Admission Dates A1600, A1700, and A1900 on the MDS
Section A of the MDS 3.0 Assessment provides the assessor with the opportunity to record information about the start date of the current SNF stay and the current episode of a stay. If these dates do not agree in a logic check performed by the software there will be an error message and the assessment will not be able to be closed until the logic conflict has been resolved. This is often termed a "warning message", and it is in place to assist providers to correct logic conflicts prior to submitting assessments to the QIES ASAP in order to decrease the number of rejected assessments during submission.
To accurately code Section A it is necessary to understand some of the concepts and definitions associated with MDS assessments. The September/October 2014 release of the RAI User's Manual left providers with several questions about these concepts and definitions. The subsequent February 2015 revision offered some clarification for these important sections. Skilled nursing facilities should be aware of the following information regarding key sections in Section A that may be found in conflict during this logic check.
First, the facility must determine if the current stay meets the definition of an Admission. Per the RAI User's Manual page 2-7, an Admission is defined as the following:
Completion of an OBRA Admission assessment must occur in any of the following admission situations:
- When the resident has never been admitted to this facility before; OR
- When the resident has been in this facility previously and was discharged return not anticipated; OR
- When the resident has been in this facility previously and was discharged return anticipated and did not return within 30 days of discharge
The key change in this definition was made effective on February 5, 2015. The admission situations that require completion of an OBRA Admission assessment no longer include “when the resident has been in this facility previously and was discharged prior to completion of the OBRA Admission assessment.”
The definition for Reentry was amended to eliminate the instruction that an OBRA admission assessment had to have been completed during the prior stay, as stated in the RAI User's Manual page 2-13:
Reentry refers to the situation when all three of the following occurred prior to this entry: the resident was previously in this facility and was discharged return anticipated and returned within 30 days of discharge.
Coding in Sections A1600, A1700, and A1900 are closely linked. Software logic checks between these items may result in a warning message that will prompt the provider to correct the logic error before the assessment will "lock" and be available for submission. As stated previously, this safety check is in place to decrease the number of assessments that would be sent to QIES ASAP and subsequently rejected. Harmony (HHI) offers the following definitions of each of these critical sections:
- A1600 Entry Date: The entry date is defined as the initial date of admission to the facility, or the date the resident most recently returned to your facility after being discharged.
- A1700 Type of Entry: This item captures whether the date in A1600 is an admission or reentry. Admission and reentry are defined as the following for this item:
- Code 1, Admission: when one of the following occurs:
- Resident has never been admitted to this facility before; OR
- Resident has been in this facility previously and was discharged return not anticipated; OR
- Resident has been in this facility previously and was discharged return anticipated and did not return within 30 days of discharge.
- Code 2, Reentry: when all three of the following occurred prior to this entry; the resident was:
- Admitted to this facility, AND
- Discharged return anticipated, AND
- Returned to facility within 30 days of discharge.
- Code 1, Admission: when one of the following occurs:
- A1900 Admission Date (Date this episode of care in this facility began): This item causes providers confusion because of the concepts of "stay" and "episode", which are made clear in the Quality Measures User’s Guide but are not always correctly referenced to the RAI User's Manual. Item A1900 should remain the same for all assessments in a given episode even if it is interrupted by temporary discharges from the facility. In this scenario, the date in A1900 will remain the same, but the date in A1600 will change to reflect the most current reentry date. If the resident returns after a discharge return not anticipated, or if longer than 30 days pass after the patient’s discharge, a new episode will begin and the facility will code A1900 with the new Admission date.
The RAI User's Manual offered many valuable Coding Tips in the February 2015 revision of the RAI User's Manual to assist providers to code Sections A1600, A1700, and A1900 correctly. The concept of a "stay" versus an "episode" is clarified. The User's Manual stresses that these three coding items are closely related and their coding is interrelated. The RAI User's Manual offers the following clarification on page A-26:
Item A1900 (Admission Date) is tied to items A1600 (Entry Date), A1700 (Type of Entry), and A1800 (Entered From). It is also tied to the concepts of a “stay” and an “episode.” A stay is a set of contiguous days in the facility and an episode is a series of one or more stays that may be separated by brief interruptions in the resident’s time in the facility. An episode continues across stays until one of three events occurs: the resident is discharged with return not anticipated, the resident is discharged with return anticipated but is out of the facility for more than 30 days, or the resident dies in the facility.
Consider the following scenario for clarification of the interrelated coding between A1600, A1700, and A1900: Upon first Admission to the facility, the facility will complete an entry tracking record and the dates entered into Items A1600 and A1900 will match. The facility should code A1700 as 1, Admission. This coding will remain constant for all subsequent assessments within the first stay in that episode. If the resident is discharged return anticipated and reenters the facility within 30 days, a new stay will begin. However, the current episode will continue. Upon readmission from the brief discharge return anticipated of 30 days or less, the facility would complete another entry tracking record and the date in A1600 would change to the new reentry date. Item A1700 would be coded as a 2, Reentry. Item A1900 would continue to show the original admission date, which is also the date that the first day of this episode of care began.
SNFs should also review pages A-25 and A-26 of the RAI User's Manual, which offer several scenarios with clarification.
Harmony Healthcare International is available to answer further questions about Admission Dates and Assessments. To contact us, please visit our website at harmony-healthcare.com or call us at (978) 887-8919.