A2400: Medicare Stay

Step-by-Step Coding Guide for A2400: Medicare Stay

Instructions:

1. Identify if a Medicare Stay Occurred:

   • A2400A: Determine if the resident has had a Medicare Part A covered stay since their most recent admission/entry or reentry.
     • Code 0 (No): If there has been no Medicare Part A stay. Skip to B0100, Comatose.
     • Code 1 (Yes): If there has been a Medicare Part A stay. Proceed to A2400B.

2. Start Date of Most Recent Medicare Stay (A2400B):

   • If A2400A is coded 1 (Yes), record the start date of the most recent Medicare Part A stay. Use the format MM-DD-YYYY.

3. End Date of Most Recent Medicare Stay (A2400C):

   • If A2400A is coded 1 (Yes), record the end date of the most recent Medicare Part A stay. Use the format MM-DD-YYYY.
   • Ongoing Stays: If the Medicare Part A stay is ongoing, enter dashes to indicate that the stay has not ended.

4. End Date Coding Specifics:

   • The end date should be recorded based on whichever of these occurs first:
     • The date SNF benefits exhaust (i.e., the 100th day of the benefit).
     • The date of the last day covered as recorded on the effective date from the Notice of Medicare Non-Coverage (NOMNC).
     • The last paid day of Medicare Part A when the payer source changes to another payer.
     • The date the resident was discharged from the facility.

5. Special Considerations:

   • A therapeutic leave of absence or a hospital observation stay of less than 24 hours (without hospital admission) is considered a continuation, not a new Medicare Part A stay.
   • If a resident has an interrupted stay and is readmitted within the interruption window, it's considered a continuation of the Medicare Part A stay.

6. Documentation and Reporting:

   • Accurately document the presence and specifics of a Medicare Part A stay to ensure proper billing and compliance with regulatory requirements.
   • Use the detailed guidelines from CMS’s RAI Manual for specific scenarios, including how to handle interrupted stays and therapeutic leaves.

Remember: Accurate coding of the Medicare Stay section is critical for billing purposes, compliance with Medicare requirements, and ensuring the facility receives appropriate reimbursement for services provided​​.

The Step-by-Step Coding Guide for item A2400 in MDS 3.0 Section A is based on the Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.18.11, dated October 2023. Healthcare guidelines, policies, and regulations can undergo frequent updates. Therefore, healthcare professionals must ensure they are referencing the most current version of the MDS 3.0 manual. This guide aims to assist with understanding and applying the coding procedures as outlined in the referenced manual version. However, in cases where there are updates or changes to the manual after the mentioned date, users should refer to the latest version of the manual for the most accurate and up-to-date information. The guide should not substitute for professional judgment and the consultation of the latest regulatory guidelines in the healthcare field.