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

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

A:

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, it should be inactivated. An Inactivation request, which differs from a modification, moves the inaccurate record into history in the QIES ASAP system but does not replace it with a new record. 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.