Under PDPM reimbursement, your MDS nurse will be the person who ensures that your facility is paid for the care it provides. So what are the attributes of a good MDS nurse? In short, you should look for a person who derives emotional pleasure from both providing care and saving money. An MDS nurse loves detail, is uber-organized, will speak up when they need something or something needs to be corrected, and can, at times, be aggressive in securing reimbursement. Here are the seven attributes to look for in an MDS nurse:
1. A Strong Grasp of What Impacts PDPM Reimbursement
When it comes to documenting care, an MDS nurse must know the rules as they pertain to PDPM reimbursement. Take this example: in triple-check meetings, the MDS nurse will be the one to remind other team members as to how many more days a particular resident is covered under Medicare. This can get complicated if a resident stays for a certain period—say, 30 days—then returns home, then spends a week in the hospital, and finally returns to the long term care facility. In this case, the MDS nurse must know to begin counting from the 31st day. Or it may be the case that a resident already spent 60 days in another nursing home. Your MDS nurse must know to start counting from day 61.
During the interview process, you should get an understanding of the potential MDS nurse’s mastery of PDPM reimbursement. Questions to ask include:
- “What catches reimbursement?”
- “Did your previous facility have any survey tags?” If they did, indeed, have care plan tags, that is cause for concern. You should then look up their previous facility on the CMS site.
- “How much money was your previous facility making?” You can also ask about case mix index scores.
- “How do you see your relationships with other care plan team members? What are your expectations of the MDS team?” Here, the candidate should indicate how he or she will ensure that others perform their duties in relation to MDS and what he or she will do when they fail to do so. What you do not want is for your MDS nurse to carry the burden of writing care plans for others, like the dietary manager, and then not reporting that. Rather, the MDS nurse must ensure that each does his or her job as opposed to bearing too much responsibility and becoming overwhelmed.
2. Sufficient LTC Experience
In addition to experience on the floor, an MDS nurse will need certification from the American Association of Nurse Assessment Coordinators (AANAC) in addition to sufficient LTC experience. This certification requires first taking part in a two-week course and then passing the relevant exams. Still, though, that will not be enough experience. In fact, it takes about six months on the job to even understand the basic functions of an MDS nurse. And it takes between one and two years to become a semi-expert even after the initial MDS nurse training. This is, in part, because learning how to calculate PDPM reimbursement is not just about knowing the rules. Rather, one must have a firm grasp of the various systems involved in PDPM reimbursement at one’s particular facility. While some may search for a PDPM cheat sheet, really all that means is learning the appropriate codes. The real challenge, though, is knowing how to get the information that you need.
3. Computer Skills In Keeping with the Role of an MDS Nurse
Your MDS nurse will spend a large portion of his or her day behind a screen documenting care in the long term care software system for the purpose of reimbursement. That means, this individual will not only need to know the basics of using a computer—clicking, moving a cursor, typing at a reasonable speed—but also how to enter information into spreadsheets, charts, or even more advanced systems that are part of a long term care EHR.
4. Knowledge of the Clinical Side As It Relates to PDPM Reimbursement
It probably goes without saying that an MDS nurse must be a good clinician in order to be able to write a care plan. He or she must know how to implement the standard of care expected at your facility. It may be difficult to determine whether one is not able to fulfill these duties during the hiring process, as those in such a position are generally experienced in the clinical side of care. However, if, after hiring an MDS nurse, your rates begin to drop, this could be on account of a deficiency in understanding your care plan.
5. A Love for Organization
An MDS nurse is very organized, perhaps even obsessively so. One tactful question to ask a potential MDS nurse during the hiring process is: “How do you feel about office supplies stories?” If they love pins and binders, that is a good sign.
6. People Skills
Your MDS is a manager, which means he or she must be personable, affable, and comfortable communicating what they need from others. You can test candidates by asking conflict questions. Here are some examples:
You say: “Imagine you’re trying to get information from your nurse aides for a particular resident, but they keep saying they’re too busy to provide it. How do you handle the situation?”
An appropriate answer would be: “I’ll tell the CNA to call me when he or she is with that resident.”
You ask: “What do you do when you’re not getting the documentation you need in your long term care software?”
A good answer would be: “If the issue is with just one staff member, I’d talk to him or her individually. If it’s a bigger problem, I’d talk to the DON.”
A follow-up to the previous question could be: “What if the DON doesn’t respond or make himself/herself available?”
An appropriate answer would be: “I’ll escalate the situation and take the issue to the nursing home administrator.”
7. Leadership Skills
If you are considering an internal candidate, you will want to look for someone who is a leader on the floor and embraces that role. This person will do his or her job well, understand surveys, and know how the systems work. The advantage of hiring from within is that this future MDS nurse already knows your systems, is familiar with your software, and has built a rapport with your staff, meaning, he or she is more likely to be able to get the documentation they need to enter in their nursing home software from other team members.
So how do you see if someone has become a strong leader? You should ask yourself:
- Do they like taking on new projects?
- How do they interact with residents?
- To what extent are they familiar with the facility’s policies?
- Do they have a vested interest in the facility?
- Are they respected by their coworkers?
- Do they work in a timely fashion?
During the interview process, you can test the individual by asking them to resolve a tense situation. For instance, you may say: “Tell me about tense situations. Imagine you have ten admissions and are overwhelmed. How do you manage that situation?”
A good answer would be: “I would look at how I could schedule those MDS assessments in the long term care software system so that they don’t all fall on the same day. Another appropriate answer would be: “I would ask for help if I needed it.” In essence, you want someone willing to accept they cannot shoulder the entire burden of MDS assessments. For instance, they may have to ask the DON to administer the BIMS this week.
The Timeline of an MDS Nurse in Training
If you decide to promote an RN or LPN to the position of MDS nurse, you will need to invest in specialized training for them. It will take about six months for one in training to simply understand the basics and about a year until you no longer have to monitor them to make sure they are not leaving money on the table. An MDS nurse will not be an expert, though, until about five years on the job.
Before a nurse receives his or her official certification from the American Association of Nurse Assessment Coordinators (AANAC), you will want them to work under another MDS nurse for about three to six months. This, of course, will only be an option for facilities that have at least two MDS nurses on staff.
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