In order to manage some of the most difficult coding items accurately, it’s necessary to look at all the CMS documents and put the instructions together. However, after reading the errata, clarifications or manual, staff may still have questions regarding how to code or schedule an MDS. In these situations, CMS wants providers to contact their state RAI coordinator instead of contacting the central office directly. The hope is that this will yield faster, more consistent responses to questions. Each state has an RAI coordinator, whose contact information is found in Appendix B of the RAI User’s Manual. If the state RAI coordinator is unable to answer a provider’s question, then the RAI coordinator will refer it to the RAI panel, which is a committee composed of state RAI coordinators. After these steps have been taken, the question may go to the CMS central office staff.
For questions regarding Medicare billing or claims processing, CMS instructs providers to contact their fiscal intermediary (FI) or Medicare administrative contractor (MAC) first, because the FI/MAC will be reviewing the claims. During the May Open Door Forum, officials stated, “If the FI or MAC is unsure of the policies or unsure of how to respond to a given question, then that question would then get referred to the [CMS] regional office for that area. Any questions that the regional office might have that they are unaware of in terms of an answer would then get referred to central office.”
Every day, AANAC members grapple with these and other issues in our online community. Our nationally recognized MDS content experts can clarify the regulations and help members understand them. For more information on receiving expert assistance, please visit http://www.aanac.org.
Judi Kulus is the vice president of curriculum development for the American Association of Nurse Assessment Coordination (AANAC). She can be reached at email@example.com.