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 expect to see the resident return to your facility.
In other words in your clinical judgment
the return is anticipated.
But first remember, there are at least a few reasons
not to file an MDS assessment just because a resident leaves your facility.
One example is the potential resident who came to your door
and tried to admit but did not stay long enough to have an entry tracking assessment.
In other words the person was not there over a midnight.
Another example might be a resident that was taken to the hospital as an emergency
but does not stay in the hospital for 24 hours.
They might be there over a midnight
but it was for observation only.
This person does not need an MDS transfer.
But you must also be sure not to charge Medicare
for the midnight they did not stay with you.
Another common reason not to file the discharge
is if an established resident is on a leave of absence (an LOA)
according to the definition used in your facility.
Allowable LOA length is a matter of facility policy
and not something specified by MDS.
Again, midnights away from the facility mean that
that specific date is not chargeable to Medicare Part A.
So your ARD might shift.
But most 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 left-hand side.
The situation in the lower left might be a family member
that comes to take the resident home for a week or two
to take their own assessment of the patient's needs.
This is like a very long LOA.
But then again, there is no discharge to another facility
and you expect in your clinical judgment they will return.
Another reason to go ahead and file a discharge even on an LOA
would be because the resident missed three days of therapy
and you must file an End of Therapy anyway.
The implications of a discharge in this square are
A0310F = 11 Discharged with Return Anticipated,
A031G = 1 Planned,
and A2100 = 01 To the Community.
If the resident is still using Medicare Part A days
then A0310H = 1 Yes It is a SNF Part A Discharge,
and A2400C equals the applicable date.
In that case Section GG will apply.
A more common situation lives in the square on the top left.
This is a return to the hospital for a planned procedure follow-up from their original surgery.
For example. this might be taking pins out of a fracture.
You know that your resident is admitted to the hospital for a night or two
but will return to your facility afterwards.
This is similar to the previous LOA situation
except the discharge is to an inpatient facility.
So A0310F = 11 Discharged with Return Anticipated,
and A0310G = 1 Planned
But in this case A2100 would depend on where they went.
If in fact they do return to your facility within 30 days of the discharge date
then you have an entry tracking record as a re-entry (A1700 = 2)
and a decision as to whether the old care plan is still valid.
In other words, will you need to file a SCSA?
Because there has been an improvement or a decline in two areas?
You have 14 days to make this decision.
But the clock starts on the re-entry date.
If your team decides that an SCSA is not warranted
then the OBRA schedule in effect when they left still applies
as to when their next Medicare-required assessment is due.
A new SCSA can seem a lot
for someone who was only gone for a few days
and nothing unexpected changed at the hospital.
But remember this also applies if the resident is gone for a long time.
Up to a month!
In the rare case the resident returns after over 30 days absence
then the entry tracking record and the OBRA admission are all new.
But the bigger question is the Part A status.
Whether or not you will have to do a PPS series and a SNF Part A admission again.
A lot will depend on how long the resident stayed with you
before being taken to the ER in the first place.
Again your billing team is an essential part of your MDS team of advisors.
What if you have filed an MDS transfer using A0310F =11
and you never see this resident again?
In other words you thought a return was anticipated
but it never happened?
In that case the MDS record is complete and no further assessments are required.
There is another video in this series
about what to file if in your clinical judgment
you believe from the start that a return is not likely.
Look for a different video on transfers
and discharges with return not anticipated (A0310F = 10).
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's a list of your MDS coordinators in Appendix B of the RAI manual.
Thank you for your time.