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Test your knowledge answers:

1) You cannot bill Medicare Part B for a resident who is receiving skilled services on a Medicare Part A stay. If the resident requires a daily skilled nursing level of care, therapy can provide services less than 5 days per week for a resident on Medicare A for nursing. Therapy must always/only provide medically necessary therapy services that are reasonable and necessary. If the resident only requires therapy 3 days per week, then only 3 days of therapy per week should be provided. Therapy will not be the reason for skilled coverage if therapy is provided less than 5 days per week—nursing would be if all requirements are met.

2) This would not be appropriate to code on the MDS.

Here is what the RAI User’s Manual says on page O-5:

“Code only when the resident requires transmission-based precautions and single room isolation (alone in a separate room) because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with highly transmissible or epidemiologically significant pathogens that have been acquired by physical contact or airborne or droplet transmission. Do not code this item if the resident only has a history of infectious disease (e.g., s/p MRSA or s/p C-Diff – no active symptoms). Do not code this item if the precautions are standard precautions, because these types of precautions apply to everyone. Standard precautions include hand hygiene compliance, glove use, and additionally may include masks, eye protection, and gowns. Examples of when the isolation criterion would not apply include urinary tract infections, encapsulated pneumonia, and wound infections.”

3) No, the provider [physician or non-physician practitioner] has to make and document a diagnosis during the look-back period. Anytime you get a diagnosis of urinary retention, you should be working with your providers to determine the underlying cause so the interdisciplinary team can develop an appropriate plan of care.

4) Per Chapter 2: Assessments for the RAI, starting on page 2-33, it reads:

"...OBRA assessments may be scheduled early if a nursing home wants to stagger due dates for assessments. As a result, more than three OBRA Quarterly assessments may be completed on a particular resident in a given year, or the Annual assessment may be completed early to ensure that the regulatory time frames are met. However, States may have more stringent restrictions."

"The ARD must be within 92 days after the ARD of the previous OBRA assessment (Quarterly, Admission, SCSA, SCPA, SCQA, or Annual assessment + 92 calendar days).

The MDS completion date (item Z0500B) must be no later than 14 days after the ARD (ARD + 14 calendar days)."

From what the above information states, it would be acceptable for you to complete the annual assessment, as long as it falls within the timeframe (dates) mentioned.

5) When a resident readmits, the look-back is limited to the day/time of readmission except for certain sections (K & O) that have columns for "while not a resident."

See the RAI User's Manual, Chapter 3, page 3-3:

3.3 Coding Conventions

There are several standard conventions to be used when completing the MDS assessment, as follows.

• The standard look-back period for the MDS 3.0 is 7 days, unless otherwise stated.

• With the exception of certain items (e.g., some items in Sections K and O), the lookback period does not extend into the preadmission period unless the item instructions state otherwise. In the case of reentry, the look-back period does not extend into the time prior to the reentry, unless instructions state otherwise.

6) If a resident is choosing to end Medicare coverage and change to another payer for their Medicare coverage, the NOMNC should not be required. I would recommend that you document why the NOMNC was not provided in the resident's medical record.

7) The answer is yes if they met the 120 hours of work within the 90 day period and then do not work there for 60 consecutive days. See the 5-star User's Guide for April 2022.

Measure Specifications

"PBJ does not collect information on employee termination dates. Nurse staff turnover measures are constructed using the daily staffing information submitted through the PBJ system. Turnover is identified based on gaps in days worked, allowing creation of a turnover measure that is defined the same way across all nursing homes and that does not depend on termination dates reported by nursing homes. Individuals are identified based on the employee system ID and nursing home identifiers in the PBJ data.

• Denominator: The turnover measures include only individuals who work at least 120 hours in a 90-day period across the baseline quarter (the quarter prior to the first quarter used in the turnover calculation) and the first two quarters used in the turnover calculation. For example, the turnover calculation for calendar year 2020 includes in the denominator, individuals who worked 120 or

more hours in any 90-day period with the first workday of the 90-day period occurring in 2019Q4-2020Q2 (October 1, 2019 through June 30, 2020). This specification excludes individuals who work infrequently (e.g., occasionally covering shifts at a nursing home). Note that both regular employees and agency staff are included in the turnover measure if they work sufficient hours to be eligible for the denominator.

• Numerator: Individuals who no longer work at the nursing home are defined as eligible individuals who have a period of at least 60 consecutive days in which they do not work at all. The 60-day gap must start during the period covered by the turnover measure. This lengthy period without any reported work hours suggests that the individual is no longer working at the nursing home. For example, the numerator for turnover in 2020 includes eligible employees who had a 60-day gap that started anytime during the year. The turnover date is defined as the last workday prior to the start of the 60-day gap. Note that data from the quarter after the period covered by the turnover measure are required to identify gaps that start within 60 days of the end of the period covered by the turnover measure. For example, data from 2021Q1 are used to identify 60-day gaps that started between November 2, 2020, and December 31, 2020.

Note that individuals who return to the nursing home after a gap of more than 60 days can have multiple 'employment spells' used in the turnover calculation if they meet the eligibility requirement for subsequent employment spell(s). Essentially, they are treated as new employees."