Author Archive for: Diane Brown
Can he have a new stay of illness and be picked up under Medicare again?
Q: We have a resident who has received dialysis treatments for years, has used 100 Medicare days and is now beyond the wellness period, and was recently hospitalized for amputation. He has remained in the skilled nursing facility and has continued to receive dialysis treatments. Can he have a new stay of illness and be picked up under Medicare again?
A: I’m going to assume that the patient was considered benefits exhaust, but still skilled for the duration and that the UB-04 bills reflected this on a monthly basis. If this is the case, then the patient never accrued a new 100 days due to the lack of a break in skilled service. In this case, no new benefits are available under Medicare Part A until the patient goes 60 consecutive days without receiving skilled care and 60 days without a hospital admission (IOM-02 Medicare Benefits Policy Manual, Ch. 8, §30).
If a patient receives only four days of skilled therapy in a week but does not miss three consecutive days, does a COT OMRA need to be done if there was no change in actual RTM delivered in the 7-day rolling period?
Q: I work in a small SNF where we work essentially five days per week and cover weekends/holidays on an as needed basis. If a patient receives only four days of skilled therapy in a week but does not miss three consecutive days (i.e., may have refused or been on hold for one day midweek), does a COT OMRA need to be done if there was no change in actual RTM delivered in the 7-day rolling period? In other words, the patient would still have enough minutes for a Rehab Medium category.
A: If a patient only receives four days of skilled therapy rather than the five days that are required in regulation, you would need to complete the COT assessment. Any change to the reimbursable therapy minutes, number of days of therapy, number of disciplines of therapy, or restorative nursing (rehab low categories) that impact a RUG score necessitates a COT assessment. In your scenario, even though the patient is still receiving therapy, the RUG score would change to a nursing category, because you need five days of therapy to remain in a rehab category.
When a resident is discharged, what information do we look up to complete the assessment?
Q: When a resident is discharged, what information do we look up to complete the assessment? As I understand it, the ARD is the discharge date. If a resident was discharged to the hospital due to a stroke, she has significantly changed. So she usually has clear speech and is able to make herself understood, but on the day of discharge she could not speak, yet was still able to follow instructions such as sticking out the tongue and smiling on command. The ADLs also went from independent in mobility and transfers to being immobile on the day of discharge due to the possible stroke. My question is what do I code the MDS as? Do we code it as the resident’s condition was on the day of discharge or does the rule of threes still apply for the ADLs? Do I code the speech as “no speech-absence of spoken words” since that is how she presented on the discharge day or do I code how the resident typically is?
A: This is a good, thoughtful question. As of April 1, you were to begin completing the new discharge item set, which eliminates many items previously captured upon discharge (changes are posted to the Resources page under “MDS, RUGS, and Care Planning”). Secondly, if the discharge is unplanned you will also eliminate the interviews from the required items. You are correct that the ARD date must equal the discharge date. The rule of three still applies for ADL self-performance, but the support coding is eliminated from the new discharge set. For other items, there is more discretion and you can capture the change as long as it occurred within the ARD assessment window for the item. However, sensory items (i.e., speech clarity) that might reflect this patients changing condition are among those no longer captured by the discharge assessment.
Should we have a discharge care plan in place for a short-term resident whether or not a Return to Community Referral triggers on the CAA summary sheet?
Q: Should we have a discharge care plan in place for a short-term resident whether or not a Return to Community Referral triggers on the CAA summary sheet?
A: If you review the intent of Section Q, I would suggest that as a practice pattern, a discharge care plan be in place: “Intent: The items in this section are intended to record the participation and expectations of the resident, family members, or significant other(s) in the assessment, and to understand the resident’s overall goals. Discharge planning follow-up is already a regulatory requirement (CFR 483.20 (i) (3)). Section Q of the MDS uses a person-centered approach to insure that all individuals have the opportunity to learn about home and community based services and have an opportunity to receive long term care in the least restrictive setting possible. Interviewing the resident or designated individuals places the resident or their family at the center of decision-making.”
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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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Interviewing Essentials for MDS 3.0 and QIS
This 48-page training guide cuts through the theory and delivers step-by-step ways to build and improve interviewing skills. Whether your staff members have prior interviewing experience or interviewing for the first time, they’ll enjoy author Diane L. Brown’s interactive approach to interviewing.
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PPS Alert for Long-Term Care
PPS Alert for Long-Term Care is the industry’s leading resource devoted to navigating long-term care professionals through the MDS and PPS processes. You’ll also find practical tips for improving your facility’s quality processes, quality outcomes, and survey results.
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