Talino- help please! Question about setting ARD

[BrookeJayneRN, DIT]

Talino - you are so savvy and knowledgeable about the MDS process and I love reading your answers to the world's MDS conundrums. I have a question and would greatly appreciate your expert opinion.

I am an MDS Coordinator in a building with a fairly high Medicare census (average Med A census about 50) and it is primarily my only focus as we have a second MDS Coordinator who tends to our 80 LTC residents and their assessment needs. As is often the case with PPS, rehab and myself don't always have the same interpretations of what the RAI Manual states. Communication with the therapy at my facility is satisfactory, as always there is room for improvement but not bad. My question is this...when setting an ARD for a Med A resident with the therapy dept, do you believe that the assessment has to be opened (as in the computer) on or prior to the date decided on? For example, if the 14 day PPS assessment has an ARD set for day 13, in your opinion, does the assessment have to be opened up in the computer by day 13? Or could it be opened up on day 14 or 15 without a penalty (still within the 14 day window but after the date set by rehab)?

I tried to make that as clear as possible... :)

[Talino]

You may set the ARD in the computer initially on day 13 then change it later on as necessary provided you are still within the allowed ARD window of a PPS assm't (e.g. 14-day is day 13 - 18). Suffice it to say, by day 19, you cannot change the ARD to day 14 or 18, etc.

Assessment Window

Each of the Medicare-required scheduled assessments has defined days within which the Assessment Reference Date (ARD) must be set. The facility is required to set the ARD on the MDS form itself or in the facility software within the appropriate timeframe of the assessment type being completed. For example, the ARD for the Medicare-required 5-day scheduled assessment must be set on days 1 through 8. Timeliness of the PPS assessment is defined by selecting an ARD within the prescribed ARD window.

RAI, p2-39

[BrookeJayneRN, DIT]

Thank you so much! I knew you would know!

Now say for example I open the assessment in the computer on day 15 (in the 14 day window) but then therapy decides they want the ARD to be day 13? Is that legit since I opened it on day 15 which is in the allowed window but after the actual ARD?

[Talino]

That's perfectly prudent as long as the day you switched the ARD is no later than day 18. So if today is already day 19, you cannot change the ARD anymore.

[BrookeJayneRN, DIT]

Thank you for your help. It is greatly appreciated!

[luvwine]

If on admission I set and open a 5d for day 8 and resident has an unplanned dc or death can I move the 5d back?

[Talino]

If on admission I set and open a 5d for day 8 and resident has an unplanned dc or death can I move the 5d back?

* Yes *

[glm777, BSN, RN]

Opening the MDS on or after the ARD might be a problem when doing the resident interviews. The interviews are to be done during the observation period - not after. If you open the MDS after the ARD then how are you inputting your interviews timely? I only question this because we are soon to be sawitching to electronic MDS and my head is spinning with how I am going to set this process up electronically.

[TigerxLiLy]

I love how the RAI manual can be interpreted a million different ways...

My corporate heads say that as long as the assessment is open in the computer--- you can move the ARD anywhere in the window afterwards... Thought the RAI was just talking about setting the assessment ( 5d,14d,etc) in a timely manner, no matter the date.

When i get a new admit, I go ahead and set the 5d, 14d and 30d in their window time frames (usually on day 7 roll)

Then track it from there..

for the interviews---I set them to be due on the first day of each roll...

my corporate consultant is coming in tomorrow-- so im going to ask her about the dates line Talino says.. if u really cant move the ARD after the window is up...

[Talino]

You can dash-fill the interview if the ARD precedes the date they were done. You can include the BIMs as part of your nursing admission assessment and use it if the ARD is moved back. For uplanned discharges, interviews are not required.

CMS recommends that interviews be conducted on or closest to the ARD. There is no guideline that an interview done 7 days ago is invalid. For unexpected events, simply document why it wasn't done. It only becomes a flag if a facility routinely foregoes interviews.