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If a resident's original payer source was Medicaid, and he or she goes to the hospital "return anticipated," and then returns five days later as Medicare Part A, how do I code the MDS reason for assessment?

Julia's PPS Chat, March 31, 2004

Welcome back to PPS Chat!

Keeping track of one's daily schedule can boggle even the most organized mind. But keeping track of MDS assessment schedules can be even more difficult. Read this question and answer for some help-

Q: If a resident's original payer source was Medicaid, and he or she goes to the hospital "return anticipated," and then returns five days later as Medicare Part A, how do I code the MDS reason for assessment?

A: I assume that you are asking about the reason for assessment codes in MDS items A8a and A8b for the first assessment, which you complete upon the resident's return to your nursing facility.

Since the resident is Medicare Part A, you must complete the five-day MDS assessment with an assessment reference date (ARD) of day one through day eight (if you use up to three grace days). You would code this as a "1" in item A8b.

Remember that you must also complete OBRA-required assessments in addition to the PPS-required assessments. If you completed an admission assessment while the resident was covered by Medicaid, you wouldn't need to complete this assessment again.

If you didn't do an admission assessment previously, you may combine this assessment with the five-day PPS MDS or the 14-day MDS. Code the admission assessment as a "1" in item A8a.

If you do not have to complete an admission assessment, consider whether a significant change occurred since the resident was discharged to the hospital. If so, you must complete a significant change in status assessment by day 14 of the resident's readmission. You would code this as a "3" in item A8a and you could combine it with your five-day PPS assessment or your 14-day MDS.

If the resident did not experience a significant change, it is possible that one of the other OBRA-required assessments-an annual or quarterly assessment-is due. If the timelines and due dates allow, you could combine the annual (A8a code of "2") or quarterly (A8a code of "5") with the five-day MDS.

Always monitor both the OBRA and PPS timelines carefully so you don't miss any assessments.

Now we're on track! Combining assessments when possible and will save you some time-time you need to handle your busy schedule.

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