Q:
What is the time frame in which a 5-day assessment should be completed?
A:
The answer depends on whether the 5-day MDS is combined with the OBRA admission assessment or completed as a stand-alone Medicare 5-day MDS. When combined with the OBRA admission assessment, the 5-day must be completed within 14 days of admission and accepted no later than 14 days from the completion date. In situations where the 5-day Medicare MDS is a stand-alone assessment it must be completed within 14 days of the ARD and accepted within 14 days of the completion date.
Example: A resident who was admitted on 1/28 and combined OBRA admission/5-day Medicare MDS with an ARD of 2/4 should have the assessment completed no later than 2/10 and accepted by 2/23. If the assessment is a stand-alone 5-day MDS, it must be completed no later than 2/18 with an additional 14 days for the assessment to be accepted.
In this example, while the assessments may be completed within the regulatory time frame for completion and submission, in some cases, facilities may find that delayed completion is holding up billing and revenue. For this reason, many facilities have established Triple Check policies with more stringent timelines to allow for claims submission within 2 weeks of month end close. For example, resident admission prior to the 25th of the month will have the assessments needed for billing completed and submitted prior to the Triple Check meeting held on or about the 8th business day of the month, and for any resident admissions on or after the 25th of the month the facility may require the Medicare assessment completed no later than the 9th day of the stay and accepted for billing no later than day 10 of their stay.
Next Steps: Contact Proactive for MDS Coding Support, Mentorship Partnerships and Interim MDS coverage during periods of staffing gaps, and make plans to register for MDS Orientation May 21-23, 2025!
Written By:
Christine Twombly, RN, RAC-MT, RAC-MTA, HCRM, CHC
Senior Consultant
Proactive LTC Consulting
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