Long Term Care Hospital (LTCH) Vendors

he MDS Version 1.30 Data Specifications state that the NPI in the header record should match the NPI in the body records. If the two values are different such as, the header is blank and the body record contains the NPI then Warning Message -399 is generated. 

To avoid this warning in the future, verify that the NPI number is being entered into both the header in bytes 577-586 and each body record in bytes 1626-1635 when the assessments are exported and that the two are an exact match.

 

The OASIS Version 1.50 Data Specifications state that the NPI in the header record must match the NPI in the body records. If the two values are different such as, the header is blank and the body record contains the NPI then Warning Message +294 is generated. 

To avoid this error in the future, verify that the NPI number is being entered into both the header in bytes 575-584 and each body record in bytes 769-778 when the assessments are exported and that the two are an exact match.

Section W is included on all assessments with an assessment reference date (A3a) on or after October 1, 2005, all discharge tracking forms with a discharge date (R4) on or after October 1, 2005 and all reentry tracking forms with a reentry date (A4a) on or after October 1, 2005. However, not all Section W fields are required at all times. Below is a breakdown that explains what fields in Section W are required with each Reason for Assessment (RFA).

W1 : An Optional Data Item

Assessments (RFA 01, 02, 03, 04, 05, 10 and 00)

W1 is optional on all assessments with an assessment reference date (A3a) on or after October 1, 2005.

Discharge Tracking Forms (RFA 06, 07, 08)

W1 is optional on all discharge tracking forms with a discharge date (R4) on or after October 1, 2005.

Reentry Tracking Forms (RFA 09)

W1 is optional on all reentry tracking forms with a reentry date (A4a) on or after 10/1/2005.

W2

Assessments (RFA 01, 02, 03, 04, 05, 10 and 00)

W2 is required on all assessments with an assessment reference date (A3a) between October 1 and June 30.

Discharge Tracking Forms (RFA 06, 07, 08)

W2 is required on all discharge tracking forms with a discharge date (R4) between October 1 and June 30.

Reentry Tracking Forms (RFA 09)

W2 is inactive on Reentries.

Sections W2 can be submitted with a Reentry Tracking Form but the data will not be edited or stored in the state database. Therefore, the user will not receive any error messages due to including W2 on a reentry tracking form.

W3

Assessments (RFA 01, 02, 03, 04, 05, 10 and 00)

W3 is required on all assessments with an assessment reference date (A3a) on or after October 1, 2005.

Discharge Tracking Forms (RFA 06, 07, 08)

W3 is required on all discharge tracking forms with a discharge date (R4) on or after October 1, 2005.

Reentry Tracking Forms (RFA 09)

W3 is inactive on Reentries.

Sections W3 can be submitted with a Reentry Tracking Form but the data will not be edited or stored in the state database. Therefore, the user will not receive any error messages due to including W3 on a reentry tracking form.

 

Fatal record error message +138 deals with M0180 Inpatient Discharge date. This message reads; "Inconsistent M0180 values: If (M0180) Inpatient Discharge Date "UK" is checked, then (M0180) date field must be blank. If (M0180) Date is present, then (M0180) "UK" must be unchecked (zero)."

Beginning with the OASIS July 2002 Release, an additional edit was added for this error message. This is not a change to the data specifications. In the OASIS-B1 Data Specifications (Version 1.20), note #3 under item identifier M0180_INP_DSCHG_UNKNOWN states: "If date is present in M0180_INP_DISCHRGE_DT then M0180_INP_DSCHG_UNKNOWN must = 0." Previously, this particular version note was not included in the edit check. Beginning with the most current release, if the M0180 Inpatient Discharge Date is filled in, then M0180 Discharge Date Unknown (byte 351) must have a zero.

 

Although the MDS Face Sheet item AB1 (admission date) is not included on the new MPAF form, this should not pose any new problem for you in tracking the beneficiary's admission date. As has always been the case, the AB1 admission date is only required to be entered and submitted once for each new admission. AB1 is required either on the Initial Admission Assessment record (reason for assessment at AA8a = 01) or on a Discharge Tracking Form record for a discharge occurring before completion of the admission assessment (reason for assessment at AA8a = 08). The AB1 admission date is not required on any other assessment, discharge tracking form, or reentry tracking form. The requirements concerning AB1 have not changed and facilities can continue to use their existing method for tracking the beneficiary's admission date.

Prior to July 1, 2002, Medicare PPS assessments were required to use the Full Assessment Form. The new, shorter MPAF assessment form is being implemented on July 1, 2002 as an optional form that can be used instead of the Full Assessment Form for Medicare PPS assessments. Note that the AB1 admission date is not present on either form allowed for Medicare PPS assessments (Full Assessment Form or MPAF). The absence of AB1 on the MPAF form should not require any change in facility practice concerning the admission date.

It is important to make a few additional clarifications. First, the AB1 admission date is on the Background (Face Sheet) Form. The entire Face Sheet is required on an Initial Admission Assessment. However, the entire Face Sheet (including AB1) can also be optionally submitted by the facility on any non-admission assessment (including a Medicare PPS assessment using either the Full Assessment Form or the MPAF form). When the Face Sheet is optionally submitted on a non-admission assessment, then all Face Sheet items (all Section AB and Section AC items) must be completed and submitted. Optional submission of the Face Sheet must be in "all or none" fashion. If item AB1 is completed and submitted with a non-admission assessment, then all Face Sheet items must be completed and submitted.

A second clarification has to do with the AB5a through AB5f Face Sheet items. These 6 items involve prior institutional history and have been included on the MPAF form. In the future, these items may be used in Quality Measures being developed for Medicare SNF care. The items have been added to the MPAF form to allow use of these items on PPS, non-admission assessments without requiring the entire Face Sheet. With the July 1, 2002, implementation of the MPAF, the AB5 items are optional on PPS, non-admission assessments with plans to make them required in the future. Since they are optional, the AB5 items may be left blank on a PPS, non-admission assessment. Note that if the AB5a through AB5f items are optionally submitted on a PPS, non-admission assessment, then all 6 items must be submitted. Optional submission of the AB5 items must be in "all or none" fashion.

Submission of AB5a through AB5f is not optional on a PPS assessment coupled with an Initial Admission Assessment. The entire Face Sheet (all items in Sections AB and AC) is required on all Initial Admission Assessments, including combined PPS and Initial Admission assessments.

A second clarification involves PPS assessments that are combined with comprehensive assessments. On a PPS assessment coupled with any comprehensive assessment (admission with AA8a = 01, annual with AA8a = 02, significant change with AA8a = 03, and significant correction of prior full with AA8a = 04), the MPAF form is not allowed. All comprehensive assessments require use of the Full Assessment Form, as well as the RAP Summary Form (Section V).

A final clarification involves use of the AB1 admission date for calculating when Medicare PPS assessments are due. The Medicare PPS assessment schedule is actually based on the day that Medicare Part A coverage begins for the current covered stay and not the admission date. For instance, the PPS 5-day assessment window is Day 1 through Day 5 (with a grace period from Day 6 to Day 8), where Day 1 is the start of a covered stay rather than the admission date. There may be confusion about the starting point for the PPS assessment schedule, because the start of coverage and the admission date are the same for about 75% of all covered SNF stays.

While the admission to the facility and the start of coverage usually coincide, they are different for about 25% of SNF stays. Examples are:

An existing long-term care resident in the facility has a hospitalization and then a SNF covered stay. Admission to the facility may have been years before the start of coverage. A new Initial Admission Assessment is not appropriate and the AB1 admission date will predate the start of coverage (perhaps by years).

A new resident is admitted primarily to receive SNF care. On the advice of the resident's physician, the start of SNF coverage is delayed several days to allow the resident to stabilize before receiving rehabilitation therapy. The AB1 admission date may predate the start of coverage by a few days to a few weeks.

A new resident is admitted and SNF covered care begins immediately. The resident is then rehospitalized. The resident returns to the facility and resumes covered care with a new covered stay.

In this case, the PPS assessment schedule must be restarted based on the day that covered care is resumed. The AB1 admission date may predate the resumption of covered care by a few days to several months. In all of these cases, the AB1 admission date cannot be used for setting the PPS assessment schedule in this case. In general, the PPS assessment schedule must be based on the day that the current covered stay started, rather than the AB1 admission date.