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Test Your Knowledge Answers: 

1) It is important to know whether the resident(s) require a one-person or two-person assist with each ADL. Section GG coding does not specify whether the resident needed one or two other than a code of dependence 01 is coded if there were two helpers, but dependence is also coded if one staff member completed the ADL task completely for the resident. The team should document whether the resident needed one or two helpers (and if two, code dependent). 

2) If the physician diagnosed a UTI during a hospital admission prior to entry or reentry, code it within 30 days. McGeer criteria or other facility surveillance criteria (e.g., NHSN, Loeb) are not required in that instance. 

The RAI User’s Manual, page I-13 states:

If the diagnosis of UTI was made prior to the resident’s admission, entry, or reentry into the facility, it is not necessary to obtain or evaluate the evidence-based criteria used to make the diagnosis in the prior setting. A documented physician diagnosis of UTI prior to admission is acceptable. This information may be included in the hospital transfer summary or other paperwork.

3) No discharge is required for a leave of absence as defined in Chapter 2 of the RAI User’s Manual.

However, if any of the conditions that create a discharge occur while on a leave of absence, the resident is then discharged effective the date they left the facility. Those conditions are:

• In-patient admission to a hospital

• Hospital observation for 24 hours or more

• Notification of discharge to a residence in the community

4) CMS did clarify the race and ethnicity items need to be asked during the look-back period on all assessments they are required on. Effective Oct. 1, the race and ethnicity items capture the resident's voice, and the resident must be asked first and only if the resident is unable to answer can we use family, significant other, or legal representative. Information from the medical record may be used if neither the resident, family, significant other, or legal representative is unable to answer. 

Carefully reviewing coding instructions will be important this October. Some items like health literacy and social isolation are resident voice items only and no other source of information is allowed to be used.

5) Per the SNF QRP requirements, you only need to answer 1 discharge goal (and care plan it) for all of the Self-Care and Mobility questions. The is no penalty for dashing the rest of the goal questions but you will receive a warning message when you submit the MDS, because of the dashes. But, remember, it's only a warning. This is also referenced in the RAI manual on page GG-29.

6) It is not a new benefit period, but it is a new Medicare stay. Part A PPS Discharge MDS would need to be completed with the OBRA Discharge to the hospital code "no" for interrupted stay. Upon return, a reentry tracking form and a new 5-day PPS MDS would need to be completed as well. The day of readmission is the new Medicare A start date  

7) If you are now past day 92 from the previous OBRA ARD, it is too late to change the ARD. If day 92 is today or later, you can change the ARD since you would still be in the allowable window to change the ARD (even though the ARD had previously been set earlier.)) 

8) There is an instruction to not code a pressure ulcer if it healed during the observation window. But there is no such instruction for the other skin problems. I would code the burn if it was present during the 7-day look-back period. 

9) The payor source would not be a factor here as the need for the Discharge assessment and reentry tracker is RAI-driven. Since the resident was gone for less than 24 hours and not admitted to the acute setting, no Discharge assessment or reentry is needed. As far as needing another 5-Day, that would be a call by the MA Plan.

10) The MDS updates are based on the ARD of the assessment. All assessments with an ARD of Oct. 1, 2023, or later will use version 1.18.11 item sets and the updated RAI User’s Manual. 

11) No, when a resident is discharged back to another Medicare provider on the same day as admission, it is not a Medicare utilization day.  No PPS MDS should be done.  Complete the entry tracking form and the OBRA Discharge MDS. 

12) Yes you need one GG functional goal with a care plan in place with that goal that should be met by the end of the Medicare A stay with interventions.  All other goal items can be dashed without penalty. 

13) No, this would not be sufficient. The physician must document the evidence-based reason that a GDR is not appropriate individually for each of the psychotropic medications per the State Operations Manual, Appendix PP.