Test Your Knowledge

Test Your Knowledge Questions:

1) A long-term (Medicaid) resident was discharged unexpectedly to the ER on the ARD of the SCSA MDS. We'd like to proceed with the SCSA as the resident had a very significant decline and was on Isolation before the ER discharge. Interviews were not completed before discharge. Will the dashed items count towards the 2% reimbursement penalty for the APU, or is that just for Med A MDSs? 

2) If Tylenol was given for fever, would it be coded in section J for pain? 

3) Is it necessary to rank a diagnosis for residents? What is the rationality? 

4) A current skilled resident was informed the Medicare number will change effective 12/29/2023 (being initiated by the government) due to a possible security breach. The entry tracking record and admission 5-day were completed and submitted with the "old" number. Is there an MDS that needs to be done now or wait until the NPE or discharge MDS to use the new number? 

5) If a resident changes from traditional Medicare A to a Medicare Advantage payor on 1/1/2024 during a skilled stay, what MDS would be required? Is a Discharge PPS needed for the end of the traditional Medicare A stay? Would there be a new 5-day for the new payor?

6) A resident admitted under UHC Medicare with a diagnosis of CVA with hemiplegia, a new PEG tube, and aphasia. UHC cut the resident, who then became private pay. Six months later, the resident converted to traditional Medicare. Can the resident now be picked up under Medicare A without a qualifying hospital stay? Given the fact her skilled status for PEG feeding, NPO status, and that the resident was never skilled other than when under UHC. 

7) If a CNA sets up the resident's meal try such as cutting up their meat, taking covers off cups, opening condiments, and buttering their bread - would these tasks be coded as set-up or clean-up assistance? 

8) A resident who was due for a Quarterly assessment, went to the hospital and was admitted. Can the Quarterly and Discharge assessment be combined? 

9) We had cases of COVID-19 in September, October, and November with all of the residents being asymptomatic. The payer source of the residents was either private pay or Medicaid. The administrator wants to have the assessments backdated to September - November to code for isolation. However, according to the RAI manual, we cannot backdate assessments. Is this correct?

10) It was recently noticed that there was an omission to obtain an order for oxygen and the resident received oxygen intermittently throughout the lookback period. Can oxygen use be coded in O0110C1B? 

11) If a patient is on Palliative/End-of-life care and develops a Kennedy terminal ulcer does an SCSA need to be completed? 

12) How are height and weight correctly coded for someone with a bilateral amputation? 

13) If a resident was set up for SCSA due to admission to hospice with an ARD of 12/28/2023, but passed on 1/1/2024, would the SCSA still need to be completed? 

14) A resident has a diagnosis of asthma and SOB while lying flat, but there is no diagnosis of COPD. The PCC analyzer pulls this as Special Care High (SCH). If I6200 and J1100C are selected, regardless of whether they have COPD or not, does the resident qualify for SCH? 

15) If asked to provide a transmission date for Medicare replacement plans and insurance MDS assessments, should this be done? 

16) What MDSs are required when a Medicare A resident comes off of skilled care? Are we required to complete the NPE as well as a significant change for end of therapy? 

17) When is a Baseline Care Plan needed? Is the Baseline Care Plan only used on Medicare Admission and Readmission? How would this apply to a Medicare resident with a comprehensive care plan that was sent out? 

18) Is there a standard letter or beneficiary notice that has to be used when a resident exhausts Medicare benefits? 

19) When does the Pain Assessment interview need to be conducted?