RAC-CT 3.0MDS Coordinator/Reimbursement Nurse Specialist

tonyadagostino@gmail.com(585)233-4687

Tonya D’Agostino

1989 Graduate of Haverling High School – Bath, NY Graduated with a 3.0 GPA while working 3 part-time jobs Recognized in the 1989 Edition of Who’s Who Among High

School Students

1990 Graduate Patricia Stevens College – St. Louis, MO

Customer Service/Business Diploma

Work Experience 1989-1994 Hellmuth, Obata and Kassabaum – St. Louis, MO Reinert, Duree and Crane, Attorneys at Law – St. Louis, MO Guardian Laboratories – St. Louis, MO Cole and Latham, Attorneys at Law – Bath, NY United Van Lines – Fenton, MO

My Journey

Enlisted in the United States Army Reserves 91 Charlie (LPN) program January 1994

Graduated 91 Charlie (LPN Diploma) – October 1995

Promoted from Private to Specialist within 16 months

My Journey Continued

Obtained New York State LPN License in May 1996

After 16 months of Blood, Sweat and Tears

Staff/Charge Nurse in various LTC/Skilled nursing facilities from June 1996-August 2004

Arbor Hill Living Center (7/96-9/97) Livingston County SNF (6/97-5/98) The Highlands at Brighton (12/97-8/04)\ Jewish Home of Rochester (6/98-12/99)

Staff Nurse 1996-2003

Medication administration (PO, SQ, PR, IM, IV, G-tube)

Tracheostomy care Closed suctioning Wound care and prevention Patient/family teaching Transcription of MD orders Physical assessments Patient care Fluid monitoring Peg/G-tube care Documentation Supervision of C.N.A.’s

Nursing Skills

Assisted human resources department with recruitment efforts

Member of employee, engagement and retention team

Assisting staff education department with in-service training and competency fairs

Ordering and maintaining unit/patient supplies Staffing/scheduling Creating/updating documents

Administrative Duties/Special Projects

Responsible for 48 Long Term Care Residents Completion of MDS’ and RAP’s Care planning PRI's and chart reviews Patient/family teaching Monitoring residents' medical conditions and collaborating with

medical staff when indicated Assisting medical staff during routine and acute rounds Follow up investigation for accident/incident reports Timely and courteous communication with family members per plan

of care guidelinesResponsible for 10 employees

Monitoring performance and attendance per facility standards Disciplinary action as needed Hiring of staff members Annual performance appraisals Staff Education as needed

Sr. LPN/Care CoordinatorThe Heritage at St. Ann’s Community

August 2004 – August 2008

Coordination of entire MDS process for 200 bed facility

Created and maintained Excel spreadsheet to ensure accurate scheduling of of OBRA and PPS MDS'

Insertion of MDS' into facility's software program for completion

Monitoring MDS' for timely completion by all disciplines Interdisciplinary staff education regarding entire MDS

process Development of tools and forms necessary for accurate MDS

completion Monitoring PPS residents & scheduling assessments per CMS

regulations Ongoing C.N.A. training regarding ADL documentation No MDS related deficiencies (NYS DOH survey) during

tenure of compliance

The Heritage at St. Ann’s – Compliance NurseAugust 2008-April 2012

Coordination of CMI periods to include Obtaining resident's baseline RUG level at beginning

of the look back period Minimum of weekly review of all charts for

opportunities to increase RUG Scores Adjusting ARD dates when applicable to capture

higher RUG scores Working with therapy to achieve rehab RUG scores Post CMI chart audits to ensure documentation is

present to support RUG scores Creating documents & forms to assist in monitoring

ADL activities during ARD look back period Achieved maximum CMI during look back periods

The Heritage at St. Ann’s – Compliance NurseAugust 2008-April 2012

MDS/Medicare/Reimbursement Consultant Training new MDS coordinators to be successful in their roles Providing MDS completion services to various facilities in New York

State Providing MDS 3.0/Medicare Training to various facilities in New York

State Completion of MDS audits for various facilities in New York State to

ensure accuracy and maximum reimbursement Determination of Medicare Eligibility for Medicare Beneficiaries Determination of non-coverage when Medicare Beneficiaries no longer

meet requirements for Medicare Part A coverage and issuance of appropriate notice of non-coverage

Act as a liaison between Medicare Part C Insurance companies and beneficiary to ensure beneficiary receives on going Part C benefits as applicable

Assisting facilities in New York State to maximize Case Mix Index Assisting with implementation of S-cores ADL software http://www.mds-consultants.com/Software.html

MDS Consultants/MDS SolutionsMay 2010-Present

What My Clients Have To Say

Oversight of MDS/PPS operations for 63 bed transitional care unit as well as monitoring all Medicare Beneficiaries residing on our LTC units

Ensure accurate and timely completion of OBRA and PPS assessment to ensure accurate and maximum reimbursement as well as QI/QM accuracy

Scheduling PPS assessments following RAI guidelines to ensure compliance with ARD dates while maximizing reimbursement and preventing default and provider liability days

Communication with Medicare Advantage plans to ensure on going coverage of Part A stays

The Jewish Home of RochesterReimbursement Nurse Specialist/TCP

Reimbursement SupervisorApril 2013-Present

Coverage at cut determinations for Medicare Part A Beneficiaries as well as post cut reviews to re-access Part A benefits when appropriate

Monitoring 60 day spell of wellness periods Triple check reviews to ensure accurate

payment of Medicare Part A claims (review of UBO4 form completion, accurate documentation to reflect the RUG scores billed on the UBO4 and payment periods associated with the corresponding RUG score)

The Jewish Home of RochesterReimbursement Nurse Specialist/TCP

Reimbursement SupervisorApril 2013-Present

Staff education pertaining to documentation, MDS coding, Part A coverage guidelines, cut notices, accurate ADL documentation and other educational needs as identified during audits, etc.

Review and revision of facility processes, policies and procedures as they pertain to RAI, MDS and Medicare guidelines

Routine audits of MDS’ completed by others in the department

Assisting residents with Medicare Appeals process Supervision of 2 other MDS coordinators

The Jewish Home of RochesterReimbursement Nurse Specialist/TCP

Reimbursement SupervisorApril 2013-Present

Medicare Part A Audits Mock Surveys QI/QM audits Medicare Part A Beneficiary Notice Training MDS Accuracy Audits

Leading Age New York Pro Care Consultant August 2014 - Present

Computer/Software SkillsWorkExcelPowerPointSocial Media

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