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Test Your Knowledge Answers:

1) For the first question, CMS's definition states this is not the resident's best or worst performance, but the usual performance. However, this does not exclude the best/worst performance from also being the usual performance. The deciding factor should not be only based on a clinical judgment of how the resident usually performs, but based on what occurred during the 3-day window. For the example, Independent would be considered the usual performance based on documentation during the 3-day window. 

For the second question, the instructions are to code how the resident usually performed, so in this example, Partial would be coded, since this was how the resident usually performed when the activity was performed.

2) Yes, insulin is a hypoglycemic medication by classification. 

3) Medicare ended on 7/10/2024 so the ARD cannot be changed on 7/11/2024 since it is outside of the Medicare A stay. 

4) Just code the Y. Resident declined to respond. No other item should be coded. 

5) Any injection during the look-back should be included. 

6) Yes, any error identified in an MDS that has been transmitted and accepted should be modified to make the data in the MDS correct if there is supporting documentation in the medical record during the original MDS look-back of what the correct response should have been. Only MDSs with ARDs within the last 2 years can be modified. 

7) The steps for assessment and coding instructions say to review the record for the observation period ending at midnight on the ARD (unless discharged earlier in the day). Questions like B0100, B0700, and B0800 should be answered after the ARD so that the entire look-back period can be considered when making the coding decision. 

8) No. The claims-based measures are updated quarterly but are based on a year. There is no monthly report about claims-based measures. 

9) If the usual performance for this resident was to participate in the transfers with the use of a stand lift and one staff member, it would not be coded as dependent. If the resident did less than half the effort required to transfer, the code would be substantial maximal.