1. I recently had a patient return from the hospital that only had 3 days left to meet her 100 days. I have done a full MDS w/raps etc qm since May. Now since her discharge with w/o anticipated returned it appears that I have to do the full blown MDS w/raps again. She is now long term. I have not had any patients that have had this scenerio (< than 10 days of medicare left to meet their 100 days) #1 I believe I have to do all this crap again since she appears as a new admit. #2 the Social worker that does the fac sheets and d/c sheets, thinks only in black and white by rope method. I spoke with our owner and she said the reason it was this way was because the MDS cord prior to me, never took the time to see if their were sign changes. She said in the future to discuss each case individually w/her, which makes alot of since, this is so terrible to waste my time, so in actuality, all patients that are PPS no matter how many days they have left, we don't have to d/c them, correct? The ones where it is a chronic reoccuring problem. One lady went in to have a blood transfusion 2x's of late, and the 5 day was done by another MDS nurse, this patient is now LTC. In put would be appreciated since the S>w. has been at this faciltiy for >10 years and can not ever think out of the box, she must always be in the same pattern or she shuts down. What do you guys do. I really feel stupid. Thanks Tex
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    About tex

    Joined: Feb '02; Posts: 168
    MDS Coordinator


  3. by   Talino
    OK Tex... first, calm down. Let's set aside your grievance on the SW.

    Discharged - Return Not Anticipated:
    Depending on your facility practice it is not always necessary to close the record IF the resident is again readmitted. You simply send a correction of the Discharge Tracking and resend a Discharged - Return Anticipated.
    But if you start w/ a new medical record and the resident will have a new identifier number (e.g. medical record no.), then you start from scratch again with the MDS stuff.

    Medicare coverage:
    Assuming a Medicare A resident was discharged and readmitted within a 30-day period, he/she can resume whatever Medicare benefit days were not used. If more than a period of 30 days, remaining benefit days are lost. If 60 days or more, w/o receiving skilled care, + a 3-day hosp. stay, can restart a new benefit period (100 days).

    PPS again for a 3 day benefit???
    If the resident is a private pay and your facility doesn't mind shouldering the expenses for 3 days, don't bother w/ the PPS then. But I kinda doubt it! Anyhow, use the 8th day of the 5-day PPS as your ARD and dually code this assessment also as an Admission assessment. Walllahh... you just do one assessment satisfying both PPS and OBRA. The next one will be a Quarterly. Ironically this is the industry we're in and must abide by regulatory constraints.

    Now for that SW? ------> ..... and you ---->
  4. by   Nursenan0
    Sounds like a plan! Lots of things are company policy! I'm just beginning in MDS and these things can be soooooooooooo confusing! Stupid is not investigating your questions...not having them ! Black and white doesnt seem appropriate way to see in MDS....Our MDS coordinator does our tracking sheets....MDS wouldnt have a clue
    Good luck Tex