Harmony Healthcare International (HHI) Blog

Medicare Part A Required SNF PPS Assessments: Back to Basics (Part 1 of 3)

Share: 

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Back to Basics written on the road.jpegWhile the Skilled Nursing Facility prepares for Payment Reform in the form of PDPM, the facility clinical teams need to ensure that the basics of the current PPS System are completed correctly and timely.  The Harmony HealthCARE Specialists audit and educate on the multiple aspects of Compliance, Regulatory, Reimbursement and Efficiency share that getting back to basics must be a focus.  Especially now given the looming changes. 

MDS 3.0 Background 

The MDS 3.0 is a core set of elements, including common definitions and coding categories, which form the foundation of a comprehensive assessment for all residents of nursing homes certified to participate in Medicare of Medicaid.  The screening, clinical, and functional status items in the MDS 3.0 standardize communication about resident problems and conditions.  The MDS 3.0 contains items that reflect the acuteness of the resident’s condition, including diagnoses, treatments, and functional status.  MDS 3.0 assessment data is personal information SNFs must collect and keep confidential by Federal law. 

Patient-Driven Payment Model (PDPM)

MDS PPS Assessment Overview

The SNF PPS establishes a Medicare-Required PPS Assessment schedule.  Each required assessment supports reimbursement for a range of days of a Medicare Part A covered stay.  The schedule includes assessments performed about Days 5, 14, 30, 60, and 90 of the stay.  

Assessment Type

AI

ARD Window

Grace Days

Medicare Payment Period

5-Day

10

Days 1-5

Days 6-8

Days 1-14

14-Day

20

Days 13-14

Days 15-18

Days 15-30

30-Day

30

Days 27-29

Days 30-33

Days 31-60

60-Day

40

Days 57-59

Days 60-63

Days 61-90

90-Day

50

Days 87-89

Days 90-93

Days 91-100

 

Each assessment must:

  • Accurately Reflect the Resident’s Status
  • Be Conducted or Coordinated by a Registered Nurse with the Appropriate Participation of Other Health Care Professionals
  • Include Direct Observation as well as Communication with the Resident and Direct Care Staff on All Shifts
  • Cover the Observation (Look Back) Period, which is the Time Period When the Resident’s Condition is Captured by the MDS Assessment (Do Not Code Anything on the MDS that Did Not Occur During the Observation Period) 

The Medicare-Required PPS Assessment Schedule includes:

  • 5-day,
  • 14-day,
  • 3 0-day,
  • 60-day, and
  • 90-day scheduled assessments. 

Except for the first assessment (5-day assessment), each assessment in scheduled according to the resident’s length of stay in Medicare-covered Part A care. 

Complete the Medicare-Required 5-Day Assessment when any of these occur: 

  • The Part A Resident Admits to the SNF
  • The Part A Resident Readmits Following a Discharge Assessment When Return was Not Anticipated
  • The Part A Resident Returns More than 30 Days After a Discharge Assessment when Return Was Not Anticipated
  • The Resident Leaves a Medicare Advantage (MA) Plan and Becomes Covered by Medicare Part A (The Medicare PPS Schedule Starts Over as the Resident Now Begins a Medicare Part A Stay) 

Additional unscheduled assessments are required under specific circumstances.  We will review these on next week’s blog. 

In the meantime, study these definitions:

Admission

The date an individual enters the facility and admits as a resident (a day begins at 12:00 a.m. and ends at 11:59 p.m.). 

Assessment Indicator (AI)

A code used to indicate the type of assessment billed on a Medicare Claim. 

Assessment Reference Date (ARD)

The last day of the observation period the assessment covers. 

ARD Window

The defined days when you must say the ARD.  This does not include grace days. 

Grade Days

The date range when you mat set the ARD or add additional days without penalty, grace days apply only for scheduled assessments. 

Assessment Window

The defined days when you may set the ARD, this includes grace days as applicable. 

Discharge

The date a resident leaves the facility or the date the resident’s Medicare Part A stay ends, but the resident remains in the facility, (a day begins at 12:00 a.m. and ends at 11:59 p.m.).

Harmony Healthcare International (HHI) is available to assist with any questions or concerns that you may have. You can contact us by clicking here.  Looking to train your staff?  Join us in person at one of our our upcoming Competency/Certification Courses.  Click here to see the dates and locations. 


harmony20 October 29-30 2020 Encore Boston Harbor

Topics: PPS


Kris Mastrangelo, OTR/L, LNHA, MBA

WRITTEN BY

Kris Mastrangelo, OTR/L, LNHA, MBA
Follow: 

Data collection is the foundation for monitoring progress, but, in itself is a daunting task


Get your FREE PDPM Revenue Analysis

Start Here

Get Expert Tips in your inbox

Subscribe to our newsletter

Latest Blog Posts

Open Enrollment (Annual) 2021 Reimbursement

Read Full Post

PDPM, Isolation, Quarantine, Skilling, COVID-19, and ICD-10

Read Full Post

QAPI: Survey Plan of Correction (Part 3)

Read Full Post

Open Enrollment (Annual) 2021 Reimbursement

Read Full Post

PDPM, Isolation, Quarantine, Skilling, COVID-19, and ICD-10

Read Full Post

Open Enrollment (Annual) 2021 Reimbursement

Read Full Post

PDPM, Isolation, Quarantine, Skilling, COVID-19, and ICD-10

Read Full Post