Ask Diane: Should we complete the admission MDS if the resident is discharged on the 14th day?
Q: I’m the RNAC at a small hospital-based transitional care unit, and most of our residents are short stay (8-14 days). The 5-day MDS is used as the assessment tool for most of our residents. Is it necessary to complete the admission (also known as the 14-day) MDS if the resident is discharged on the 14th day of his or her stay?
Diane: If the resident is discharged before midnight on the 14th day, you are not required to complete the 14-day MDS. In these situations, you would indicate that the resident was discharged prior to completion of the assessment.
However, if you have already completed the 14-day MDS, code the resident as discharged, return not anticipated, rather than discharged prior to completion of the assessment.
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MacKenzie Kimball
MacKenzie Kimball is a Managing Editor in HCPro's long-term care division. She is the editor of the monthly newsletter PPS Alert for Long-Term Care and the MDS 3.0 Update e-newsletter.
MacKenzie has written 321 posts.
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Comments
I hope the questioner meant she is doing the full admission /5day assessment initially -correct?I never knew you had to code the discharge before the 14th day as prior to completion of assessment.Is that in the MDS user’s manual?I thought you only used that if the resident was discharged before a required assessment was due. The 14 day is not a required assessment for this resident if they are discharged before midnight of the 14th day.
If you do not do the MDS wouldn’t you get the Medicare default rate only?
Years ago our state agency contact told me to never put “discharged,return not anticipated” unless the resident had died. Death was the only sure way we knew the resident wasn’t going to return. He stated that we should routinely use “discharged, return anticipated”. Has this changed?
All great questions! Let me clarify. In this situation, the 5-day MDS was completed and the assessment we are referring to is the OBRA admission assessment, which is to be completed by the 14th day, provided that the resident is in the bed at midnight on day 14. This OBRA is not required by Medicare.
In regards to your questions about discharge coding, page 2-24 of the MDS 2.0 RAI User’s Manual states the following:
“A Discharge-return not anticipated (AA8a = 6) is completed when it is determined that the resident is being discharged with no expectation of return after a comprehensive Admission assessment has been completed. A discharge with return not anticipated can be a formal discharge to home, to another facility, or when the resident dies. If the resident is formally discharged from the facility and returns at a later date, this will be a new admission and requires a new Date of Entry (AB1). The MDS assessment schedule will start over with a new comprehensive Admission assessment. If the resident will receive Medicare Part A services, then the Medicare 5-Day assessment would be completed and the Medicare assessment schedule would continue.
A Discharge-return anticipated (AA8a = 7) reports a more temporary absence from the facility after the Admission assessment is completed, when it is anticipated that the resident will return for continued nursing facility services. If a resident is temporarily admitted for acute care in the hospital, or a hospital observation stay lasts more than 24 hours, but the resident is expected to return to the nursing facility, the Discharge Tracking form would be coded as a discharge with return anticipated. When the resident returns to the facility, a Reentry Tracking form must be completed to report the return of the resident. In some situations, a resident may be discharged with a return anticipated and later the facility learns that he/she will not be returning or has died. In this situation, another Discharge Tracking form (return not anticipated) is not necessary unless the State requires this second discharge document. Please contact your State RAI Coordinator for clarification if your state requires this additional Discharge Tracking form.
The Discharged-prior to completion of the initial assessment (AA8a = 8 ) is indicated when a resident is admitted to the facility and the Admission assessment is not completed before the resident is discharged. This reason for assessment should be selected whether or not the resident is expected to return, e.g., from an admission to the hospital, or is not expected to return, e.g., the resident dies in the nursing facility. If the Admission assessment had not been completed, the only discharge that may be selected is AA8a = 8.”
I hope this answers your questions. Please feel free to contact me with any other questions.
Thanks!!
Do you know what the actual $ amount is for the MDS default rate?
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