What should be done if a PPS 5-Day assessment completed for Managed Care is submitted to CMS?



Assessments that are completed for purposes other than OBRA and SNF PPS reasons are not to be submitted, e.g., private insurance, including but not limited to Medicare Advantage Plans. If a PPS assessment is incorrectly submitted, an MDS 3.0 Manual Assessment Correction/Deletion Request is required. The facility must contact the State Agency which will send the facility the appropriate MDS 3.0 Manual Individual Assessment Correction/Deletion Request form. The facility is responsible for completing the form and submitting the form to the State Agency. The State Agency will review the request for completion and accuracy. After approving the provider’s request, the State Agency must sign the form and send it to the iQIES Help Desk. Keep in mind also that Item A2400A, “Has the Resident Had a Medicare-covered Stay since the Most Recent Entry” should only be complete when the SNF stay is billable to traditional Medicare; it should be answered “No” for stays billable to Medicare Advantage Plans.

Eleisha Wilkes, RN, GERO-BC, RAC-CT, DNS-CT
Clinical Consultant

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