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Contact Information

Wendy Castro

MDS Training Coordinator RAC-CT

 wendy.castro@state.co.us

cdphe_mds_colorado@state.co.us

303-692-2854

Test Your Knowledge Answers:

1) No, MDS modifications can be done that are more than 2 years from today's date. 2021 is more than 2 years ago, so MDSs cannot be sent or modified for ARDs in 2021.

2) We must use the information in the federal database. If the resident has Medicare, the common working file HIQA would be used to verify the correct date of birth and match it to the information that is in the Social Security system for the resident. 

3) It means that some residents who did not receive the vaccine either weren't offered it (code 5) or were offered but not given the vaccine (code 9). 

4) Yes, TPN is considered IV fluids for nutrition or hydration. Total parenteral nutrition (TPN) is when the IV-administered nutrition is the only source of nutrition the patient is receiving. TPN is a mixture of separate components which contain lipid emulsions, dextrose, amino acids, vitamins, electrolytes, minerals, and trace elements.

IVF (Intravenous Fluid) is just that, fluids. No nutritional value. A few examples are 0.9% Normal Saline; 0.45% Normal Saline, D5W, and Lactated Ringers.

5A) This resident can be picked back up on MCR in the 30 days following the end of the skilled stay, as long as it is for a reason related to the prior skilled stay in the SNF or the hospital. If the 30-day window has passed, then they will need a new qualifying 3-night stay. If the 60-day wellness has not passed, they would only have their remaining MCR days to use, and not a full 100: a new 5-day and physician certification would be needed. When a resident's Medicare ends with days remaining, the resident can be picked back up on Medicare within 30 days of the Medicare end date to treat a condition that had been treated during the 3-day qualifying hospital stay or which arose during skilled care in the SNF.  There would be a new Medicare A start date but the Medicare benefit period picks up where it left off using as many of the remaining days as are necessary.

If the resident has been off of Medicare with days remaining more than 30 days but less than the 60 days required to end    their Medicare benefit period, the resident can be put back on Medicare A to use the remaining days in the Medicare            Benefit Period after a new 3-day Qualifying Hospital stay.  This QHS can be for the same condition or a new condition. 

5B) See above regarding the 30-day window, then apply the other rules mentioned: new 5-day and physician certification would be needed. The best resource to review about the Medicare Benefit Period is the Medicare General Information, Eligibility and Entitlement Manual, Chapter 3.

5C) Set the PPS discharge ARD for the day it should have been completed. A submission warning will be generated due to late completion from A2300 to Z0500. The provider can complete the late Part A PPS Discharge now if the end of Medicare was less than 2 years ago. The ARD is the Medicare Last covered day if it is a standalone Part A PPS Discharge. If the resident is physically discharged on the Medicare end date or the day after the Medicare end date, the OBRA Discharge MDS would be modified to add the Part A PPS Discharge reason for assessment in A0310H. Discharge MDSs (OBRA Discharge MDSs or Part A PPS Discharge MDSs) must use the date of the physical discharge (OBRA) or Medicare end date (Part A PPS Discharge) so creating the missed assessment now and using the actual dates of discharge would not be backdating. The facility would complete the assessment from information in the documentation and sign and submit it with dates actually signed--not backdated. The iQIES Final Validation report will give a warning message showing that the assessments were completed late.  

6) If the OBRA Discharge was a standalone MDS, the PHQ-2 to 9 is skipped. However, if the OBRA Discharge is combined with the 5-day PPS MDS or any other OBRA MDS, the interviews were live. When someone discharges unexpectedly and interviews cannot be conducted, you must code that the resident interview should have been conducted (unless the resident was rarely never understood) and then dash the interview and cannot go to the staff assessment. In order to lose the 2% APU, more than 10% of your PPS MDSs must contain a dash in an SNF QRP item. The dashed PHQ-2-9 causing the PPS MDS to be considered invalid for the SNF QRP measures goes into the bad bucket.