A2400A: Has Resident Had Medicare-Covered Stay?, Step-by-Step

Step-by-Step Coding Guide for Item Set A2400A: Has Resident Had Medicare-Covered Stay?

1. Review of Medical Records

• Objective: To determine if the resident had a Medicare Part A covered stay since their most recent entry into the facility.
• Process:
  • Admission Records: Check admission records for any documentation indicating a Medicare Part A stay.
  • Medicare Billing Records: Review Medicare billing records for Part A services.
  • Physician Orders: Examine physician orders related to admission under Medicare Part A.
  • Discharge Records: Look at discharge records from previous hospital stays that indicate continuation under Medicare Part A.

2. Understanding Definitions

• Medicare-Covered Stay: Refers to a period during which the resident received services covered by Medicare Part A, such as skilled nursing care or rehabilitation services.

3. Coding Instructions

• Code A2400A:
  • 0: No, the resident has not had a Medicare-covered stay since the most recent entry.
  • 1: Yes, the resident has had a Medicare-covered stay since the most recent entry.
• Example: If a resident was admitted to the facility under Medicare Part A for skilled nursing care, code A2400A as '1'.

4. Coding Tips

• Confirmation: Confirm through multiple sources such as Medicare billing records and physician notes.
• Consistency: Ensure that all relevant records consistently indicate a Medicare-covered stay.

5. Documentation

• Required Documentation:
  • Admission Records: Indicate the start date of the Medicare-covered stay.
  • Billing Records: Medicare Part A billing documentation.
  • Care Plan: Notes in the care plan that reflect the Medicare coverage for the stay.
• Example: "On 05/10/2024, the resident was admitted under Medicare Part A for skilled nursing services. This is documented in the admission records and confirmed by billing documentation."

6. Common Errors to Avoid

• Assuming Coverage: Do not assume Medicare coverage without proper documentation.
• Incomplete Records: Ensure all documentation is complete and accurately reflects the Medicare-covered stay.
• Overlooking Changes: Regularly update records to reflect any changes in coverage status.

7. Practical Application

• Scenario: A resident admitted for post-operative rehabilitation under Medicare Part A. The admission records, physician orders, and billing documentation confirm the coverage. Based on this documentation, A2400A is coded as '1'.

Please note that the information provided in this guide for MDS 3.0 Item set A2400A  was originally based on the CMS's RAI Version 3.0 Manual, October 2023 edition. Every effort will be made to update it to the most current version. The MDS 3.0 Manual is typically updated every October. If there are no changes to the Item Set, there will be no changes to this guide. This guidance is intended to assist healthcare professionals, particularly new nurses or MDS coordinators, in understanding and applying the correct coding procedures for this specific item within MDS 3.0. 

The guide is not a substitute for professional judgment or the facility’s policies. It is crucial to stay updated with any changes or updates in the MDS 3.0 manual or relevant CMS regulations. The guide does not cover all potential scenarios and should not be used as a sole resource for MDS 3.0 coding. 

Additionally, this guide refrains from handling personal patient data and does not provide medical or legal advice. Users are responsible for ensuring compliance with all applicable laws and regulations in their respective practices.