Medicare 5 day and 14 day, EOT, then restarted therapy - help!


I am trying to help a facility get caught up with MDS's that they are late on - I have not done them for about 18 months (at a different facility) so am a bit rusty and do not know some of the updates/changes. Today this came across my desk.

A resident went to the hospital, gone for more than 3 days, returned on Medicare on Aug 15th. Entry tracking and a 5 day were done; EOT August 29th so EOT and 14 day were combined, then continued on skilled nursing due to IV antibiotics through Sept 9th at which time antibiotics were DC'd so he no longer qualified for Medicare. I do not know if they gave him a denial letter at this time, it was not in the chart but that doesn't mean it isn't somewhere.

On Oct 4th they started him on therapy again, and since it is within 30 days of being taken off of Medicare he is back on Medicare. They want me to do another 5 day with an ARD of 10/11/12 combined with his annual. He did not leave the facility again so I do not understand how there would be another 5 day assessment due. Then they want the 14 day done with ARD 10/18.

My questions:

1. Does there have to be a SOT done?

2. Why do they want me to do another 5 day?

3. It wouldn't be a return/readmission would it as he did not leave the facility after returning from the hospital August 15th?

I have absolutely no idea what to do, please help! Thank you...............

wyogypsy, RN

197 Posts

lol ok hours later I have found something in my MDS 3.0 RAC-CT Certification Program booklet.

For resumption of therapy after EOT we can do a SOT OMRA, or wait until next scheduled assessment. As the next scheduled assessment would put us out of the 30 day window we will have to do the SOT OMRA. EOT-R does not apply here as there has been too long of a break.

Also, as the resident was DC'd from Medicare Part A and remained in the facility in a Medicare and/or Medicaid certified bed, and criteria are met for Part A services to resume within 30 days of last Part A day, then PPS schedule starts again with a 5-day.

So we would do a 5 day PPS, SOT OMRA. Correct?

Sheesh, maybe now I can get some sleep!


124 Posts

I believe you are correct. An SOT is optional but necessary IF you want to start getting paid for therapy before the next scheduled assessment RUG starts paying. It would not have been necessary because the 5-day covers the same period of time as the COT except, as you said, there is the issue of the 30-day window. The 5-day seems appropriate because the RAI Manual pg 2-46 specifically says readmission is used when a resident discharges return anticipated to the hospital and then returns, which is not what happened.


1,010 Posts

Specializes in ER CCU MICU SICU LTC/SNF.
So we would do a 5 day PPS, SOT OMRA. Correct?

If you're capturing a Rehab RUG w/ the 5-day, the SOT is not necessary since the therapy rate will be paid from day 1 of the resumed SNF stay. The SOT will only be rejected.


124 Posts

I know that people should not combine a 5-day with an SOT unless it is a short stay, but I'm not sure if the SOT would be rejected if it was sent separately with a different ARD. Talino is correct that the 5-day would start paying the therapy rate from day 1, usually rendering an SOT pointless, but what about that 30-day Medicare deadline she was referencing? Is that a deadline for setting an MDS ARD or is that a deadline for beginning Medicare again (via paperwork) and claiming a therapy/nursing RUG?