ICF resident returns skilled for short term

Talino · Jan 29, 2011

corporate says this doesnt work ... that they have no rug... shouldnt that 5 day give them a rug for adm day til day 14????

-yes

or do i have to do a separte pps 5day and pps readm assessment since i cant combine pps assessments?????? at wich time he had been d/c from skilled so i didnt need one right?

- code 5-day only since this is the first medicare-required assessment to be completed when the resident is first admitted for snf part a stay. code a readm/return if the resident was already receiving med a benefits before d/c'd to hosp, then returns to facility and continues to require snf part a stay. it cannot follow a 5-day. a 14-day is next if required.

also shouldnt my signif change take the place of the annual as it was a full comprehensive assessment and i should now continue with the next quarterly???

correct

also ... when a resident returns from hospital and was non skilled before but now returns skilled within the 30 day window, and was disch ret anticipated what assessments are required on return????? i know a re-entry tracking..... then what ???? my former mds coordinator always did an admission (obra) with a 5 day (pps) but the manual if i am reading correctly says we only do 1 adm ever for each resident unless discharged return not anticipated, or no return in 30 day window....since obra choices dont include a re-adm assessment i have choden a signif change/ and a 5 day pps is this wrong ????

the obra assm't is only done when it is actually required. was there an actual sig. change or the criteria met? if none, just do a 5-day and pursue the next obra assm't as originally scheduled.

brandnew2mdsrn · Jan 29, 2011

code a readm/return if the resident was already receiving med a benefits before d/c'd to hosp, then returns to facility and continues to require snf part a stay. it cannot follow a 5-day. a 14-day is next if required.

so you would do a readm/ return assessment then a 5 and then a 14 for a part a that returns part a ???? 3 full assessments ????

brandnew2mdsrn · Jan 29, 2011

also you said the readm cant follow a 5 day ???? is the readm a comprehensive assessment??? dont you have 13 days to do adm and / or readm assessments or is that only the OBRA ??? Im so confused ...lol

Talino · Jan 29, 2011

a readm/return is a pps assm't, the same as a 5-day. however, you can only choose one type of code for a pps assm't when resident returns to facility depending on the situation:

5-day - if this is the first time resident will be receiving med a benefits. that is, resident was d/c'd to hospital non-skilled (icf) and now returns to facility requiring skilled services. your pps assm't will be: 5-day --> 14-day --> 30-day --> etc.
readm/return - resident was already receiving skilled services (med a benefits) while in your facility then goes to the hospital for an acute problem. he returns to facility and will continue to require skilled services. your pps assm't will be: readm/return --> 14-day --> 30-day --> etc.

print the 1st page of the mds all item set to familiarize yourself w/ the assm't type codes.

brandnew2mdsrn · Jan 30, 2011

thanks so much that helps a lot.... so do you have to do a new OBRA assessment as well on return if you did an adm on the last entrance to the facility what is required on return in this case ?

Talino · Jan 30, 2011

If there is evidence of a sig. change do a SCSA. If not, do the Quarterly or the Annual if due. Otherwise, just do a PPS assm’t.

iceprincess492 · Jan 30, 2011

If this were my facility, I would have done a d/c return exp on d/c date. Upon return I would have done reentry, then a 5day assessment. They dont need a 14 day because they were cut from part A before day 14. If they are MCD resident I would wait until completed with skilled care and do sig change or annual (whichever is approp) as long as it is still within the time frame for OBRA assessment. This way you can capture rehab score for case mix this quarter.....

andy3k · Jan 31, 2011

Just to clarify the above answers, you do not complete a readmission/return PPS AND a 5-day. You do one or the other, as appropriate.

The ONLY times you do an admission assessment are when the resident is admitted for the very first time, when the resident is admitted after a discharge - return not anticipated, or resident is admitted over 30 days after a discharge - return anticipated. In your case above, you do not complete an admission since you did a discharge - return anticipated less than 31 days before the reentry.

RainRN1, ASN, RN · Feb 3, 2011

If this person is medicaid and you give the significant change assessment an ard a day apart from the pps then what you are doing is giving this person a rug score on the medicaid side. I think that is what your corporate is talking about. But you have to do it after you do the pps using a different ard. This helps with the CMI in the end.

Bella'sMyBaby · Feb 3, 2011

Wow, this scenario had me confused too.

I wouldn't do a sig change unless it was something that would not resolve itself in a few weeks.

catlvr · Feb 4, 2011

I'm a floor nurse, and am grateful that I don't have to try to understand the complexities of the MDS - sunshine and rainbows to you nurses who do this work.

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