Harmony Healthcare Blog

MDS Short Stay Policy: Does the Patient Qualify? (Part 1 of 2)

Posted by Kris Mastrangelo on Tue, Jun 28, 2016


Edited by Kris Mastrangelo

short stay dischargeLast week’s Harmony Healthcare International (HHI) site visits spurred much discussion on the MDS Short Stay Policy. The criteria for this policy can be confusing, yet, should always be considered for patients with a Medicare Stay less than 8 days.

As we have all learned, the Short Stay Policy can generate a higher RUG Score for Rehabilitation patients who are discharged from the facility or terminated Medicare coverage on or prior to day 8 in their SNF stay. The early discharge may be caused by benefits exhausting, discharge home, death or discharge the hospital.

Here are the commonly asked questions that may be useful for your facility:

1.    How to choose ARD (Assessment Reference Date)?

It must be equal to the end of stay date (Section A). In most cases, e.g. hospital transfers, this will be equal to the date of discharge. Harmony Healthcare International (HHI) reinforces that any discharge assessment, with the exception of death in facility, can be combined with any Medicare Assessment as long as the ARD requirements are met and there is no financial loss by combining them.

2.    What RUG Category is billed?

A Nursing RUG Category will be billed until the first evaluation date of therapy and then the Rehabilitation RUG Category will be billed from the first therapy evaluation date until the last billed day.

Please note, if the first therapy evaluation occurs on the discharge date, the Rehabilitation RUG will not be paid since the date of discharge is not a billable day. (Therefore this policy does not apply).

3.    How do we determine if the patient qualifies for the MDS Short Stay Policy?

  • Did the patient discontinue their Medicare stay by day 8 (MLOA discharge, denial or exhausted benefit)?
  • Was at least one therapy actively treating the patient at the time Medicare was discontinued (or discharged MLOA)?
  • Did the MDS RUG Score result in a Nursing Category or a Rehabilitation Category?
  • Did at least one therapy evaluate prior to the date of discharge?
  • Did all therapy treatment initiate during the last 4 days of the Medicare Part A covered stay, including weekends (count from the end date of the most recent Medicare stay date)?
  • If the answer is YES to all of the above, then you can proceed to the Short Stay Policy.

Stay tuned for Part 2 of the MDS Short Stay blog post, which will be published on Thursday, June 30th.  If you have questions about MDS Short Stay, please contact Harmony Healthcare International by clicking here or calling our office at 1.800.530.4413. 


 
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Tags: MDS Short Stay, Patient Discharge

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