Long-Term Care

Tip of the week: Understanding MDS basics for residents skilled under Part A

Contemporary Long-Term Care Weekly, January 21, 2010

The Minimum Data Set (MDS) drives all billing, including consolidated billing. It is a federal Omnibus Budget Reconciliation Act of 1987 (OBRA) requirement that must be performed on all residents. Certain MDS requirements must be fulfilled when a resident is admitted in and is skilled under Medicare Part A, including:

  • A five- and 14-day MDS assessment, followed by a 30-, 60-, and 90-day MDS assessment if the resident continues to utilize Medicare
  • Daily Medicare charting, which must be completed by nurses with an emphasis on the skilled issue (MDS coding should strongly reflect the skilled issue as well)

It’s important to have a skilled MDS person who can set correct assessment reference dates (ARDs), which become the common point of reference for look-back periods. Look-back periods can be seven, 14, or 30 days. Many areas of the MDS assessment will ask you questions regarding the resident’s condition over the previous seven, 30, 90, or 180 days from the ARD. Also, on five-day MDS assessments the reference period can extend back during the hospital stay and needs to be counted. Many make the mistake of counting only the nursing home days, which can result in a big reimbursement loss.

This is an excerpt from HCPro’s book, The Long-Term Care Administrator’s Field Guide, by Brian Garavaglia, PhD.

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