MDSRN15

Experts, Clarification please! I have a stage 3 sacral pressure ulcer that healed 2 years ago, now I have a new redness on the sacrum, is it the same Stage 3? OR a new pressure ulcer. Thank you!

Can you clarify the use of the extra 100 days under the 1135 waiver. * Resident has exhausted her 100 days. *Just went out again for new pacemaker, can I use the extra 100 waiver without any covid dx? Separate question: * Do I do an EOP for the 100th day? FYI, I created another 5day with day 101 as day1 as per CMS, just not sure of the EOP. Then, what will be the start of Med A on the new 5D. Thank you!

No dc on 3/15 with interrupted stay checked off then re-entry with an ARD of 3/21 ???? I'm so confused with rules

Experts, Need some help with setting ARDs: Entry 3/14 DC to hospital 3/15 Interrupted stay Came back 3/17 THANK YOU

Thank you!

Experts, Need help on how to set an assessment with this unique scenario. 1. LTC resident got an authorization from Aetna Mcr to cover her recent Covid with symptoms. 2. Hospitalization was waived as per CMS guideline. 3. What assessment do I open to get reimbursed? I'm assuming a 5 day without submitting, but kept in system which will capture the GG on it. OR.....? Thank you!

Experts, Can adding 6 days of restorative for a Med A patient affect an IPA? Not sure if it will increase reimbursement or at least stay on the same HIPPS payment without the 2% reduction. Thank you!

Hard to teach. I'll stay in my desk. Thanks.

I wish I can paste an image, but I did created an admission assessment and I have an icon that can calculate a PDPM and RUG at the same time on this assessment. So, I can create a 5D with a HIPPS, submit to biller and its ok to have an admission submitted to CMS. Its same rule when we had RUGs. ? Its already January and this is still giving nightmares. Im just glad that I have this forum to go to and have Ms.Talino's expertise. Thank you.

Since our United plans pay using PDPM, then I have to create an admission then a stand alone 5D with GG filled out, please confirm. Wouldn't it be fraud since I'm submitting a different information to CMS and I'm billing a different one?

rehab expects both of us to have the same HIPPS.

I can calculate it automatically in my system. Did not combine assessment. So, when I create a standalone 5D as you stated I should dash-out GG, but rehab factors it out to create their HIPPS.

Follow-up on this Ms. Talino: 1. Received a letter from United MCR plans that they will use PDPM rules for billing. 2. Rehab follows PDPM and sets more minutes. Rehab then bills on a higher rate. 3. Submitted an admission assessment to CMS and created a 5Day that's just in my system. 4. Admission and 5Day assessments created with two different HIPPS because of Section GG. Question: a. Which one do I give the biller? The one I submitted to CMS or the 5D in my system? b. Which one should rehab follow, my HIPPS admission or my 5 day?

Experts, I have a resident with Aetna Managed Medicare, what assessments do I need to open. Biller needs a HIPPS code as she said AETNA adopted the PDPM rule. Thank again for all the help from these confusion ?

Another follow-up with regard to setting ARD: If it is a Managed Medicare, do I separate admission from 5 day assessment? Or I can combine too?

Experts, For new PDPM requirement, I understand that Med A admission needs a 5 day, but do I still do an admission assessment to satisfy the OBRA schedule? If I do can I combine like before or I have to separate the assessment? Can I use the same ARD for both admission and 5 day assessment? Thank you!

My biller is saying that I do not need the EOT because I got nursing RUGS. Not sure how to go about this. 5D - 1/3 - HC110 EOT-R - 1/4 - HC10A ---- not needed??? I think I need it to do the resumption. 14D/COT - 1/14 - HB12D 30D/COT - 1/28 - RVA3D

Chose 1/4 ARD for the EOT and added yes for resumption on 1/8. Thank you.

Need some experts on this: 5D - 1/3 refused rehab starting 1/4 - HC1 started back again on 1/8 14D/COT - 1/14 as per rehab - RHA Where do I set the EOT-R, or I just check-off EOTR on section O? THANK YOU!

Expert, I have a med A resident with a NEW gtube placement, but was done in Barbados. He is 90 y/o, vacationing in his country, had CVA and needs gtube. Came back to US and used Med A in our facility. Is it ok to skill for gtube even if it was not performed here in US? Thank you!

Yes. It was 7/28 for an RMC pays for 7/24 - 7/28 THANK YOU VERY MUCH AGAIN!!!

Can I use 7/28 5th day for SOT-ARD? It says 5-7 days for the ARD. It is also the end of PPS and she was seen that day. Will it apply in the scenario?

It turned out, it will only be an RM. How do I get paid for 5 days. See below. 14D --- 7/14 ARD - pays for 7/14 -- 7/20 - RVC20 EOT-R or EOT --- 7/23 ARD - 7/21 -- 7/23 - LD10A SOT??? --- what ARD to pay for - 7/24 - 7/28 - what rug payment? --- rehab has an RM End of PPS - 7/28

Experts, I need help setting dates with eot, eop...here's the situation. last day of therapy 7/20 last day of Med A 7/28 missed therapy on 7/21 7/22 7/23 started therapy again on 7/24 rehab rug will be higher, nursing rug is lower. same rug level when it ended please help me set the dates, im getting confused with sot

Experts, We have a 60 bed subacute in my facility, every week the IDC team schedules to meet with family on Wednesday about 10-15 patients every week. Based on that meeting, they would write on the progress note of the patient's plan of care. Then on Thursdays, they would meet again to read each of their interdisciplinary note which has all the detailed information for the resident. Care plans are not updated based on these meetings, some care plans created on admission and some by the 8th day or updated accordingly. Question is: Can we get rid of the interdisciplinary note from each SS, act, nursing and Dietary - and use the progress note only. OR can you give me a suggestion on how to streamline our process based on CMS rules, so we can save some time for all disciplines. THANK YOU EXPERTS!