2014 AANAC 9_30_ AANA C AANA

Transcription

1 AANAC AANAC 9_30_14

2 Expert Advisory Panel Guests Deb Myhre, RN, RAC-MT, C-NE Mark McDavid, OTR, RAC-CT

3 Requirements for Successful Completion 1 Contact hour will be awarded for this continuing nursing education activity The American Association of Nurse Assessment Coordination is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on accreditation (ANCC). Criteria for successful completion includes purchase of and attendance for at least 80% of the entire event. Partial credit may not be awarded. Approval of this continuing education activity does not imply endorsement by AANAC or ANCC of any commercial products or services.

4 Conflict of Interest Disclosure Judi Kulus, NHA, RN, MAT, RAC-MT, C-NE Deb Myhre, RN, RAC-MT, C-NE Mark McDavid, OTR, RAC-CT There are no conflicts of interest to disclose with this presentation.

5 Poll Question Tell us who you are: MDS Coding Nurse Other IDT MDS Clinician DON Nurse Manager Administrator Corporate Consultants Other

6 Learning Objectives Describe the most recent updates to the MDS, sections A Z Explain items added and deleted from the Item Sets Detail clarification to Change of Therapy (COT) assessments Review End of Therapy (EOT) examples

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8 Maintaining RAI Records in the Clinical Record Update Federal regulation requires that 15 months of RAI information be kept in the active clinical record After 15 months have passed, RAI information can be thinned. The exception is that demographic information (Items A0500-A1600) from the most recent Admission assessment must be maintained in the active clinical record until the resident is discharged return not anticipated or is discharged return anticipated but does not return within 30 days (p. 2-6). 8

9 Assessment Types and Definition There are 10 nursing home and 8 swing bed item sets, listed on pages 2-10 through 2-12, that will become effective October 1, 2014 (v ) Printed layouts for the item sets are available in Appendix H of this manual (p. 2-12) The item sets can be downloaded on the CMS MDS 3.0 technical information page Update 9

10 Deletion of Readmission/Return Assessments Update Effective October 1, 2014, A0310B (06) has been deleted from all item sets and the manual For all providers, including Swing bed providers, the first required Medicare assessment is always the Medicare-required 5-Day assessment (Item A0310B = 01) as long as the resident is eligible for Medicare Part A services, requires and receives skilled services and has days remaining in the benefit period. (p. 2-73) 10

11 Scheduled PPS Assessments SNF PPS Assessment Type Reason for Assessment (A0310B code) Assessment Reference Date Window Assessment Reference Date Grace Days Applicable Medicare Payment Days 5-day* 01 Days through day 02 Days through day 03 Days through day 04 Days through day 05 Days through 100 *Columns 3, 4, and 5 of this row also apply to Readmission/Return Assessment (A0310B code = 06) related to days of the readmission 11

12 SECTION A IDENTIFICATION INFORMATION 12

13 Discharge Assessments Update When a resident is transferred from a Medicareand/or Medicaid-certified bed to a noncertified bed, a Discharge assessment is required (p. 2-10). 13

14 Discharge Assessments Example: Mr. K. was transferred from a Medicare-certified bed to a noncertified bed on December 12, 2013 and plans to remain long term in the facility. Code the December 12, 2013 Discharge assessment as follows: A0310F=10 A2000= A2100=2 Update 14

15 Unit Certification or Licensure Designation (A0410) Update Coding instructions: Code 1, Unit is neither Medicare nor Medicaid certified and MDS data is not required by the State: if the MDS record is for a resident on a unit that is neither Medicare nor Medicaid certified, and the state does not have authority to collect MDS information for residents on this unit, the facility may not submit MDS records to QIES ASAP. If any records are submitted under this certification designation, they will be rejected by the QIES ASAP system. 15

16 Unit Certification or Licensure Designation (A0410) Update Coding instructions: Code 2, Unit is neither Medicare nor Medicaid certified but MDS data is required by the State: if the nursing home resident is on a unit that is neither Medicare nor Medicaid certified, but the state has authority under state licensure to collect MDS information for residents on such units, the facility should submit the resident s MDS records per the state s requirement to QIES ASAP or directly to the state. Note that this certification designation does not apply to swing-bed facilities. Assessments for swing-bed residents on which A0410 is coded 2 will be rejected by the QIES ASAP system. 16

17 Unit Certification or Licensure Designation (A0410) Update Coding instructions: Code 3, Unit is Medicare and/or Medicaid certified: if the resident is on a Medicare and/or Medicaid certified unit, regardless of payer source (i.e., even if the resident is private pay or has his/her stay covered under e.g., Medicare Advantage, Medicare HMO, private insurance, etc.), the facility is required to submit these MDS records to QIES ASAP. Consult Chapter 5, page 5-1 of this Manual for a discussion of what types of records should be submitted to the QIES ASAP system. (p. A-8) 17

18 Medicare Advantage Assessments that are completed for purposes other than OBRA and SNF PPS reasons are NOT to be submitted, e.g., private insurance, including but not limited to Medicare Advantage plans (p. 5-1) 18

19 Medicare Advantage Managed Care transition to traditional Med A When a resident goes from Medicare Advantage to Medicare Part A start scheduled assessment over with a 5 -day PPS assessment (2-46) Begin submitting PPS assessments to the QIES ASAP system starting with the 5-Day assessment The current benefit period continues Resident does not get another 100 days after transition

20 Entry Date (A1600) Update This item is the initial date of admission to the facility, or the date the resident most recently returned to your facility after being discharged. Capture the date by using the following format: Month-Day-Year: XX-XX-XXXX. Example: October 12, 2010, would be entered as (p. A-22). 20

21 Type of Entry (A1700) Update The admission (A1700 = 1) is coded when a resident is: admitted for the first time to this facility; OR Is readmitted after a discharge return not anticipated; OR Is readmitted after a discharge return anticipated when return was not within 30 days of discharge (p. 2-33). 21

22 Type of Entry (A1700) Update Reentry (A1700 = 2) is checked when a resident is: Readmitted to this facility, AND Was discharged return anticipated from this facility, AND Returned within 30 days of discharge. Note: When either and entry or reentry occurs, an Entry Tracking Record should be completed (A0310F = 01) (see 2-33) 22

23 Admission Date (A1900) Update New Coding Item! This new item on the item sets is to indicate when the current admission (or episode of care) in this facility began (p. A-25). While the RAI User s Manual does not define an episode of care, the MDS 3.0 Quality Measures User s Manual defines an episode as a period of time spanning one or more stays (p. 1). 23

24 Admission Date (A1900) Update QM Glossary: An episode is a period of time spanning one or more stays An episode begins with an admission Entry record (A0310F = 01 and A1700 = 1) 24

25 QM Glossary: Episode An episode ends with the earliest of the following: Discharge assessment with return not anticipated (A0310F = 10) or Discharge assessment with return anticipated (A0310F = 11) but the resident did not return within 30 days of discharge or A death-in-facility tracking record (A0310F = 12) or The end of the target period (the 3-month reporting period for the report) 25

26 QM Glossary: Episode Example 2 3 Stay Episode Admission Reentry Reentry Stay 1 Stay 2 Stay 3 Admission Date (A1900) Entry Date (A1600) Entry Date (A1600) D/C Return Anticipated (Out <31 days) End: Discharge Return Not Anticipated Discharge Return Anticipated but gone at least 31 days Death End of Target Period D/C Return Anticipated (Out <31 days)

27 SIGNIFICANT CHANGE IN STATUS ASSESSMENT (SCSA) 27

28 Hospice and SCSA A SCSA is required when a terminally ill resident enrolls in a hospice program and remains a resident of the nursing facility Must be completed regardless of whether an assessment was recently conducted on the resident must be within 14 days from the effective date of hospice 28

29 Hospice and SCSA If a resident is admitted on the hospice benefit (i.e. the resident is coming into the facility having already elected hospice), or elects hospice on or prior to the of the Admission assessment, the facility should complete the Admission assessment, checking the Hospice Care item, O0100K. Completing an Admission assessment followed by a SCSA is not required. Where hospice election occurs after the Admission assessment but prior to its completion, facilities may choose to adjust the to the date of hospice election so that only the Admission assessment is required. In such situations, an SCSA is not required. (p. 2-21) Update 29

30 Hospice and SCSA If a resident is admitted on the hospice benefit but decides to discontinue it prior to the of the Admission assessment, the facility should complete the Admission assessment, checking the Hospice Care item, O0100K. Completing an Admission assessment followed by a SCSA is not required. Where hospice revocation occurs after the Admission assessment but prior to its completion, facilities may choose to adjust the to the date of hospice revocation so that only the Admission assessment is required. In such situations, an SCSA is not required. (p. 2-22) Update 30

31 Hospice and SCSA Update The must be less than or equal to 14 days after the IDT s determination that the criteria for a SCSA are met (determination date + 14 calendar days). (p. 2-22) 31

32 SECTION K SWALLOWING / NUTRITIONAL STATUS 32

33 Percent Intake by Artificial Route (K710) K0710 (Percent Intake by Artificial Route):

34 Coding Average Fluids (K0710B) Mon Tues Wed Thurs Fri Sat Sun Total Hospital Hospital Hospital Hospital Nursing Home Nursing Home Nursing Home 400cc 520cc 500cc 480cc 510cc 520cc 490cc 7 days Hospital Total Update = 1900 Nursing =1520 = /4 Home 1520/3 3420/7 Total

35 Coding Average Fluids (K0710B) Mon Tues Wed Thurs Fri Sat Sun Total Hospital Hospital Hospital Hospital Nursing Home Nursing Home Nursing Home 400cc 520cc 500cc 480cc 510cc 520cc 490cc 7 days Hospital Total Update = 1900 Nursing =1520 = /4 Home 1520/3 3420/7 Total

36 Coding Average Fluids (K0710B) Mon Tues Wed Thurs Fri Sat Sun Total Hospital Hospital Hospital Hospital Nursing Home Nursing Home Nursing Home 400cc 520cc 500cc 480cc 510cc 520cc 490cc 7 days Hospital Total Update = 1900 Nursing =1520 = /4 Home 1520/3 3420/7 Total

37 Coding Average Fluids (K0710B) Mon Tues Wed Thurs Fri Sat Sun Total Hospital Hospital Hospital Hospital Nursing Home Nursing Home Nursing Home 400cc 520cc 500cc 480cc 510cc 520cc 490cc 7 days Hospital Total Update = 1900 Nursing =1520 = /4 Home 1520/3 3420/7 Total

38 SECTION O SPECIAL TREATMENTS, PROCEDURES, AND PROGRAMS 38

39 Ventilator or Respirator (O0100F) Update This item s definition was expanded to include residents receiving closed-system ventilation... via an endotracheal tube (e.g., nasally or orally intubated) as well as those residents with a tracheostomy (p. O-3). 39

40 Influenza Vaccine (O0250) Once the influenza vaccination has been administered to a resident for the current influenza season, this value is carried forward until the new influenza season begins (p. O-8). CMS also instructs that residents should be immunized as soon as the vaccine becomes available and continue until influenza is no longer circulating in your geographic area (p. O-8). Update Info about current flu season can be obtained at 40

41 Chapter 5: Correcting Errors Update According to the update to this section of the manual, facility staff should correct any errors noted on a submitted record within 3 years of the target date of the record for facilities that are still open. If a facility is terminated, then corrections must be submitted within 2 years of the facility termination date (p. 5-10). Note that even with the timeframes listed above, Errors identified in QIES ASAP system records must be corrected within 14 days after identifying the errors (p. 5-10) 41

42 CHANGE OF THERAPY (COT) OMRA Other Medicare Required Assessments 42

43 Change of Therapy OMRA Required when Resident is receiving therapy and The intensity of therapy increases or decreases to the extent that the RUG in effect is no longer an accurate reflection of the intensity of therapy received Informal evaluation of therapy RUG required essentially every 7 days 43

44 Change of Therapy OMRA Change may be due to increase/decrease in: Reimbursable Therapy Minutes (RTM) Days of therapy Number of disciplines Restorative Nursing ADL score is not taken into account COT OMRA also applies when index maximized RUG is non-rehab but resident is receiving enough therapy to classify into a therapy RUG 44

45 Change of Therapy OMRA Actual number of minutes resident spends in therapy should be documented in chart RTM for calculating the RUG = sum of 100% of individual minutes from chart 50% of concurrent minutes from chart 25% of group minutes (not to exceed 25% cap per discipline) from chart 45

46 Change of Therapy OMRA Facility monitoring of therapy intensity COT observation - successive 7-day windows Begin day after of most recent PPS assessment If COT OMRA not required, next COT observation starts day 1 after 7th day of COT observation When EOT-R has been completed, COT observation starts the day therapy resumes Must evaluate rehab intensity after each 7th day until COT OMRA or other PPS scheduled or unscheduled assessment is completed 46

47 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 47

48 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 48

49 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 49

50 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 3 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 50

51 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 3 Day 4 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 51

52 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 3 Day 4 Day 5 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 52

53 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 27 53

54 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 7 COT Check Date Day 27 54

55 Change of Therapy OMRA Rolling Observation and Check Date Day 13 Day 14 Day 15 Day 16 Day 17 Day 18 Day Day Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 20 Day 21 Day 22 Day 23 Day 24 Day 25 Day 26 Day 7 COT Check Date Day 27 Day 7 COT Check Date Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Explanation: The COT check date after an unscheduled or scheduled assessment (with the exception of the EOT-R) is the plus SEVEN days. 55

56 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 56

57 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Therapy Resumes Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 57

58 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 58

59 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 2 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 59

60 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 2 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Day 3 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 60

61 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 2 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Day 3 Day 4 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 61

62 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 2 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Day 3 Day 4 Day 5 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 62

63 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 2 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Day 3 Day 4 Day 5 Day 6 Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 63

64 Change of Therapy OMRA COT Observation After EOT-R Day 35 Day 36 Day 37 Day 38 Day 39 Day 40 Day 41 Last Day of Therapy EOT Day 1 EOT Day 2 EOT Day 3 Day 1 Therapy Resumes Day 2 Day 42 Day 43 Day 44 Day 45 Day 46 Day 47 Day 48 Day 3 Day 4 Day 5 Day 6 Day 7 COT Check Date Explanation: The COT check date after an EOT-R is the resumption date plus SIX days. 64

65 Change of Therapy OMRA Facility monitoring of therapy intensity COT observation required following all PPS assessments that calculate a therapy RUG Required even if the therapy RUG is not going to be billed because the assessment also qualifies for a nursing RUG that will pay more Due to index maximization, the software will assign the RUG with the higher rate 65

66 Change of Therapy OMRA Update A COT OMRA may only be completed when a resident is currently classified into a RUG-IV therapy group (regardless of whether or not the resident is classified into this group for payment), based on the resident s most recent assessment used for payment. 66

67 Change of Therapy OMRA Update The COT OMRA may be completed when a resident is not currently classified into a RUG-IV therapy group, but only if both of the following conditions are met: 1. Resident has been classified into a RUG-IV therapy group on a prior assessment during the resident s current Medicare Part A stay, and 2. No discontinuation of therapy services (planned or unplanned) occurred between Day 1 of the COT observation period for the COT OMRA that classified the resident into his/her current non-therapy RUG-IV group and the of the COT OMRA that reclassified the resident into a RUG-IV therapy group. Under these circumstances, completing the COT OMRA may be considered optional. (p. 2-52) 67

68 Change of Therapy OMRA Example: Mr. T classified into the RUG group RUA on his 30-day assessment with an set for Day 30 of his stay. On Day 37, the facility checked the amount therapy provided to Mr. T. and found that while he did receive the requisite number of therapy minutes to qualify for this RUG category, he only received therapy on 4 distinct calendar days, which would make it impossible for him to qualify for an Ultra-High Rehabilitation RUG group. Due to lack of 5 distinct calendar days of therapy and a lack of restorative nursing services, Mr. T. did not qualified for a therapy RUG group. Mr. T. s rehabilitation regimen has continued throughout this time period. The facility may complete a COT OMRA with an of Day 44 to reclassify Mr. T. back into RUA. 68 Update

69 Scheduling Tracking Systems Resource available at: 69

70 END OF THERAPY (EOT) Other Medicare Required Assessments (OMRAs) 70

71 End of Therapy OMRA Used to establish a non-therapy payment rate when: A resident is being discharged from therapy but will continue on Medicare Part A for a nontherapy reason for at least three (3) days A resident who is receiving therapy has a break in the furnishing of therapy for at least three (3) consecutive days regardless of reason 71

72 End of Therapy OMRA Update When determining whether a resident missed a day of therapy, a treatment day is defined the same way as in Chapter 3, Section O, 15 minutes of therapy a day. If a resident receives less than 15 minutes of therapy in a day, it is not coded on the MDS and it cannot be considered a day of therapy (p. 2-48). 72

73 EOT-R Resumption of Therapy May be used When a skilled resident resumes therapy within 4 5 days of the last therapy treatment Resumes at the same RUG-IV classification level that had been in effect prior to the EOT OMRA Resumes with the same therapy plan of care that had been in effect prior to the EOT OMRA 73

74 EOT-R Resumption of Therapy If therapy is not provided for more than 5 days, or therapy resumes within 5 days but the therapy RUG or treatment plan changes, EOT-R OMRA not applicable EOT OMRA required When therapy restarts, do SOT OMRA or wait until next scheduled assessment New therapy evaluation and care plan required 74

75 EOT-R Resumption of Therapy If the resumption occurs after the start of next billing period, resumed RUG continues in effect until next PPS assessment takes effect Last tx Day 10 Day 11 Day 12 Day 13 Day 14 Resumed Day 15 Day 16 Non-Therapy RUG Resumed RUG 14-day assessment RUG would not be used

76 EOT-R Resumption of Therapy Update In all cases where an EOT-R would be completed, the resident must resume therapy at the same RUG-IV therapy level as had been in effect prior to the break in therapy It is possible that the for an EOT OMRA reporting resumption may be set for the first grace day of the allowable grace days for a scheduled PPS assessment, while the for the scheduled assessment was set for a day within the normal window In this case, the resumption of therapy should occur using the previous RUG-IV therapy level (which should be the same as the therapy level determined on the scheduled PPS assessment if the resumption is appropriate) but using the Activities of Daily Living (ADL) score from the most recent PPS assessment (ch. 6-12) 76

77 EOT-R Resumption of Therapy: Example Example: Mrs. Smith, is admitted on 10/01/14. The of the 5-day assessment for Mrs. Smith is set for 10/07/14 (Day 7) and the RUG assigned to Mrs. Smith is RVB. The of the 14- day assessment is set for 10/14/14 (Day 14) and the RUG assigned to Mrs. Smith is again RVB. The of the 30-day assessment is set for 10/28/14 (Day 28) and the RUG assigned to Mrs. Smith is now RVA. Due to an acute illness, Mrs. Smith is unable to receive therapy services from 10/29/14 through 10/31/14, but is expected to resume therapy on 11/2/14 under the same therapy regimen. The facility completes an EOT for Mrs. Smith with an of 10/31/14 and reports that the resumption of therapy will occur on 11/2/14. The EOT OMRA assigns Mrs. Smith a nontherapy RUG of CE2. Mrs. Smith is discharged from the facility on 11/12/14. 77

78 EOT-R Resumption of Therapy: Example RAI Example Answer: Assuming no intervening assessments were necessary, the facility would bill in the following manner. Days 1-14 would be billed under HIPPS code RVB10. Days would be billed under HIPPS code RVB20. Days would be billed under HIPPS code CE20A. Days would be billed under HIPPS code RVA0A. This represents the one and only occasion where the three character RUG-IV therapy RUG code may differ from that which was billed prior to the break in therapy, and the difference may only be in the third character in the therapy RUG code related to the resident s ADL score. (pp ) 78

79 EOT-R Resumption of Therapy: Example SUN MON TUES WED THU FRI SAT Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day Day RUG (RVB) 30-Day Window 79

80 EOT-R Resumption of Therapy: Example SUN MON TUES WED THU FRI SAT Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day Day RUG (RVB) 30-Day (RVA) 30-Day Window 80

81 EOT-R Resumption of Therapy: Example SUN MON TUES WED THU FRI SAT Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day 33 No Therapy 14-Day RUG (RVB) 30-Day (RVA) 30-Day Window 81

82 EOT-R Resumption of Therapy: Example SUN MON TUES WED THU FRI SAT Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day 33 No Therapy 14-Day RUG (RVB) 30-Day (RVA) EOT (CE2) 30-Day Window 82

83 EOT-R Resumption of Therapy: Example SUN MON TUES WED THU FRI SAT Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day Day RUG (RVB) 30-Day (RVA) No Therapy EOT (CE2) Therapy Resumes 30-Day Window 83

84 EOT-R Resumption of Therapy: Example SUN MON TUES WED THU FRI SAT Day 27 Day 28 Day 29 Day 30 Day 31 Day 32 Day Day RUG (RVB) 30-Day (RVA) No Therapy EOT (CE2) Therapy Resumes 30-Day Window Rehab RUG RVA 14-Day Rehab RUG pays from day 32, with the ADL score from the 30-day RUG 84

85 Resources AANAC cm/ RAI User s Manual for MDS Patient-Assessment- Instruments/NursingHomeQualityInits/MDS30RAIManu al.html SNF Proposed Rule FY /pdf/ pdf

86 QUESTIONS? Join us directly after the webinar in the AANAConnect community. Check your confirmation for the link!