MDS Alert

Published on Fri Mar 04, 2011 PDF

Question: When you combine a 5-day assessment with a significant change in status assessment, when does the RUG rate change?

Answer: When you combine the SCSA or a significant correction of a prior assessment with a 5-day PPS assessment, "it replaces the 5-day and the RUG at Z0100 starts paying on day 1 -- as long as the assessment reference date is timely," which would include being set on one of the grace days, says Rena Shephard, MHA, RN, RAC-MT, C-NE , founding chair and executive editor for the American Association of Nurse Assessment Coordinators, and president and CEO of RRS Healthcare Consulting in San Diego.

Rationale: "You don't have a rate established yet so the assessment would establish the rate for day 1 through 14," says Ron Orth, RN, NHA, CPC, RAC-CT, president of Reimbursement Solutions in Milwaukee, Wis.

"If you combine a SCSA [or significant correction of a prior assessment] with any other PPS assessment, the rate will change on the ARD of the significant change [or correction] assessment, unless you've gone into the grace period for setting the ARD," adds Orth. If you have used a grace dayfor the ARD, "then the rate changes as of the first day of the payment window for the respective PPS assessment."