How long should you keep residents on PPS?

[texasheat]

I've been doing MDS for about six months now and everyday is like the first but I think I'm getting my rhythm. I have a situation that we can't agree on. I have a PPS resident, hospitalized, came back, we are monitoring for post IV meds, weakness, etc. So went ahead and did the 5day. The problem is that the previous MDS states I should only keep her on for 5 to 10 days, while the MDS person that trained me is saying that I should keep her on for the full 14 days and d/c from PPS on 15th day. But wouldn't that make me have to do a 14day assessment? If so, then should I d/c her on day 13th to eliminate having to do a 14th day?

[Talino]

CMS allows for a "presumption of coverage" immediately following a beneficiary's discharge from the hospital. If the beneficiary scores into the top 35 RUG III groups, he/she is "presumed covered" until the ARD of that 5-day assessment (days 1-8). If the beneficiary is no longer skilled following ARD, the resident should be cut from coverage.

You can bill all 14 days of the 5-day assessment as covered days as long as the beneficiary remains technically and medically eligible. Proof that resident required and received daily skilled services up to the last day is vital.

The 5-day PPS pays up to the 14th day, hence, DC or cut as of the 15th. (PPS 14-day pays for day 15-30)

[texasheat]

Thanks for your reply. I believe that is what the MDS trainer was trying to point out. That in order to be able to claim all 14 days, we had to d/c on 15th or when medical necessity no longer needed, whichever came first but the previous MDS person kept stating she would get in trouble when she was audited due to keeping past the initial 5-10 days.

[edhcinc]

Hi.

Here's a good question to ask when considering whether or not to continue MC skilled coverage--

Assume that another patient came off of MC skilled 20 days ago. Assume that he/he has exactly the same problems and care needs as patient you now want to "cut" or "continue". Would you place the other patient back onto MC skilled coverage?

In your case, SNF's get a "free ride" (which will end October 1st) through the ARD of the 5 day because the hospitalized patient required IV meds to treat a MEDICAL CONDITION within the past 14 days of ARD.

But the REASON for SNF coverage is NOT "...monitoring for post IV meds, weakness, etc..."

Hopefully the reason is monitoring the MEDICAL CONDITION that caused the hospitalization, or a condition that arose in the hospitalization. If the person has weakness, what are we DOING about it that is skilled care? A restorative program? Increased nutritional support? Work-up?

And hopefully we don't continue or "cut" MC coverage based on whether or not we will be audited, how many assessments we have to do, a consultant's recommended or facility "policy".

Good luck.

[susanthomas1954]

You keep the patient until there is no more skilled need. That patient, if s/he has Medicare is entitled to receive Medicare coverage until s/he has reached his/her optimal level of practicable recovery and function. She should be at Prior Level of Function or better, if that can be achieved. If that occurs on day 18, you do a 14 day and when you dc the patient off Medicare, the billing office will only bill for 18 days. The patient's level of function determines when they no longer qualify, or until their 100 days of entitlement exhausts. I have had, in my career a number of people who exhaust 100 days after a dense stroke, or only need three days of IV therapy and are back home on day 4, as well as everything in between. You do the PPS MDS on schedule, and the patient gets well when they get well. Apples and Oranges.

ST