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Solution Center Q&A - Part One

Polaris Group
August 12, 2021
Summary

Part One of a two-part interview. When our MDSC completes a Significant Change in Status MDS, does this change the PDPM rate for Medicare?

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Question:

When our MDSC completes a Significant Change in Status MDS, does this change the PDPM rate for Medicare?

Answer:

A Significant Change in Status MDS does not affect the payment.

Question:

If a resident has documentation of shortness of breath related to COVID-19 “long hauler”, would we code SectionI6200 as having a chronic lung disease?

Answer:

According to multiple resources with out the specific diagnosis from the physician, the facility wouldn’t be able to code I6200 on the MDS.  COVID-19 is due to a virus and therefore would not be considered a chronic condition.

Question:

We have a resident who we put on the CMS extended stay waiver for coverage of extended care services due to COVID-19.Therapy did not complete a new evaluation when we transitioned them to the additional waivered days. Were they supposed to complete a new evaluation for the transition?

Answer:

There is no requirement that therapy complete a new evaluation when the resident transitions to the CMS extended stay waiver.

Question:

What is the impact of triggering depression for long-term residents on the quality measures (QM)?

Answer:

Depression affects two of the Long Stay QMs:

Percent of Residents Who Have Depressive Symptoms (Long Stay)

Prevalence of Antianxiety/Hypnotic Use(Long Stay)-A diagnosis of Manic Depression (bipolar disease) (I5900 = [1])will exclude that resident from this QM.

Question:

Is the Medicare Secondary Payer (MSP)form required for beneficiaries who admit to the facility with a Medicare Advantage (MA) Plan?

Answer:

In the Medicare Claims Processing Manual, Chapter 3, Section 20.1 it states “If the beneficiary is a member of a MA plan, hospitals are not required to ask the MSP questions or to collect, maintain, or report this information

Question:

We had a resident who received an IV with normal saline provided for dehydration. The MDS Nurse marked yes to O0100H2 IV Medications and no to K0510A2 but shouldn’t O0100H2 be marked no because the reis no pharmaceutical and K0510A2 be marked yes since the IV is specifically for hydration?

Answer:

Yes, you are right. Here is what the RAI states on page K-12:

K0510A includes any and all nutrition and hydration received by the nursing home resident in the last seven days either at the nursing home, at the hospital as an outpatient or an inpatient, provided they were administered for nutrition or hydration.

Parenteral/IV feeding - The following fluids may be included when there is supporting documentation that reflects the need for additional fluid intake specifically addressing a nutrition or hydration need. This supporting documentation should be noted in the resident’s medical record according to state and/or internal facility policy.

IV fluids can be coded in K0510A if needed to prevent dehydration if the additional fluid intake is specifically needed for nutrition and hydration. Prevention of dehydration should be clinically indicated and supporting documentation should be provided in the medical record.

Question:

We have a resident who had an orthopedic appointment and when they removed the left lower extremity cast, they discovered a pressure ulcer. Is this considered in house since it was discovered during the orthopedic appointment?

Answer:

Yes, it would be facility acquired. It would still be considered in-house because the resident was not discharged. The RAI says to report the number of these pressure ulcers that were present upon admission/entry or reentry

Question:

We have a long-term resident who hadCOVID-19 in May of 2021 and I am completing the Quarterly for this month. Do I still code the COVID-19diagnosis?

Answer:

Not unless it meets the RAI definition of an active diagnosis.

Question:

What does the numerator and denominator mean under the short stay Quality Measure for the Percent of Residents Who Made Improvements in Function?

Answer:

The higher the percentage under the short stay Quality Measure for Percent of Residents Who Made Improvements for Function is better because this is looking at the number of residents who improved in function while in the facility less than 100 days.

The numerator is short-stay residents who have a change in performance score that is negative ([valid discharge assessment] - [valid preceding PPS 5-Day assessment or OBRA Admission assessment] < [0]). Performance is calculated as the sum of G0110B1 (transfer: self- performance), G0110E1 (locomotion on unit: self-performance), and G0110D1(walk in corridor: self-performance), with 7s (activity occurred only once or twice) and 8s (activity did not occur) recoded to 4s (total dependence).

The denominator is short-stay residents who meet all of the following conditions, except those with exclusions:

Have a valid Discharge Assessment (A0310F= [10]), and

Have a valid preceding PPS 5-Dayassessment (A0310B = [01]) or OBRA Admission assessment (A0310A = [01]).

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