What do I do if a resident is admitted Med A and then has an unplanned discharge or death in facility prior to the 5 Day MDS being opened/created?



This would be considered a Missed PPS Assessment. The facility would be liable and would not be able to Medicare A for the stay.

For example, Resident was admitted on Friday, December 24th and the PPS 5-Day MDS was not opened/created at that time. The resident discharges and is admitted to the hospital Sunday night, December 26th.

RAI Manual_Page_2-52

Missed PPS Assessment

If the SNF fails to set the ARD of a 5-Day assessment prior to the end of the last day of the ARD window, and the resident was already discharged from Medicare Part A when this error is discovered, the provider cannot complete an assessment for SNF PPS purposes and the days cannot be billed to Part A.

Answer by Angie Hamer, RN, RAC-CT
Clinical Consultant

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