Ask Diane: Should we issue a new medical record number for a readmission?
Q: Our facility doesn’t have a bed hold at present time due to a low numbers of beds occupied by residents. When a resident is discharged to the hospital, the discharge tracking form is coded as returned is anticipated (7). When the resident returns to the facility, should we keep the same medical record number and just follow the MDS schedule from the previous admission if there are no significant changes on the new admission of the resident?
If the resident was Medicare Part A, should we code as Medicare Return/Readmission (AA8b5)? Is it okay in that case if we are doing a new full assessment on every resident returning to the facility and the residents have a new medical record number? Every resident coming back is treated as new admission.
Diane: Issuing a new medical record number is an internal policy unrelated to the MDS and RAI rules. Many facilities keep the same number, but that is up to you. The requirements for completing an MDS follow the federal OBRA and Medicare regulations. If there is no significant change and an assessment is not due, then you don’t need to do anything for OBRA assessments (AA8a).
Regarding your second question, you code a Medicare assessment as a Medicare Return/Readmission (AA8b5) if the patient was on a Medicare Part A before returning to the hospital and then when they were readmitted from the hospital they were still on the Medicare Part A stay. This assessment indicates a return readmission to the Medicare program.
Lastly, the regulations do not specify that you need to do a new full assessment on every resident returning to the facility. However, if the resident in on a Medicare Part A stay and was out of the SNF for more than 24 hours, you will need a new Medicare assessment. Again issuing a new medical record number is an internal policy.
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Diane Brown
Diane Brown is a long-term care regulatory specialist and lead educator for HCPro's MDS 3.0 Boot Camp and Medicare Boot Camp-Long-Term Care Version. She is also a long-term care consultant with over 25 years of operational experience in healthcare. For Diane's complete bio, visit the About page.
Diane has written 240 posts.
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Comments
Our facility caters mostly to residents with behavior problems with dementia/alzheimers and usually do not have family to interview. How does the care plan committee get accurate answers to the questions that are required for face sheet information, activities, social services, and the MDS. What are the state guide lines on having empty spaces on the face sheet and the ss/activities documents?
One clarification I would add is that all Medicare assessments that are not combined with an OBRA assessment are full assessments, this is dictated by the RAI manual. Therfore, if the resident returns from the hospital and the facility opts not to make th eresident a new admission and/or create a new medical record number, the readmission return assessment tha will always be a full assessment (MPAF being the preferrable option), as opposed to an admission, significant change or annual, comprehensive assessment that might be combined with the readmit return assessment.
Joel.
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