Talino

The waiver is a one time use. If this is the first time, there must be a wellness period (non-skilled) after exhausting benefits. If skilled level of care continued after exhaustion, the waiver can not be applied. The waiver, if applicable, is not dependent of the diagnosis (Covid or not) but the need to have a skilled level of care. Read more here.

Bill the default rate for 3 days.

A surgical wound usually heals in less than 10 days unless comorbidities complicate the process. The MBPM Chapter 8 p33 specifies a prescribed dressing and aseptic techniques as a skilled service. This would require detailed documentation to represent wound characteristics and resident’s response to treatment daily. Additionally, care planning to promote wound healing and/or ongoing health teaching for self-wound management may support a skilled level of care.

You are correct to check the matrix manually and regularly and remove what flagged items do not apply. MDS software programs conduct logic tests based on CMS specs. The provider has to document why the flags do not apply. The 672 contracture definition refers to a more permanent or chronic limitation. Limitation in ROM due to a recent fracture is self-limiting or reversible. A frequently incontinent resident cannot be on individualized urinary toileting program because she’s incapable of making needs known, has a neurogenic bladder, or paraplegic.

Total. No physical exertion from resident transpired during the actual position change.

1. Hospital, even when admitted directly from the ER. 2. Hospice at home is Hospice

When the MDS had already been accepted, the resubmitted one will be rejected. Review the validation reports after every submission. It will show the status of each submitted MDS - accepted, rejected, and other warnings. Signing the MDS late will not affect reimbursement. It can be a survey issue.

Are you referring to the former calculator that shows due dates for 14, 30, 60, etc.?

Sometimes. The answers, not all, seemed relevant.

Try to look into other areas that may contribute to the new pressure injury - change in nutrition status, ADL decline, increased incontinence, exacerbation of a clinical condition / comorbidities. Also if mood or psychosocial wellness is affected by the worsened condition. If none and all contributory factors are already addressed in the current plan of care you may forgo the SCSA. Just make sure there are no 2 areas or more of change.

S72.142D

Being the new kid in the block where ignorance is bliss, I can emphatize. I would probably start by printing the triggered CAA worksheet and share with the DON or care planner, seek their insight on how they would analyze the findings, direct you to the source of supportive documentation, and arrive at their care planning decisions. Then make a suggestion to add in "their" care plan your thoughts.

The primary diagnosis should be the main reason for skilled service. If a patient is initially admitted after a hip fracture and requires skilled therapy, the occurence of COVID during his stay does not nullify the hip fracture-related dx as primary. If the skilled therapy ended (goal achieved) and symptomatic COVID is now the main reason the patient requires a skilled level of care, only then should COVID be made primary. Otherwise, continue w/ the same primary and add COVID as a new contributing dx which will likely impede or alter the therapy goal. For long-term stay residents who were initially admitted for CVA or Dementia as primary but is now afflicted w/ COVID that demands the most amount of care, then COVID should become the primary dx. When COVID is resolved, the dx may revert back to the previous primary. In a nutshell, the primary dx should always be the main reason a resident requires the largest amount of care.

If Medicare was the primary prior and Medicaid would have been on day of discharge, select Medicare. The day of discharge is a non-billable day, hence, no payer is evidently responsible. For tracking purposes, NY requires it to gather info of payer sources during the period/s of residency.

You have up to 14 days to complete an MDS on reentry. If you forgo the quarterly, the SCSA will still need to be completed within 14 days of reentry.