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A1) Yes, the MDS would need to be modified to add the SSNs. This is an important identifying item on the MDS to show that the MDS was submitted for the correct resident. If you do not correct the prior MDSs, the iQIES system will think this is a new resident and that you have missed assessments for the other (no SSN) resident. 

A2) Yes, the Part A PPS Discharge MDS is required when a resident's Medicare coverage ends due to benefits being exhausted. A Part A PPS Discharge is completed every time Medicare A ends for any reason other than death (not done in interrupted stays because Medicare didn't end). 

A3) To code Respiratory therapy minutes on the MDS, the following must be present:

RAI User's Manual, Chapter 3, Section O, page O-28:

• For purposes of the MDS, providers should record services for respiratory, psychological, and recreational therapies (Item O0400D, E, and F) when the following criteria are met:
- the physician orders the therapy;
- the physician's order includes a statement of frequency, duration, and scope of treatment;
- the services must be directly and specifically related to an active written treatment plan that is based on an initial evaluation performed by qualified personnel (See Glossary in Appendix A for definitions of respiratory, psychological and recreational therapies);
- the services are required and provided by qualified personnel (See Glossary in Appendix A for definitions of respiratory, psychological and recreational therapies);
- the services must be reasonable and necessary for treatment of the resident's condition.

RAI User's Manual, Appendix A:

Services are provided by a qualified professional (respiratory therapists, respiratory nurse). Respiratory therapy services are for the assessment, treatment, and monitoring of patients with deficiencies or abnormalities of pulmonary function. Respiratory therapy services include coughing, deep breathing, nebulizer treatments, assessing breath sounds, mechanical ventilation, etc., which must be provided by a respiratory therapist or trained respiratory nurse. A respiratory nurse must be proficient in the modalities listed above, either through formal nursing or specific training, and may deliver these modalities as allowed under the state Nurse Practice Act and applicable state laws.

A4) The resident is not up to date. Reason would be dashed since none of the coding options are correct.