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
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MDS Automation Coordinator608-212-0385For technical/automation questions related to submitting MDS records, interpreting validation report messages, and generating CASPER reports.
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RAI Education Coordinator920-360-6102For questions on the RAI, coding MDS items, or clinically related.
CMS RAI/MDS Items
- The MDS 3.0 RAI Manual (PDF) is available under the Related Links area of the CMS MDS 3.0 RAI Manual webpage.
- The MDS 3.0 Final Item set v1.17.2 dated October 1, 2020, is available under the Downloads area of the CMS MDS 3.0 RAI Manual webpage.
- The MDS Item Sets and Data Submission Specifications are available for download from the CMS MDS 3.0 Technical Information webpage.
Wisconsin RAI/MDS Items
- Preadmission Screening and Resident Review (PASRR)
- MDS 3.0 Section Q Referral Process
- Wisconsin does not have a Section S for MDS 3.0
- Wisconsin does not require the submission of State Optional items.
- Wisconsin will not require the completion of the Optional State Assessment (OSA).
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
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July 7, 2021, recording - Agenda (PDF) Slide Presentation (PDF)
A special thanks to everyone who participated in the Jeopardy Game!- Miranda - 5400
- MD - 2800
- Dina - 2600
- May 6, 2021, recording - Agenda (PDF) Slide Presentation (PDF)
- Note: A correction was made to Slide 8 of the presentation for Emergency Blanket Waivers.
- January 20, 2021, recording - Agenda (PDF) Slide Presentation (PDF)
- October 28, 2020, recording - Agenda (PDF) Slide Presentation (PDF)
- July 29, 2020, recording – Agenda (PDF) Slide Presentation (PDF)
Training
- CMS MDS 3.0 Training
- Quality, Safety & Education Portal (QSEP)
- CMSHHSgov YouTube Channel
- An interactive training video on Section M: Skin Conditions is available in QSEP
- Section GG MDS 3.0
- CMS Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Training provides links to trainings such as:
- Cognitive & Mood Assessment
- Achieving a Full Annual Payment Update (APU)
- Section J
- Section N
- Section GG
- DHS Nursing Home Pressure Ulcer Information
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.
- Software (jRaven)
- Reference & Manuals
- Training
- Access Forms
- FAQ
- Important Links
- Appendix A-Quick Reference (PDF)
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
- The MDS 3.0 Quality Measure User's Manual is available under the Downloads area of the CMS Quality Measures website.
- Section 11 of the CASPER Reporting Users Manual provides information for how to generate the MDS 3.0 Quality Measures reports.
- Medicare Nursing Home Compare
- CMS Five Star Rating System
- CMS Nursing Home Quality Initiative
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Measures and Technical Information
- CMS Nursing Home Quality Assurance & Performance Improvement (QAPI)
- Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Public Reporting includes information for Provider Preview Reports
Payment Information
Medicare Payment Information
- CMS SNF PPS
- Patient Driven Payment Model
- Medicare Benefit Policy Manual Chapter 8 (PDF)
- Medicare Claims Processing Manual Chapter 6 (PDF)
- National Government Services - Medicare claims
- Skilled Nursing Facility Value-Based Purchasing (SNF VBP) Program
Medicaid Payment Information
- MDS 3.0 Section Z items Z0200 and Z0250 are not required to be coded and may be left blank.
- Wisconsin Medicaid uses the MDS 3.0/RUGS IV-48 classification system for Medicaid residents.
- Forward Health Update 2021-22 Nursing Home Acuity-Based Billing (PDF)
Additional CMS Resources
- Skilled Nursing Facility Center
- SNF/Long Term Care Open Door Forum
- CMS SNF Consolidated Billing
- Nursing Home Certification and Compliance
- State Operations Manual (SOM) and SOM Table of Contents (PDF)
- CMS Form 672 Resident Census and Conditions of Residents (PDF)
- CMS Policy & Memos to States and Regions
- CMS Staffing Data Submission PBJ (QTSO Reference & Manuals webpage)
- Medicare Learning Network
Additional Resources
- DQA Email Subscription Service (Listserv)
- The Clinical Resource Center (CRC) was designed by the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin – Madison. The project was jointly sponsored by the Wisconsin Health Care Association (WHCA/WiCAL), LeadingAge Wisconsin, and the Wisconsin Department of Health Services. The CRC website is designed to provide key information and resources about clinical care for staff members caring for residents living in long-term care (LTC) facilities.
- Metastar - Wisconsin's Quality Improvement Organization
