Welcome to this video series for skilled nursing facilities.
We will be discussing the MDS, which is the Minimum Data Set
that is required for submission to CMS
on a regular basis for every resident.
If you need more information than this short video can provide
please go to the www.cms.gov website for the most recent RAI Manual.
There are many reasons to file a transfer or a discharge assessment in MDS.
Today we will be discussing what happens
when you do not expect to see the resident return to your facility.
In other words in your clinical judgment
the return is not anticipated.
Most transfers and discharges are for medical reasons,
emergent or pre-planned.
And either kind can be with return anticipated
or with return not anticipated.
So let's think of it like a grid.
Today's video will concentrate on the squares on the right-hand side.
We will start with the upper right square
Emergency Room Visit with Return Not Anticipated.
This is for someone with a fall or an infection
or an urgent ambulance type situation
whom you suspect from the family reaction
will not be returning to your facility.
It may well be that they expect the resident to be released from the hospital
but the family intends to permanently place the resident elsewhere
when it comes to that point
Or perhaps the resident is going to the emergency room
and sadly you anticipate that will be their last visit.
Coding for this discharge will look like this:
A0310F equals 10: Discharge with Return Not Anticipated,
and A0310G equals 2: Unplanned.
Remember, a Section GG SNF Part A discharge is never needed on an emergent discharge.
This is true even if you were preparing to do the discharge anyway
but it just so happened that the ambulance was called.
Even if you had a NOMNC out
and you knew what the resident's discharge plans were.
As long as the resident stays 24 hours
and qualifies for a discharge in the first place
this would be a live emergency room transport
and an unplanned transfer to an inpatient facility.
Keep in touch with the family
to decide how to answer A2100: Discharge Status.
Another situation that belongs in this quadrant is a Death in Facility.
Even if an ambulance ride was not involved
it is still an unplanned event with no return anticipated.
Even if the resident was on hospice.
If the resident took the ambulance ride
but was called Dead on Arrival at the hospital
it becomes a Death in Facility.
The MDS coding in this case is:
A0310F = 12: Death in Facility,
A0310G = 2: Unplanned,
and A2000 is the discharge date.
Its the date the feet left your door.
Now let's look at the bottom right quadrant:
Planned Discharge with Returned Not Anticipated.
This is for someone who met their clinical and/or therapy goals.
Everyone is happy that they are going home!
Or perhaps there is someone choosing to leave
either with or without medical advice.
Sometimes the Part A eligibility runs out
and they decide to go home.
Or sometimes they select hospice and choose to go home.
Not quite the same celebration.
The implications of a discharge in this square
are similar to the above:
A0310F = 10: Discharge with Return Not Anticipated,
A0310G = 1: Planned,
and A2100 = 01: To the Community.
Most likely the resident is done using their Medicare Part A days
so A0310H = 1: Yes it is a SNF Part A DIscharge,
and A2400C = the applicable date.
Remember if you are correct and they do not return
no further discharge or records are needed.
However if a resident has been sent out
with A0310F =10: Discharge with Return Not Anticipated
and they do return even after just a few days away
your next submissions will be an entry tracking - not a re-entry -
and a full-on comprehensive OBRA assessment, A0310A = 01.
Even if you know them from a long time back.
This is officially a new resident for MDS purposes
with a comprehensive assessment due
using your new eyes to see them as they now are.
Thank you for watching this video on MDS.
As always if you need further information
please go to www.cms.gov
for the most recent RAI Manual.
That's your best information.
Another good source of information is your State Coordinator.
There is a list of your MDS Coordinators in Appendix B of the RAI Manual.
Thank you for your time.