It would seem if you want to take this statement below literally, then the
assessment must be COMPLETED before the end of the window - R2b date???????? How
can this be?
Subject: RE: Changing PPS Assessments
weeks after R2B before transmission
Then Nathan, how do you justify the
sentence in the RAI Manual that says "A late or missed assessment may be
completed as long as the window for the allowable ARD (including grade days)
has not passed". If you wait until day 9 or 10 aren't you passed the
"window"?
-----Original Message----- From: Nathan
[mailto:[EMAIL PROTECTED] Sent: Tuesday, March 09, 2004
5:53 PM To: [EMAIL PROTECTED] Subject: Re: Changing PPS
Assessments weeks after R2B before transmission
I must weigh in on my favorite subject. I agree that the standard
interpretation of the rules says this is not allowed, but I have always
argued it should be allowed - with one caveat. I believe the facility should
be able to change the ARD up until the point of submission (lock) as long as
they change the R2b date when they make the ARD change. Think about it. For
one, how would this be fraud or cost the government any money they do not
owe the facility? Take this scenario:
The resident is admitted on January 10 after a 10 day hospital stay.
You collect as much information as possible from the hospital, and
immediately begin documenting everything related to any PPS item that occurs
in your facility. You are going to do full data collection for 8 days.
Remember, this is only hypothetical. That means that on day 9 you can look
at each of the first 8 days and know how you would answer every MDS
item if that day was the ARD. The team sits down on day 9 or 10
and reviews all this data. To take it to an extreme, you might do 8
different Medicare 5 day assessments each with a different ARD and view the
results. The team decides that choosing day 7 gives an assessment that best
represents the care being delivered to the resident. They complete the
assessment and put day 10 as the R2b. The next day (day 11) the PT says
the documentation for the rehab minutes was incorrect Based on the new
information, the team decides to change the ARD to day 8 and they change the
R2b to day 11.
The only difference between this scenario and the way it is normally
done is that this does not make you guess at the impact of the day you
choose. You know for a fact what the outcome will be since you have all the
data in front of you. There is no fraud. You are honest in your
documentation, honest in your R2b date and you are making the right choice
for reimbursement.
A second point - regardless of whether you do things in the normal way,
or the way I presented, the burden is still on the facility to make sure the
data in the assessment is accurate for the chosen ARD. In the end, there
should be no difference between the two assessments other than the normal
differences that occur due to changes in the ARD. Facilities that do
things this way probably have better data collection than those that just
pick a day in the heat of battle.
Subject: Re: Changing PPS
Assessments weeks after R2B before transmission
In a message dated 3/8/2004 6:11:20 PM Pacific Standard Time, [EMAIL PROTECTED]
writes:
When the consulting group determines that additional
money could have been made by modification of the MDS and/or
changing the ARD, the facility is directed to complete a new MDS.
This is done after the R2b date and before
transmission.
uh oh
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