Skip Day

[returnexpected]

A resident was admitted on 4/4/11. They were out to the ER from 2230 4/10 until 0330 4/11, being gone over midnight, but not admitted. I understand 4/10 will be the skip day, and that I may need to adjust the PPS schedule. My question is, if I need to use grace days for the 5day PPS, would it then be ok to use day 8 as 4/12/11 including the skip day? I am also concerned my software and QIES will flag it as a late assessment as it would be the 9th day from their admission date. Would I be better off going no later than actual Day 8 (not counting the skip day)?

The only info I found on skip days in the RAI was on page 2-64. Is there more info I overlooked?

[Talino]

Adjusting the assm't schedule only applies to the next scheduled PPS assm't. For an ongoing assm't, follow what the next paragraph says (same page)-

Resident Leaves the Facility and Returns During an Observation Period

The ARD is not altered if the beneficiary is out of the facility for a temporary leave of absence during part of the observation period. In this case, the facility may include services furnished during the beneficiary's temporary absence (when permitted under MDS coding guidelines; see Chapter 3) but may not extend the observation period.

Your ARD, using day 8, is still 4/11. Day 10 is included in the observation but skipped as a payment day.

[iceprincess492]

We just had this happen last week at my building. According to my biller, if they are out at midnight during the 5 day assessment period it does NOT change the days during the 5 day assessment but will move everything back for 14 day assess. For example I cannot use the original day 11 for 14 day, have to move it out to day 12. This didn't make a lot of sense to me but my billing person pretty much knows everything :) :redpinkhe

[returnexpected]

Thank you both for your replies. The therapy mgr was trying to get me to use Day 9 of actual stay since the one day would be a skip day, but that didn't sound right, nor fit into the guidelines in my opinion. The 14 day PPS won't be an issue then, as they are projecting using day 14 as the ARD.

I appreciate the help!

[lorihi09]

hello i have a question on skip day- if didnt realize was skip day and continued with assessments. Resident was discharged and then re-entry. what can you do? thank you for help.

[Talino]

hello i have a question on skip day- if didnt realize was skip day and continued with assessments. Resident was discharged and then re-entry. what can you do? thank you for help.

There is nothing you can do (or should do) once it's submitted. As long as the succeeding PPS' ARD fell within the adjusted window, you should be fine. Worst case scenario the ARD was scheduled 1 day early (not adjusting the LOA day) which will then result in a 1 day default payment.

If still Med A covered on return, you will start with a brand new PPS clock.

[lorihi09]

Hello thank you for help. So i get this straight- the resident wasnt admitted to the hospital but we d/c'd from out system because thought she was but wasnt admitted.(wasnt informed earlier of skip day scenerio) So we dont need to do anything correct? Do we need to do another assessment to correct?

thank you for help.

[Talino]

So we dont need to do anything correct? Do we need to do another assessment to correct?

No, do not make any correction. Like I said above if your ARD was indeed early you will only lose a day of the actual RUG rate. If there is an upcoming PPS assm't, apply the skip day then.

If you inactivate the previously submitted PPS assm't/s which omitted the skip day and change the ARD you will lose more... much more. See this thread on what happens if you inactivate to make that correction.