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Test Your Knowledge Answers:

1) Unless there is a compact between states, the nurse should not document in the medical record unless licensed in that state.

2) This is absolutely false. CMS has instituted some edits to the claims processing software that will automatically reject claims with certain codes if listed on the UB-04. Note that this has nothing to do with the MDS itself.

3) A death in the facility would be correct. No Discharge assessment would be needed unless a resident is admitted to a hospital as an inpatient and less than 24 hours from the time the resident transferred from the SNF.

4) The instructions for newly certified nursing homes can be found at the beginning of Chapter 2 of the RAI User Manual beginning on page 2-4. The RAI User's Manual instructs that the first assessment completed and transmitted after a facility receives its CMS Certification should be coded A0310E = 1 on the first OBRA, Scheduled PPS or OBRA Discharge assessment that is completed and submitted once a facility obtains CMS certification. Note: the first submitted assessment may not be an OBRA Admission assessment.

5) A SCSA must be completed within 14 days of the determination of significant change in condition regardless of which ARD was chosen. It is important to document the determination of significant change in status in the medical record. The ARD of the SCSA cannot be set before the date of determination.

6) Yes, the weight loss for a new admission can be based upon reports from the resident, family, community physician records, etc.

See the RAI User's Manual, Chapter 3, Section K, page K-5:

For a New Admission

1. Ask the resident, family, or significant other about weight loss over the past 30 and 180 days.

2. Consult the resident's physician, review transfer documentation, and compare with admission weight.

3. If the admission weight is less than the previous weight, calculate the percentage of weight loss.

4. Complete the same process to determine and calculate weight loss comparing the admission weight to the weight 30 and 180 days ago.

6) Melancholy