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Test your Knowledge Answers:

1) Therapy evaluations are not required every time the resident gets a new diagnosis. Therapists may decide to reevaluate or just update the plan of care. 

2) Refer to Chapter 5, starting around page 8. Determine if the data error would be considered a "significant error" or a "minor error" and proceed from there. Each MDS error must be corrected within 14 days of identifying the coding error.  MDSs more than 2 years old cannot be corrected, but any MDS less than 2 years old should be corrected.  If the error is a significant clinical error, a significant correction of a prior assessment should be completed within 14 days of determining the error in addition to modifying the erroneous assessment.

3) The car transfer would be coded when the resident enters or exits the car from a passenger seat (any seat), so long as it is not in the driver's seat. The car transfer can be a simulated car cabin if there is one in the therapy gym. If weather prevents the resident from getting into or out of a car or if there is no car available during the three-day window, this item may be coded as 10. Helpers must be staff members. 

4) No. If the resident is NPO, that is their diet. If speech therapy is trialing a diet, it cannot be coded as a mechanically altered diet until the trial is successful and the resident is given a new order for a mechanically altered diet. 

5) Bill these days as skipped days. They are not Medicare utilization days.

The Medicare Claims Processing Manual, chapter 3, provides additional information in section 40.2.6 – Leave of Absence:

The provider bills for covered days with days of leave included in Noncovered Days. Noncovered charges for leave of absence days (holding a bed) may be omitted from the bill or may be shown under revenue code 018x. Providers will be instructed by their A/B MAC (A) on which billing method to use. Occurrence span code 74 is used to report the dates the leave began and ended. Although the Medicare program may not be billed for days of leave, the provider is not permitted to charge a beneficiary for them.

6) The Part A PPS Discharge assessment is not considered a scheduled PPS assessment. Chapter 2 of the RAI User’s Manual only includes the 5-Day as a scheduled PPS assessment on page 2-43 and lists the Part A PPS Discharge under the discharge assessment header.

Additionally, the MDS 3.0 Quality Measures (QM) User’s Manual v15.0 does not include the PPS discharge as a qualifying reason for assessment for long-stay measures, which includes the Prevalence of Falls measure that uses J1800.