DAVE and MDS Errors, LTCS Article

In January of 2004, CMS launched its national data surveillance program to assess the MDS data, resident care, and reimbursement rates of long term care facilities. CMS states that the primary objective of the project is to improve the accuracy of the MDS data that facilities transmit.

Analysis of assessment and Medicare claims data to identify national, state, and provider patterns and trends. This information will be used to select facilities for further review activities and to identify educational needs.

Based on data analysis, the DAVE team may request that a facility submit copies of medical records for a period associated with a particular Medicare SNF stay. The offsite review may lead to a decision to visit the facility to gather more data.

If a facility is selected for an onsite review, the Dave team will notify the facility several days in advance, and provide an informational packet outlining the review process and what material they will need when they arrive. The review will be conducted by two DAVE RNs. They will evaluate a resident who has been recently assessed by the facility, and compare their assessment to the one performed by the facility.

These consist of national conferences, satellite broadcast training, bulletins, and tip sheets. Also, the DAVE team provides individualized training for facilities through the use of reports and onsite review exit conferences. The DAVE Bulletin from March, 2004 states that future training materials will be based on the MDS items that are found to have the greatest potential of discrepancies.

More information about the DAVE project, and links to the DAVE Bulletin and Tip Sheet can be found at:

In its March, 2004 Bulletin, the DAVE team reports that it found the most common discrepancies in these MDS sections:

Discrepancy Report
DAVE Satellite June 20, 2003

MDS Section	Item Description	Most Frequent Reason for Discrepancy
Section AA	Identification Information	Facility Data Entry Error
Section AB	Demographic Information
Section AC	Customary Routine
Section AD	Face Sheet Signatures
Section A	Identification and Background	Advance directives in record but not coded. Inaccurate payment information coded.
Section B	Cognitive Patterns	Contradictory information. Full look back period not used.
Section C	Communication/Hearing Patterns	Hearing aides, communication devices and resident's ability to understand others are not coded.
Section D	Vision Patterns	Visual appliances are not coded.
Section E	Mood and Behavior Patterns	Indicators of depression, anxiety, sad moods that occur only once or twice in the past 30 days, are not coded. Contradictory information.
Section F	Psychosocial Well-Being	Contradictory information.
Section G	Physical Functioning and Structural Problems	ADL coded to reflect better than actual performance. Full look back period not used, e.g., all three shifts.
Section H	Continence in Last 14 Days	Failure to code regular bowel elimination pattern.
Section I	Disease Diagnoses	Diseases not relevant to current functioning and care plan are coded.
Section J	Health Conditions	Inaccurate coding of pain symptoms and site. Falls not coded.
Section K	Oral/Nutritional Status	When intervention in place, swallowing and chewing problems are not coded. Weight from last assessment is coded instead of an accurate weight for most recent 30 days.
Section L	Oral/Dental Status	Dentures and/or removable bridges not coded.
Section M	Skin Condition	Incorrect staging of wounds. Coding stasis ulcers as pressure ulcers.
Section N	Activity Pursuit Patterns	MDS and activity documentation conflict.
Section O	Medications	Mis-counting the number of different medications used in the last 7 days. Mis-counting the number of days injections were received in the past 7 days.
Section P	Special Treatments and Procedures	Miscalculation of rehab minutes. Coding nursing rehab/restorative care that does not meet criteria. Not capturing special treatments, procedures and programs in the last 14 days. Restraints not accurately coded. Hospital stays, physicians visits and physicians orders not accurately coded.
Section Q	Discharge Potential and Overall Status	Inconsistent documentation regarding discharge potential.
Section T	Therapy Supplement for Medicare PPS	Section is left blank on a Medicare readmission/return assessment. Minutes and days are miscalculated

More information about MDS procedures and regulations can be found in the books:

Discrepancy Report DAVE Satellite June 20, 2003

Discrepancy Report
DAVE Satellite June 20, 2003