MDS Assessment Questions... help I am so confused!

[brandnew2mdsrn]

I have a few questions and I am so grateful for any knowledge shared as I am a new MDS coordinator by default, as the former quit and I am new and have no support or resourses...... thanks so much ..

1. for an ICF resident...... went to hosp (d/s return antic)...returned (7 days later) less than 30 days out.... how do I code re-entry/return and what assessments do I do ?

2. skilled resident (skilled for nursing only on d/c and return.. no signif change) disch to hosp ret antic..... (14 day had been completed day before she was d/c..... she returned 3 days later.... how do I code re-entry and what assessments do I do and / or what can I combine?

3. I am clear on the d/c criteria... I am clear on skilled and icf admits... I am totally confused on readmits....

Do you have to submit a simple stand alone reentry (combined with no other assessment) whenever a resident returns after a d/c return anticipated for tracking purposes?

4. my former MDS coordinator said if less than 30 days you can continue with next OBRA assessment as schedules if no sig change for ICF only.... but that all skilled had to be discharged, readmiited and started over at day 1 requiring a new adm assess, new 5 d=new 14 d etc ...is this correct ?????

5. On section A (MDS 3.0) where it asks if resident has had a qualifying medicare stay and asks the dates..... what if you have a skilled private pay or private insurance patient that doesnt have medicare do you still answer yes???? It seems misleading since they it would be a qualified stay if they had medicare... but they dont so what do you code there??>

Thanks sooooooooooooooo much for any guidance......

Ive taken the cert classes online but the more I read the more I read into the questions and the more confused I get ......

sighhhhh

[mdecastronp]

Here's my response:

1. You will have to do an "entry" assessment. This is required for every admission and re-admission. The entry tracking cannot be combine with any assessments. If your resident has no change of condition, you can continue the same schedule you have prior to discharge. Otherwise, you will have to do a significant change of condition. Admission assessment can only be completed once in the resident's stay, and since you have discharge the resident with return anticipated, you will need to do a significant change of acondition if there was a change. However, if there were no significant change, you can continue the next "due assessment" prior to the resident's discharge.

2. You'll have to do an entry tracking. Then complete "Readmission/Return assessment. This type of assessment tells CMS that the resident came back to your facility after 3 days and re-start counting the Medicare days, the resident is eligible for this admission. The grace period for this assessment is the same as your 5-day PPS. If your resident is covered under Medicare for clinical services only and then started on therapy, you can combine this two types of assessment (as long as the ARD falls within the same time period). The next assessment will be 14-day PPS assessment. If the resident had a change of condition on re-admission, you may want to combine this assessment with the Readmission/Return assessment.

3.Yes, an entry tracking will need to be submitted for any admissions and re-admissions. This tracking as well as death in the facility tracking cannot be combine with any other assessment.

4.Yes, see my response on number 2.

5.If you are talking about A2400 - this asks for the Medicare dates of service.

Goodluck!

[brandnew2mdsrn]

thanks for the quick reply you are awesome !

on question number 2.... what if the resident was not out 3 days... what if over night only and medicare skilled same rules apply ? do rentry... then readmission assessment ? lets see if I have this right.....

so if mr jones was admitted first time

I did admission combined with 5d on day 8

then I did a 14 day

then on day 15 he goes to the hospital ... so I have to do a d/c ret antic with an ARD of d/c date

he comes back before 30 days is up.....

I do re-entry tracking (stands alone)

now Im hesitant....

I do a readmission assessment if no change or a signif change if there is a change...???by day 14 of return????

then follow with 30 day as previously scheduled and so on ?????

is that right ?????

and if the resident is gone over 30 days do we start as new admission ???

thanks again !!!!

[mdecastronp]

first question: yes... do entry tracking for resident that was out less than 23 hours, granted resident was out at 12 midnight (midnight rules applies). then 'readmission/return assessment'

next question: john doe, who is out before the 30 days is up - if skilled and with change of condition - do entry tracking, next combined readmission/return assessment with change of condition assessment, then follow 14 PPS, 30 days, etc depending on how many medicare days are left.

there is a financial trick to the next question: the reason why you will do sig. change of condition with 5day PPS and/or readmission/ return assessment is to be able to use the grace days, especially if the resident is receiving rehab. If you combine sig change of condition with 14 days PPS - you cannot use grace days for the 14th day PPS as the sig change will need to be completed on day 14 versus when it is not combine (a 14 day PPS if not combined with OBRA admission and/or sig change - can use grace days to increase reimbursement).

[brandnew2mdsrn]

it seems like the readmission assessment should be an OBRA assessment not a PPS assessment yet it is in my softwares PPS dropdown box ..... makes more sense for the readmission to be an OBRA to combine with a 5 day (PPS) since you can click on 2 PPS assessments to combine .... or can you ???? is there a trick that I dont know about....

[mdecastronp]

readmission/return is a PPS assessment and has the same ARD and grace period rule. and yes, PPS assessment can be combine - the rule is any unsceduled PPS assessment can be combined wuth scheduled PPS assessment as long as the ARD falls within the same timeframe.

[Magaly63]

It may help you to think of the readmission/return assessment as a return to PPS. it restarts the PPS process with another 5, 14,30 and so forth as long as they have balance days left.

If a resident is sent out to hosp, not in bed at midnight, the trick is in knowing if admitted by midnight or not. If held under observation and not admitted, returns to your facility next day, your PPS schedule is not reset but adjusted by one day (LOA day). Everything moves over a day.

If admitted then a D/C is needed, upon return an entry and then a readmission/return (5 day).

Confusing I know........

[brandnew2mdsrn]

thanks! the way you just explained it made so much more sense.... my only question is how do I combine the readm with the 5 day on the PPS drop down menu it only lets me click on one or the other.......

[Magaly63]

Readmission IS the new 5 day assessment................ if this was a brand new resident first time in the buiding a 5 day assessment is coded as "1"........then he goes out, comes back resetting PPS, readmission/return codes as "6"..............

continue to ask questions and process the info in your mind......read manual.....it will make sense.......eventually!:)

[katoline]

great answers and great support from all who posted!!! who says nurses eat their own. we all need each other now more than ever, especially those new to any aspect of nursing.

this was not easy before 3.0 and now besides being much more time consuming, is more confusing due to the added start and end of therapy etc.

some of the issues i'm having is, well first being behind still, then having to do either a discharge summary without an interview or an admission, or readmission, then a discharge summary without an interview. even though the resident was interviewable when in the facility, i lost my chance and now have to put, no-resident unable to be interviewed, then head down to the staff interview. unfortunately our software says the resident must be rarely/never understood to use the staff interview, so, i have to go back and put that because at the time of my assessment, they are not understood because they are not there.

i guess i'll just have to explain my answers if anyone asks. so many of our residents are discharge from the hospital too soon only to be readmitted in a day or two. makes doing assessments that much harder. at least before you could do an assessment with what you could find and a one page discharged on what date. these 27 page discharges are adding a lot of extra work. beside the fact that the next assessment besides the reentry, can't be opened before the others are finished. i think i'll just lock myself in my office and if anyone needs me, they can come get me. i'll have to wear a disguise to go out on the hall for the interviews.

[rukiddingme]

Our software allows for more than one assessment to be open at a time, so we're very very lucky that way.

But, it can be confusing - you always have to make sure you're on the right assessment when putting in the information.