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Q: My director of nursing tells me that I can only use grace days with the five-day or readmission MDS. She says never to use grace days with the 14-, 30-, 60-, or 90-day PPS assessments. Is this correct?

Julia's PPS Chat, August 18, 2004

Welcome once again to our PPS chat!

The use of grace days with the PPS MDS has been a difficult concept to understand for many assessment coordinators. Will you be sending up a red flag if you use them too often? Will Medicare take your money back if you use them inappropriately?

You aren't the only one with these questions. Read on to find the answers-

Q: My director of nursing tells me that I can only use grace days with the five-day or readmission MDS. She says never to use grace days with the 14-, 30-, 60-, or 90-day PPS assessments. Is this correct?

A:The frequency with which you use grace days will probably be much higher with your five-day and readmission/return MDSs than with your other PPS assessments. When a resident is first admitted, you might not begin rehabilitative therapy and other services right at admission-therefore, it would be appropriate to use grace days in order to capture services being provided to the resident.

In regard to the 14-, 30-, 60-, and 90-day assessments, you may use grace days if the MDS more accurately reflects the resident's condition and services received. One example of a reason to use grace days is if the resident is ill for a few days and unable to participate in therapy.

If you set the assessment reference date without using grace days, and the illness occurred in your lookback period, your Resource Utilization Group (RUG) score might be lower than it should be. Using grace days would more accurately reflect the amount of therapy the resident usually received.

Use grace days with discretion, however. For instance, if every 30-day MDS used five grace days, this practice could cause concern to a fiscal intermediary. However, if the use of grace days places a resident in the appropriate RUG based on the services received, you should use the extra days.

Finally, remember that you can't use grace days with your 14-day MDS if this is also your admission assessment. You must complete this admission assessment MDS by day 14. If you don't code your 14-day MDS as your admission assessment, you can use grace days.

So, be sure that you use grace days to paint a more accurate picture of the care your resident received. However, don't use them on every assessment, or that red flag might be waving in the breeze. As long as grace days are used when appropriate, you shouldn't have any problems.

We'll be chatting again soon-