RAI/MDS 3.0 Information

New Billing Requirements

Effective for dates of service on and after January 1, 2022, providers must submit claims using the HIPPS codes in Form Locator 44 (HCPCS/Rate/HIPPS Code) of the UB-04 claim form. This billing requirement is already in place for Medicare.

 

This page provides links to information pertaining to the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS) 3.0. Many of the links on this webpage will exit the Wisconsin Department of Health Services (DHS) website.

Wisconsin RAI/MDS Contacts

  • MDS Automation Coordinator
    608-212-0385
    For technical/automation questions related to submitting MDS records, interpreting validation report messages, and generating CASPER reports.
  • RAI Education Coordinator
    920-360-6102
    For questions on the RAI, coding MDS items, or clinically related.

CMS RAI/MDS Items

Wisconsin RAI/MDS Items

Provider Education

RAI/MDS Educational Forum

The Division of Quality Assurance (DQA) sponsors a quarterly educational forum to assist in keeping nursing homes updated with evolving RAI/MDS information and to provide an avenue for nursing home staff to ask RAI/MDS-related questions. The forum is hosted jointly by DQA's RAI/MDS Education and Automation Coordinators.

Attend the RAI/MDS Educational Forum
  • Join Zoom forum (select this link to go straight to the room without needing to enter the meeting ID and password)
    • Meeting ID: 942-2027-1641
  • Join by Phone: 312-626-6799
    • Enter 94220271641# when asked for the meeting ID
    • Enter # if asked for participant ID
Previous Forums
Training

Technical Resources

Only OBRA and Medicare PPS Assessments are Allowed to be Submitted

Only MDS 3.0 assessments that are OBRA assessments or Medicare Part A PPS assessments should be submitted to the QIES ASAP MDS System. Assessments completed for Medicare Advantage Plans or for other insurance purposes should not be submitted. Additional information related to Transmitting MDS Data is identified in Chapter 5 of the MDS 3.0 RAI Manual (PDF).

OBRA assessments are required to be completed and submitted for all residents regardless of payer source.

MDS Correction Policy

The MDS correction policy is described in the MDS 3.0 RAI Manual (PDF) under Chapter 5.5 MDS Correction Policy.

QIES Technical Support Office (QTSO) Submission Information and User's Guide

Providers, vendors, state agency and regional office personnel, and other organizations performing Survey & Certification functions will find technical guidance such as references & manuals, software tools, and training materials on the QTSO website.

CMS User Account Registration

QTSO is moving towards a single sign-on option to access the secure side of the website. Providers will need to register for a Health Care Quality Information Systems (HCQIS) Access Roles and Profile (HARP) account.

All providers must request a CMSNet User ID to access secure CMS websites for submissions and reports unless an otherwise secure connection has been established. Account registration instructions are located on the QTSO MDS Individual Access webpage.

Please reference Certification And Survey Provider Enhanced Reports (CASPER) Reporting User's Guide For MDS Providers for information on creating a CASPER account.

Quality Improvement

Payment Information

Medicare Payment Information

Medicaid Payment Information

Additional Resources

Last Revised: September 17, 2021