Federal audit and Adm MDS

[glm777, BSN, RN]

Federal MDS audits:

This came up as a tag on a recent MDS audit.

A resident was admitted to the facility. He went out to the hospital on day 5 and was DRA. We had scheduled an admission MDS but closed it due to his MLOA (only section F had been completed).

He returned on day 8. We again scheduled his admission MDS but no one had completed any of it when he went out again on day 10.

He returned day 14. We scheduled his adm MDS and completed it within 9 days of his return which was day 22. The federal surveyors tagged us for a late MDS. They said that even if a resident goes out to the hospital (no matter how many times) DRA, during his first 14 days in the facility, the facility must still complete the admission MDS by day 14.

No place that I have ever worked does this. The RAI manual says that if a resident goes to the hospital when an MDS is due, you have 14 days upon return to complete the scheduled assessment. Which is what we did. Which is what I (and every one I know) has always done.

My question to the surveyor was "what if he goes out day 2, DRA, and doesn't return until day 16? Is it reasonable to expect that the MDS would have been done by day 14???" She said that in that case they would "probably" be more lenient.

Since when is MDS timing and completion based on "leniency" and not the hard and fast rules put forth by the RAI manual - the instructions for completion?

I have been doing MDSes for over 2 decades and have never heard of this.

I would appreciate any and all comments.

[Talino]

In their line of work, it's not uncommon to see one who purports to be "the expert" moreso when confronted by the real thing. Simply dispute it with the RAI reference if cited.

[mdsNurse2016]

• An auditor is not the final decision maker. I would wait for the final results of the Audit and then Appeal it should her decision stand. . Hopefully you saved the started OBRA assessments that you were unable to complete due to the resident's medical condition. I would explain the situation. Provide your evidence and cite the RAI. Use their own guide against them.
  
  
  
  If a resident had an OBRA Admission assessment completed and then goes to thehospital (discharge return anticipated and returns within 30 days) and returns during anassessment period and most of the assessment was completed prior to the hospitalization,then the nursing home may wish to continue with the original assessment, provided theresident does not meet the criteria for a SCSA. In this case, the ARD remains the sameand the assessment must be completed by the completion dates required of the assessmenttype based on the timeframe in which the assessment was started. Otherwise, theassessment should be reinitiated with a new ARD and completed within 14 days after re-entry from the hospital. The portion of the resident's assessment that was previouslycompleted should be stored on the resident's record with a notation that the assessmentwas reinitiated because the resident was hospitalized.
  
  
• If a resident is discharged prior to the completion deadline for the assessment, completionof the assessment is not required. Whatever portions of the RAI that have been completedmust be maintained in the resident's medical record.3 In closing the record, the nursinghome should note why the RAI was not completed.
  
  

3 The RAI is considered part of the resident's clinical record and is treated as such by the RAI utilizationguidelines, e.g., portions of the RAI that are started” must be saved. (RAI, 2-17)