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, 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.

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

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