Harmony Healthcare Blog

MDS Short Stay Policy: The 8 Conditions (Part 2 of 2)

Posted by Kris Mastrangelo, OTR/L, LNHA, MBA on Thu, Jun 30, 2016
Kris Mastrangelo, OTR/L, LNHA, MBA
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therapy_calendar.jpgAs a continuation from Part 1 of our MDS Short Stay Policy post, let’s carry on with the 8 Conditions required for the MDS Short Stay Policy: 

  1. The assessment must be a Start of Therapy OMRA (may be combined with 5 day and discharge).
  2. A PPS 5 day or readmission/return assessment has been completed.
  3. The ARD of the Start of Therapy OMRA must be on or before the 8th day of the Part A Medicare stay
  4. The ARD of the Start of Therapy OMRA must be the last day of the Medicare Part A stay.
  5. The ARD of the Start of Therapy OMRA may not be more than 3 days after the start of therapy date.
  6. Rehabilitation therapy (speech-language pathology services, occupational therapy or physical therapy) started during the last 4 days of the Medicare Part A covered stay (including weekends).
  7. At least one therapy discipline continued through the last day of the Medicare Part A stay.
  8. The RUG group assigned to the Start of Therapy OMRA must be Rehabilitation Plus Extensive Services or a Rehabilitation group. 

How to Calculate the Payment Level? 

If all eight of these conditions are met, the Rehabilitation RUG Classification is calculated based on average daily minutes actually provided

  • 15-29 average daily therapy minutes = Rehabilitation Low category
  • 30-64 average daily therapy minutes = Rehabilitation Medium category
  • 65-99 average daily therapy minutes = Rehabilitation High category
  • 100-143 average daily therapy minutes = Rehabilitation Very High category
  • 144 or greater average daily therapy minutes = Rehabilitation Ultra High category 

This average is the Total Therapy Minutes recorded on the MDS divided by the number of calendar days from the start of therapy (earliest date in O0400A5, O0400B5, and O0400C5) through the assessment reference date (A2300). 

This may not equal the number of treatment days on the MDS. 

For example, if therapy started on August 1 and the assessment reference date is August 3, the average minutes is calculated by dividing by 3 days. 

An ideal way to determine the category expected is to multiply the average daily minutes by 5. 

For example, if the average daily minutes total 150 minutes, 150 times 5 equals 750 minutes (above the RU requirements).


How to Code on the MDS? 

The assignment of the Rehabilitation Classification is calculated based on the average daily minutes actually provided from evaluation to discharge, and the resulting RUG group is recorded on MDS item Z0100A. This payment begins on the date the first therapy evaluation was completed and continues through the date of discharge. If the evaluation was not completed on day one, a Nursing, Non-Therapy RUG would be billed for the days prior to the completion of the therapy evaluation, this RUG group is recorded in MDS item Z0150A. 

When all of these conditions are met, a short stay assessment can be completed and should be coded: 

  • Yes (1) at MDS item Z0100C where the following question is asked: “Is this a Medicare Short Stay assessment?”
  • In most software systems, this will be automatically coded if all the conditions are met. If this doesn’t automatically trigger, a number of areas should be reviewed.  
  • The start date of this Medicare stay must be less than 8 days from day of discharge or last covered day so therefore section A2400B should be within 7 days of the ARD.
  • The Medicare end date A2400C must be equal to the ARD as well.
  • If these two areas are not accurately coded a short stay assessment will not trigger

Harmony Healthcare International (HHI) reinforces the importance of completing the therapy end date in O0400 as dashes in order to signify that therapy would have been ongoing if the patient remained in house. 

Harmony MDS Coding Tip 

In many cases, the Medicare 5 day PPS assessment can be combined with the Start of Therapy OMRA as well as the Discharge Assessment to facilitate that all the required assessments are completed utilizing the same Assessment Reference Date.  In the situation of a short stay assessment, the discharge assessment may not be needed if the patient has exhausted benefits.  Harmony Healthcare International (HHI) warns not to code this assessment as an EOT OMRA as this will not trigger a short stay assessment.  

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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Topics: MDS Short Stay, Rehabilitation RUG Classification

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