The answer for the 'special assessments' [OMRA, SCSA should be in more detail. The following reference can be found at www.cms.hhs.gov/medlearn/SNFbilling.pdf
Assessment Reference Date (ARD)
The ARD marks the end of the look back period. It must be set within the
window of days allowed by the Medicare MDS assessment schedule. All medical
data scored on the MDS is based on this date. An inaccurate date might results
in an inaccurate RUG III score for Medicare billing. It is a requirement of the
program that it be reported correctly on the claim. Failure to do so may result in
claim denials (on prepay review) or the cancel of claim payment (on a post pay
review.)
â ARD is reported in field 45 (service date) on the UB92
â ARD is = A3 (page 3) on the MDS
â ARDs set outside the timetable established by the assessment schedule
requires billing the DEFAULT code (AAA00) for all days up to the ARD date
â The ARD of a regularly scheduled assessment does not effect a change in
billing
â Billing codes change on the first day of the next payment block
â An âoff cycleâ assessment (significant change in status, significant correction
to a full prior, OMRA) changes the billing effective with the ARD of that
assessment:
â If the ARD falls within the window of the next regularly scheduled
assessment, the billing changes with that ARD date and REPLACES the
regularly scheduled assessment
â If the ARD falls within the grace day period, the billing changes with the 1st
day of the regular payment block
If the ARD falls in the window of the next regularly scheduled assessment--it replaces that regular assessment
, 60, and 90 day PPS assessments, the payment changes once
the number of days the particular PPS MDS "buys" concludes. For example,
the 5 day "buys" the first 14 days of admission, therefore, the 14 day
"buys" the next block of days identified by the Final PPS rules as the next
16 days. Then the 30 day "buys" a 30 day block, the 60 day "buys" another
30 day block and the 90 day "buys" the last 10 days.
An OMRA, however, changes the payment ON the ARD, whatever that date
is-regardless of where the main PPS assessment schedule is. A significant
condition change during a Medicare A stay will do the same thing.
Jane Craven, RN, C.
Sr. Consultant, Nursing Services
Tendercare (Michigan) Inc.
Delores L. Galias, RN, RHIT
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