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Test Your Knowledge Answers:

1) Restraints are coded by the effect they have on the resident, not by the reason they were ordered.  Restraints must have a medical reason for use.  If the resident could get up out of the chair when no seatbelt is in place, but cannot stand from the chair by opening the seatbelt when desiring to get out of the chair it would be considered a restraint. 

2) Usually the care plan meeting is held within 7 days after the completion of the Quarterly Assessment.

3) "Do not code services that were provided solely in conjunction with a surgical procedure or diagnostic procedure, such as IV medications or ventilators." (page O-2 of the Guidance Manual)

4) The RAI User's Manual restricts the coding of trach care to the cleansing of the tracheostomy and/or cannula.

5) Yes you must round the weights, using the math rounding theory, before calculating a weight loss/gain. 

6) Rules for stopping the interview C-5:

The BIMS should be attempted with all residents to determine if they are sometimes understood. If so, record the BIMS on the MDS. The first four questions on the BIMS are not yes/no questions so if the resident gives no answer or answers that are unrelated or nonsensical, the interview is stopped, the rest of the items are dashed, a 99 is entered for the summary score, and staff is interviewed to complete the assessment. The staff assessment gives more latitude for assessing memory/recall than is allowed with the structured BIMS. For staff completing the assessment, it should be documented that the BIMS was attempted with the resident, the resident's actual response along with additional approaches to communication that did work. Even if the BIMS is stopped, this is would be useful assessment information.

7) Even when a resident discharges with return not anticipated, if they return on Medicare no later than 11:59 pm on the 3rd non-covered day, it is an interrupted stay – not a start over. In this case, the Part A PPS MDS should not be completed with the OBRA Discharge MDS. The OBRA Discharge should be coded 'Yes' for interrupted stay and 'No' for Part A PPS Discharge. While a new OBRA Admission MDS would be completed within 14 days of this new admission-type entry, a new 5-day PPS MDS should not/cannot be completed. The resident can be assessed for an interim payment assessment (IPA) but it is not required to be completed. The previously completed 5-Day PPS MDS that was completed before the discharge to the other SNF would continue to be the payer until and if an IPA was completed.

8) Per Chapter 2 of the RAI Manual, when a resident has been discharged and did not return before the Quarterly was due, it would be acceptable to complete the missed Quarterly Assessment within 14 days after readmission. 

9)  If a goal(s) were not set, the items would be dashed.

10) Any nurse should be able to complete Section K without difficulty. The RAI Manual leaves it up to the facility to determine who will complete the different parts of the MDS. The exceptions to this are Z0500 and V0200B, as only an RN can certify the completion of the assessment.

11) When a resident dies in the ER, has not been admitted to the hospital as an inpatient, and is away from the nursing home for less than 24 hours, the death in facility tracking form must be done, but not an OBRA discharge.

12) Only the staff member who conducted the resident interview can attest to the accuracy of the interview. If the activity staff member does not have access to Section Z0400 to attest to the accuracy of the interview, print out the Z0400 page and ask them to sign to attest to Section F on the hard copy page. Scan the page into the electronic record or keep the signed hard copy page in the resident's paper chart. The MDS nurse cannot attest to the accuracy of an interview they did not conduct. Be certain the staff member enters the date the interview was actually conducted when dating their signature in Z0400.

13) If a beneficiary qualified for the special one-time renewal of SNF benefits under the benefit period aspect of the section 1812(f) waiver while the section 1812(f) waiver is in effect, that reserve of 100 additional SNF benefit days would remain available for the beneficiary to draw upon even after the waiver itself has expired. 

14) There is nothing that needs to be done at this point. Continue using the PDPM score that was generated from the 5-Day PPS assessment until a Notice of Medicare Non-Coverage (NOMNC) is issued when the nursing skill ends. When Medicare Part A ends, an End of PPS MDS (Part A PPS Discharge assessment) would be completed. The only other assessment that would change the reimbursement is an interim payment assessment (IPA) if it was determined to be warranted. 

15) In the “Provider User Roles and Privileges” matrix (page 11), the Assessment Submitter is not able to submit an assessment, but the Assessment Coordinator is able to submit an assessment.