, a system is set up for all team members to know when a date is selected as a rule. Some MDS coordinators set up 5 days, 7 days, and even 14 days to complete the MDS, then complete the RAPs by day 14. Make sure you have enough time to complete the MDS and RAPs by day 14, of course. Another factor is your workload. Additionally, seasoned MDS coordinators plan for vacations dates with flexibility to meet compliance and completion of the regulations. Know your facility, and see what works best with your residents and team members.
       Question: What do I do about interruptions? I cannot seem to finish my resident assessment protocols (RAPs) in one sitting! (licensed practical nurse, New Mexico)
       Answer: This is a common problem. Finishing RAPs in one session ensures completion and efficiency. Finding a quiet time to complete one’s work is of utmost importance. I suggest closing one’s door and asking not to be disturbed.

MDS News

       By now, everyone has completed Section W for residents for the administration of the influenza and pneumococcal vaccines. This is a good Quality Indicator (QI) for your facility. Certainly, a record of administration helps the facility keep track of compliance as stated in the new guidelines from the Centers for Medicare & Medicaid Services (CMS).
       New RUG levels help the facilities with reimbursement issues. It is now of even greater importance to have medication administration records and information on the hospital course to capture IV medications, suctioning, tracheostomy care, or ventilator/respirator use. Direct nursing care and the cost of nontherapy ancillary services are now factored into the new RUG levels and reimbursement. For more information, visit http://www.cms.hhs.gov/QuarterlyProvider Updates/OCT2005/list.asp#TopOfPage, which is the CMS Quarterly Provider Update for October 2005. Click on “Medicare Claims Processing Manual, Transmittal Number 630: Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update and Health Insurance Prospective Payment System (HIPPS) Coding Update Effective January 1, 2006.” Although 30 pages long, it will give you information on the hierarchy for the 53-group RUG-III coding system (formerly a 44-group RUG-III coding system).