andy3k 4,543 Views
Joined: Sep 21, '09;
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Some states have a nursing act that requires comprehensive assessments to be done by RNs. In those states, the RN must perform the comprehensive assessment and sign complete. Quarterly and PPS/OMRA assessments obviously don't require an RN to perform. This rule is sometimes disregarded but it exists in some states, never-the-less.
The only way to fix an ARD is to inactivate the MDS and submit a new one. The completion date of the new Discharge MDS must be no later than Discharge date + 14 or it is too late to send it, according to CMS.
It is on page 2-35 "If a SCSA is not indicated and an OBRA assessment was due while the resident was in the hospital, the facility has 13 days after reentry to complete the assessment (this does not apply to Admission assessment)."
The RAI Manual is very clear (pages 2-45 and 2-46).
• Is the first Medicare-required assessment to be completed when the resident is first admitted for SNF Part A stay.
• Is the first Medicare-required assessment to be completed when the Part A resident is re-admitted to the facility following a discharge assessment – return not anticipated or if the resident returns more than 30 days after a discharge assessment-return anticipated.
• Completed when a resident whose SNF stay was being reimbursed by Medicare Part A is hospitalized, discharged return anticipated, and then returns to the SNF from the hospital within 30 days and continues to require and receive Part A SNF-level care services. Under these conditions, the entry tracking record completed upon return to the SNF will be coded as a reentry with Item A1700 = 2.
The RAI Manual says early assessments are allowed and does not define how early. Therefore, one day after an admission assessment, you could perform a quarterly or annual. The next day you could do yet another quarterly or annual, if you so chose. There is no 14 day requirement as mentioned in the previous post.
RAI Manual page 2-46 explains this and more, "Completed when a resident whose SNF stay was being reimbursed by Medicare Part A is hospitalized, discharged return anticipated, and then returns to the SNF from the hospital within 30 days and continues to require and receive Part A SNF-level care services. Under these conditions, the entry tracking record completed upon return to the SNF will be coded as a reentry with Item A1700 = 2."
In other words, a 5-day follows an admission for a Medicare resident while a resident who discharged - return anticipated while on Medicare and returns on Medicare gets a readm/return assessment instead of a 5-day.
An entry tracking record is required EVERY time a resident is admitted or returns after discharge. OBRA/PPS/OMRA assessments are in addition to the entry. At the bare minimum, a resident who enters and leaves the facility would receive an entry and a discharge. All other assessments are performed as needed.
Now I'm curious. If there is a PPS tracking form different from the MDS 3.0 PPS Assessment Calculator that is helpful to people then I would certainly like to see it. If someone has a copy then please email to email@example.com. Equally important, I'd like to know what people, facilities, or companies created any forms that are emailed to me. Thanks.
... The Care Plan MUST be completed by day 21 on a new admission. That is really the only rule. So if the resident was admitted on February 2 and you didn't sign V200C2 until Febuary 25, then you are out of compliance. I hope this helps.
I'm sorry to hear about your situation. I can't help with the workload management issue but I can recommend resources for MDS help when your regional coordinator is busy. First and foremost, I recommend contacting your state MDS RAI Coordinator with questions regarding anything in the RAI Manual or performing assessments in general. Their email address can be found on the CMS website and you should also be able to find their contact information on your state's MDS website. Many state RAI coordinators used to work in facilities and might have suggestions for workload. Another resource I recommend is the Texas DADS MDS website - some of the information is Texas-specific but it has a lot of information, links to other website, and its own resources that you might find useful.
I recommend you contact your state RAI Coordinator, Cheryl Shiffer, at 210.619.8010 to discuss MN requirements.
MDS 3.0 RAI Manual, page V-6:
The date on which a staff member completes the Care Planning Decision column (V0200A, Column B), which is done after the care plan is completed.
Hope that helps.
I know that at least one software product DOES allow you to distinguish non-Part A PPS-like assessments, but I'm afraid I don't remember which one. If you happen to be on the market for software, ask about this.
ibtootie, you are correct. MDS completed for residents in certified beds require A0410=3. In Texas, residents in non-certified beds require A0410=2.
I found out from a colleague that CMS no longer endorses the following, "marking A0310B something other than 99 for a non-Part A record is incorrect, as well, since A0310B is for Medicare Part A PPS records." They got in trouble with the provider organizations and took it back.
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