brandnew2mdsrn

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 ?

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

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 ????

Help with this coding please!!!..... an ICF resident is doing fine then develops pneumonia, receives normal in house treatments but isnt responding well so gets sent to hospital..... he stays out several days (meets the 3 midnight and prior 60 day wellness rules) returns skilled for therapies and IV's which are completed before day 14 and he returns to ICF (non skilled status)His annual MDS was set for a date b/w day 5 and 14 on my original calendar. OK , I did a disch ret. anticip ARD date of actual disch. I did a re-entry tracking form on day of return I did a signif change/ 5 day on day 8 (per therapy request for minutes) Corporate says this doesnt work ... that they have no RUG... shouldnt that 5 day give them a rug for adm day til day 14???? 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? 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??? 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 ???? Help !

What if the resident is admitted skilled for therapies on say , a Friday night after I leave ...no one from therapy even has seen them as eval is planned for Monday... and resident is dich back to hospital on Sunday before I ever see them either? This happened this month, so from the chart I did an entry tracking, ARD Fridays date, and a d/c return anticipated with the ARD of Sunday (she has since never returned) Now our corporate office is bugging me for an admission and 5d adm so they can get a RUG... I told them no therapy was ever in yet, and no nursing area to skill on my knowledge, and she wasnt here but 48 hours so I ddint need to do a 5 day or admission ... then I started to wonder.... should I have done a d/c combined with a 5 day on day 2 even though therapy never saw her ?????

#1 resident is non skilled...LTC... goes to hospital ... returns less than 30 days ... you already have done an admission assessment on prior entry date... chart is reviewed on return and no sig change noted ... I do disch return anticipated when she left.... entry tracking when she returns... and then just continue with next quarterly as scheduled ? is this correct ? Where do you note that you determined no signif change if no assessment is required to be submitted???? #2 resident is skilled for therapies.... has had 60 day assessment done ... is now approx 10 days shy of 90 day ARD and leaves the facility with family for a visit... she doesnt return and midnight passes.... am meeting (IDT) decides discharge asap return not anticipated as of prior day..... ok....... now its 5 pm ..Im ready to leave and get otice of same resident returning from home now to admitted ICF/LTC non skilled...... Do I have to do full d/c return not anticipated/ then full admission back to facility separately? I know it seems silly in theory to combine a d/c RNA with an admission but is it acceptable???? one more..... Resident is a full code.... arrests and cpr is started when found with no pulse and no resp./ ems called and arrives to continue CPR and transport to hospital where resident is pronounced... I have to complete a disch per facility protocol as he was not pronounced until he reached the hospital. is that common ????

This may sound silly to seasoned coordinators but I am new and alone and in a sea of 125 residents with only 2 months experience so all help and advice is appreciated... I know that all residents are required to have assessments regardless of payor source... my question is this.... on part A at the bottom .... when it asks if this is a medicare elligible stay do we only code yes for actual medicare recipients or do we code yes for all skilled residents regardless of payor source???? next question.... do psychotherapeutic agents such as namenda or aricept get coded for the psychotropic section... or just meds such as seroquel or Librium ????? last question... I have been submitting an entry tracking form on every resident on admission.... then for my skilled I have been doing a 5d/adm combined.... my validation report is coming back error in sequence ???? The only thing I can think of is that I should be coding the tracking form as a "1" yes for is this first assessment (I have been coding it 0 since to me it really isnt an assessment)and the 5day/adm as the first) is this what is causing my error????? do I need to go back and fix all of them ???? or keep going ???? oh , one last question for Keane users.... no info carries over from one assessment to the next like it did in 2.0... all assessments are 100% needing to be filled in every blank, every time ... is this something wrong with my settings or is this true for everyone ???? Nothing will carry over except for a few items on section A..... not even adm dates or flu vac dates etc..... I lied.... one more last question came to mind.... If a patient returns with a dx of sepsis .... is that coded as "septicemia" on the dx page ... I have been told conflicting answers ..... are the terms interchangeable... or not ?????

ok ... I just reread my original post and let me clarify .... the therapy question was for long term care , ICF patients... NOT SKILLED.... but PT or OT picks up for a certain period of time under part B... do we add those minutes to the quarterly or annual MDS if in the look back period???? Even if therapy bills seperately ???? Will that change the reimbursement rate and does that mean double billing ???? I am confused ... thanks

well they just allowed me an LPN 2 days a week to help with the info gathering and careplans.... I'll take any help I can get I was swamped ... I have to enter everyones sections, therapy included... no one has access except me (I think there was a problem in the past with unauthorized access or something anyway I am the only one to do the whole thing now.... all for the bargain price of well less than $30/hr ( I have completed the certif class through AANAC and am certified now though not yet experienced.... but learning quickly with the sink or swim method...lol)

Hi all.... After reading and rereading the 3.0 manuel section O ..I am confused... Are we supposed to code minutes of therapy for nonskilled snf patients who the therapy department picks up for a skill under Part B ???? Should they be turning in minutes to me ????? also ... I am entering entry tracking on all residents as they come in... then for the skilled I am combining a 5 d / adm assessment.... (usually with a day 7 or 8 ARD for rug rates .... I thought this was correct but my validation reports are coming back with a sequencing error notice .... what gives ???? thanks for all the advice ... I have only been the coordinator since the beginning of Nov and we have 120-125 residents for me to keep up with,,, its very hard .... Is this average for one MDS person ????? I also have to do all screen updates and all careplans and careplan meetings, am meetings, high risk meeting, IDT, and billing audits.... Im swamped

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.......

Everyone is new when they start ... we all learn ... just make sure you have great educational opportunities and support before accepting a new position from scratch ....

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....

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 !!!!

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