i have an mds pps & leave of absence question that is stumping me.
the trailblazer (mac) snf services manual
page 71 says:
the effect of loa on benefit days and the assessment schedule includes the following:
* medicare part a benefit days are not taken.
* do not code non-covered charges on loa days.
* loa days do not interrupt the assessment schedule.
the current mds 3.0 rai manual page 2-64 says:
if a resident is out of the facility over a midnight, but for less than 24 hours, and is not admitted to an acute care facility, the medicare assessment schedule is not restarted. however, there are payment implications: the day preceding the midnight on which the resident was absent from the nursing home is not a covered part a day. this is known as the “midnight rule.” the medicare assessment schedule must then be adjusted. the day preceding the midnight is not a covered part a day and therefore, the medicare assessment clock is adjusted by skipping that day in calculating when the next medicare assessment is due. for example, if the resident goes to the emergency room at 10 p.m. wednesday, day 22 of his part a stay, and returns at 3 a.m. the next day, wednesday is not billable to part a. as a result, the day of his return to the snf, thursday, becomes day 22 of his part a stay.
one document clearly says the assessment schedule changes and the other says the assessment schedule does not change.
i called trailblazer about the discrepancy and they were not helpful. they directed me to the medicare claims processing manual chapter 6 - snf inpatient part a billing and snf consolidated billing
and that had no information. they could not direct me to an mds expert and asked me to write to their freedom of info address.
cms was no more helpful with their answer.
i do not do billing so i do not know how loa days really affect the assessment schedule from the practical perspective. can someone please tell me and, if possible, cite a third reference that settles the discrepancy? if loa days actually affect the assessment schedule then i cannot see how the pps assessment calculator i am working on, or its predecessor, is useful without having the ability to adjust the days and dates based on loa days. please help me understand.