2 more assessment/coding questions please

[brandnew2mdsrn]

#1 resident is non skilled...LTC... goes to hospital ... returns less than 30 days ... you already have done an admission assessment on prior entry date... chart is reviewed on return and no sig change noted ...

I do disch return anticipated when she left.... entry tracking when she returns... and then just continue with next quarterly as scheduled ? is this correct ? Where do you note that you determined no signif change if no assessment is required to be submitted????

#2 resident is skilled for therapies.... has had 60 day assessment done ... is now approx 10 days shy of 90 day ARD and leaves the facility with family for a visit... she doesnt return and midnight passes.... am meeting (IDT) decides discharge asap return not anticipated as of prior day..... ok....... now its 5 pm ..Im ready to leave and get otice of same resident returning from home now to admitted ICF/LTC non skilled......

Do I have to do full d/c return not anticipated/ then full admission back to facility separately? I know it seems silly in theory to combine a d/c RNA with an admission but is it acceptable????

one more.....

Resident is a full code.... arrests and cpr is started when found with no pulse and no resp./ ems called and arrives to continue CPR and transport to hospital where resident is pronounced...

I have to complete a disch per facility protocol as he was not pronounced until he reached the hospital. is that common ????

[Talino]

i do disch return anticipated when she left.... entry tracking when she returns... and then just continue with next quarterly as scheduled ? is this correct ?

1. assuming no skilled service is required on return, that is correct. a "no sig. change status" determination can be recorded anywhere in the medical record, usually in the nurses' notes. the determination should be agreed upon by the idt.

2. the resident cannot be discharged if he/she explicitly went out for a family affair and failed to return to facility before midnight. this should be treated as a therapeutic leave of absence. on return, facility will adjust billing for a no payment on day of absence. your 90-day ard will also be moved by 1 day (that is, if ard is between day 80-94, it is now day 81-95 on return). see additional info next post ('can't seem to have the entire post together)

3. a discharge mds is required since death occurred outside of facility.

[Talino]

im ready to leave and get otice of same resident returning from home now to admitted icf/ltc non skilled......

why is resident treated a readmission as non-skilled? this is what cms says...

the "practical matter" criterion should never be interpreted so strictly that it results in the automatic denial of coverage for patients who have been meeting all of the snf level of care requirements, but who have occasion to be away from the snf for a brief period of time. while most beneficiaries requiring a snf level of care find that they are unable to leave the facility, the fact that a patient is granted an outside pass or short leave of absence for the purpose of attending a special religious service, holiday meal, family occasion, going on a car ride, or for a trial visit home, is not, by itself evidence that the individual no longer needs to be in a snf for the receipt of required skilled care.

http://www.cms.gov/manuals/downloads/bp102c08.pdf p35