RE: Question re OMRA - Excerpt from the RAI MAnual

[Faye Jones]

I would suggest contacting intermediary for clarification of their interpretation-  My intermediary is Empire and I would not do an OMRA just because rehab restarted.  Perhaps if there really was a case for decline/sig change but around here that is not usually the case.  We are usually waiting for weight bearing change or something.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Brenda Bonnema Sent: Tuesday, November 11, 2003 11:21 AM To: '[EMAIL PROTECTED]' Subject: RE: Question re OMRA - Excerpt from the RAI MAnual       I discovered that the RAI manual has contradicting info:  See page 2-31 -- it indicates that the "OMRA is completed only if the resident was in a RUG III ....."   Other Medicare-Required Assessment - The OMRA is completed only if the resident was in a RUG-III Rehabilitation Classification and will continue to need Part A SNF-level services after the discontinuation of therapy. The last day in which therapy treatment was furnished is day zero. The OMRA ARD (Item A3a) must be set on day eight, nine, or ten after all rehabilitation therapies have been discontinued. The OMRA must be completed (Item R2b) within 14 days of the ARD. The OMRA will establish a new non-therapy RUG-III group and Medicare payment rate. The MDS records must be submitted electronically, and will be considered timely if submitted and accepted into the database within 31 days of completion (Item R2b). If the OMRA falls in the assessment window of a regularly schedule Medicare assessment, code the assessment as an OMRA to affect the change in payment status. However, on page 2-39 - 2-40 it states that the OMRA can be combined with other assessments.  Resident in a Part A Stay Begins Therapy Adding therapy services to the treatments furnished to a beneficiary in a Part A stay does not automatically require a new assessment. However, if the therapy was added because the beneficiary experienced a significant change, an SCSA must be completed. In this case, the primary reason for assessment would be a SCSA (A8a = 3). If the SCSA is done during a Medicare window, the SCSA can be combined with a regularly scheduled Medicare assessment. If the SCSA is not within a Medicare assessment window, the Medicare reason for assessment should be coded as AA8a = 3 and AA8b = 8, Other Medicare Required assessment. My suggestion to lessen confusion:  With the next RAI update the word "only" on page 2-31 be deleted?  -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Tuesday, November 11, 2003 3:49 AM To: [EMAIL PROTECTED] Subject: Question re OMRA - Excerpt from the RAI MAnual In a message dated 11/10/2003 10:49:12 PM Eastern Standard Time, [EMAIL PROTECTED] writes: An OMRA is NOT done when therapy starts.  OMRAs are only appropriate when all therapies end and the previous RUGS score was in a rehab RUGS group.  An OMRA is done no sooner than 8 and no later than 10 days after therapy ends and the resident continues to require skilled services for something other than therapy.     If the resident is still on Medicare Part A services (has completed therapies and D/C'ed and now is on a Nursing RUG), has a decline in function, is screened by rehab services, and is appropriate for rehab services, then an OMRA is done to place back onto a rehab RUG Level.     From the RAI MANUAL:   Other Medicare Required Assessment OMRA   An assessment required when a Medicare Part A resident that was in a RUG-III Rehabilitation Classification, continues to require skilled care after all therapy is discontinued. This assessment is to be done 8-10 days after the cessation of therapies in order to re-calculate the RUG Classification from a therapy RUG to a non-therapy group. An OMRA may also be used in the situation where a significant change in status occurs for a Medicare resident outside a Medicare assessment window. AA8b is coded 8 for these assessments.     Glenn Gorleski (Barnes) RAC-C Case Manager, MDS Coordinator Quality Assurance Nurse