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Test your knowledge answers:

1) For MDS purposes it would be treated as a fall unless the assessment establishes that it was not. To do that, you have to determine the person's intent with regard to both change of surface level (e.g. wheelchair to the floor) and implementation of the transfer (e.g. how did they choose to transition and was their implementation consistent with that choice). For example, if I chose to dive from a diving board into a pool and then proceed to do it, that's not a fall. If I choose to dive but slip or lose my balance, that's a fall. If I decided to get into the water and fell without choosing to jump or dive, that's a fall. If I'm on the diving board and my brother pushes me off, that's not a fall because it's due to an overwhelming external force. The presence of behavioral issues does not in itself sufficiently establish that there was not also a fall.

2) Here is the link to the Quality Measures User Manual. At the bottom of the page under downloads is one that was updated in January 2022 and contains numerous files. Once the information has been downloaded, click open the one that reads 'MDS 3.0 QM User Manual'. Once you find the QM with the information, click the QM and it will take you to that section.

3) The signature date is the date the physician signs the certification/recertification. The initial certification is required on admission or as soon as is practical after admission. The first recertification is due within 14 days of admission.

Subsequent recertifications are due within 30 days of the last recertification.

Recertifications can be done/signed/dated early but remember that the due date for the next recertification is calculated from the previous signature date.

There is no "grace" period but delayed certifications/recertifications are allowed in isolated cases. This is not the same as certification/recertification with a late date as it requires acknowledgment/explanation.

So to sum it up, each recertification must be signed within 30 days of the previous recertification signature and date. The physician must date his/her signature for the actual date signed. The date cannot be backdated. Delayed certification statements are acceptable when isolated late recertification occurred.

4) Completion must be within 48 hours, and delivery of the summary must be before your comprehensive care plan completion. It is good to look at the intent of this rule, which is to prevent errors in care and to meet the resident's basic needs. That may help you with the decision.

Baseline Care Plan Summary

The facility must provide the resident and the representative, if applicable with a written summary of the baseline care plan by completion of the comprehensive care plan.

INTENT §483.21(a)

Completion and implementation of the baseline care plan within 48 hours of a resident’s admission is intended to promote continuity of care and communication among nursing home staff, increase resident safety, and safeguard against adverse events that are most likely to occur right after admission; and to ensure the resident and representative, if applicable, are informed of the initial plan for delivery of care and services by receiving a written summary of the baseline care plan.

5) The OBRA schedule continues to ‘run’ and the Quarterly assessment is due on the same date it was prior to the new acute Medicare Part A stay. You have the choice in this situation to do the Quarterly assessment early and combine it with the PPS 5-Day, but it does still have to be completed with an ARD that is within 92 days of the prior OBRA ARD.