A2400B: Start Date of Most Recent Medicare Stay, Step-by-Step

Step-by-Step Coding Guide for Item Set A2400B: Start Date of Most Recent Medicare Stay

1. Review of Medical Records

• Objective: Collect accurate information regarding the start date of the resident's most recent Medicare stay.
• Steps:
  1. Obtain Admission Records: Access the resident’s admission records to identify the start date of the most recent Medicare-covered stay.
  2. Check Medicare Enrollment: Verify the resident’s enrollment in Medicare at the time of admission.
  3. Review Billing Information: Confirm the start date by checking billing records and Medicare claims.

2. Understanding Definitions

• Start Date of Most Recent Medicare Stay (A2400B): The date on which the resident began the most recent period of stay in the facility that was covered by Medicare.
• Examples:
  • The date when a resident was admitted for skilled nursing care under Medicare.
  • The start date of the current benefit period if the resident has multiple Medicare-covered stays.

3. Coding Instructions

• Steps:
  1. Locate Item Set: Find item set A2400B on the MDS form.
  2. Identify Start Date:
     • Admission Date: Use the admission date as the start date if it aligns with the beginning of the Medicare stay.
     • Medicare Coverage Confirmation: Confirm that Medicare was the primary payer from the start of the stay.
  3. Format the Date: Ensure the start date is formatted correctly (MM/DD/YYYY).
  4. Enter the Date: Input the start date of the most recent Medicare stay into item set A2400B.
  5. Double-Check Accuracy: Verify that the date entered matches the records from admission and billing.

4. Coding Tips

• Verify with Multiple Sources: Cross-check the start date with admission records, Medicare enrollment details, and billing information to ensure accuracy.
• Update Regularly: Keep the Medicare stay dates updated to reflect any changes in the resident's coverage or stay.
• Use Consistent Formats: Always use the standard date format (MM/DD/YYYY) to avoid errors.

5. Documentation

• Required:
  • MDS Form: Correctly filled entry for item set A2400B indicating the start date of the most recent Medicare stay.
  • Admission Records: Documentation confirming the admission date.
  • Medicare Enrollment Verification: Records showing Medicare coverage at the start of the stay.
  • Billing Records: Invoices or claims verifying the start of the Medicare-covered period.

6. Common Errors to Avoid

• Incorrect Date: Ensure the start date is the actual date Medicare coverage began, not just the admission date.
• Misalignment with Records: Double-check that the start date matches all relevant documents, including admission and billing records.
• Formatting Errors: Use the correct date format (MM/DD/YYYY) to prevent misinterpretation of the data.

7. Practical Application

• Example:
  • Resident Background: Mrs. Jane Smith, admitted on 02/15/2024 for skilled nursing care under Medicare.
  • Review Process: Access Mrs. Smith’s admission records, Medicare enrollment, and billing information.
  • Coding Process:
    • Step 1: Locate item set A2400B on the MDS form.
    • Step 2: Identify 02/15/2024 as the start date of the Medicare-covered stay.
    • Step 3: Confirm with billing and Medicare records that the stay began on 02/15/2024.
    • Step 4: Enter 02/15/2024 into item set A2400B.
  • Illustration:
    • Provide a sample MDS form showing item set A2400B with the start date 02/15/2024 entered.
    • Include an example of an admission record and a Medicare enrollment confirmation.

Please note that the information provided in this guide for MDS 3.0 Item set A2400B 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.