DSHS is looking to pilot Case Mix Accuracy Reviews using remote access.  They will be sending out a dear provider letter soon asking for volunteers.  The process for this pilot is as follows – 

The CMAR Nurse will:

• Announce the CMAR visit to the facility administrator (or designee) by telephone and email and conduct the entrance conference over the telephone, requesting:
  • Census data and staff contact information
  • Electronic health records (EHR) access and copies of other records that supports MDS coding
• Conduct record review off-site including completing a QAN protocol on 3 sample residents
• Interview staff by telephone so the facility may:
  • Provide missing documentation, and
  • Discuss MDS coding discrepancies
• Summarize CMAR inaccuracies, QAN protocol information and email summary documents and evaluation to the facility
• Schedule an exit conference with facility staff via Zoom or other mutually accessible electronic media to:
  • Review the CMAR and QAN reports
  • Elicit provider feedback regarding the off-site Modified CMAR visit and garner suggestions for improvement
  • The provider will email securely the signed CMAR Report and the Off-site CMAR visit evaluation form.

The timeline for this pilot is –

1. Recruit volunteers and selection process by August 1, 2020
2. Conduct the CMAR pilot August 1 through August 31, 2020
3. Collect and analyze evaluations early September
4. Report back to stakeholders results of the CMAR off site pilot and determine next steps mid- September 2020.

We have many concerns about this remote CMAR process and have communicated with DSHS regarding them.  Some of our concerns are –

1. How many providers are you needing to volunteer in order to determine if the pilot is a success?
2. What is your plan if you do not get enough providers to volunteer?
3. What criteria are you looking at to determine if the pilot is a success?
4. Some facilities do not employee full time IT staff to grant remote access, how will that be handled?  There could be extra costs associated with this.
5. Some facilities do not have remote capabilities, how will that be handled?  There could be extra costs associated with this.
6. How will you ensure that once remote access is granted, it is revoked once the review has been completed?
7. When a CMAR nurse finds an item that has been miscoded, what happens next?  There is some concern that any miscoding will be reported to the hotline as fraud.
8. How will you assure that CMAR notifies provider of entry and exit times and that no off-hours are used to enter data/ software?
9. How will you ensure that CMARs are trained and familiar with all software vendors programs, without using time of provider/staff to navigate and train on software and data?
10. For providers who are not yet paperless, how will CMARs complete a thorough review without utilizing time of facility staff?

We recommend that providers consider all the ramifications of this remote CMAR review in the middle of the COVID-19 pandemic before agreeing to participating in this pilot.

Questions? 

Contact:

David Carter | Director, Health Care Finance & Policy

C 360.888.5702