Understanding and Coding MDS 3.0 Item A2400A: "Has Resident Had a Medicare-Covered Stay"

Understanding and Coding MDS 3.0 Item A2400A: "Has Resident Had a Medicare-Covered Stay"

Introduction

Purpose: Accurate coding of MDS 3.0 Item A2400A, "Has Resident Had a Medicare-Covered Stay," is vital for ensuring that a resident’s eligibility and utilization of Medicare benefits are properly documented. This item plays a critical role in determining whether a resident has had a stay in a skilled nursing facility (SNF) that was covered by Medicare. Correctly identifying and coding this information affects reimbursement and compliance with federal regulations.

What is MDS Item A2400A?

Explanation: MDS Item A2400A is designed to capture whether the resident has had a Medicare-covered stay in a skilled nursing facility (SNF) during the current admission. This item is part of Section A, which deals with identification and demographic information, and it helps track the utilization of Medicare benefits, which is crucial for billing and reimbursement purposes.

This item specifically asks whether the resident's stay is being or has been covered by Medicare Part A. The data captured by this item are used to determine payment under the Medicare program and to assess the utilization of Medicare benefits by the resident.

Guidelines for Coding A2400A

Coding Instructions: When coding MDS Item A2400A, follow these steps based on the MDS 3.0 RAI Manual:

1. Determine Medicare Coverage: Identify if the resident has had a stay covered by Medicare Part A during the current admission. This includes any stay in the facility that qualified for Medicare coverage, regardless of whether the coverage is ongoing or has ended.

2. Answer Yes or No:

   • Code '1' (Yes): If the resident has had a Medicare-covered stay, meaning Medicare Part A covered at least one day of the stay in the skilled nursing facility.
   • Code '0' (No): If the resident has not had a Medicare-covered stay during the current admission, or if Medicare Part A has not paid for any portion of the stay.

3. Verify Documentation: Ensure that the decision to code 'Yes' or 'No' is supported by documentation in the resident’s record, such as Medicare billing records or eligibility verification documents.

Example Scenario: A resident was admitted to a skilled nursing facility following a hospital stay. The stay was initially covered by Medicare Part A for rehabilitation services. After several weeks, the resident’s Medicare coverage ended, but they continued to stay at the facility. In this case, you would code A2400A as '1' (Yes) because the resident had a Medicare-covered stay during the current admission.

Best Practices for Accurate Coding

Documentation:

• Ensure that all Medicare coverage dates and relevant billing information are clearly documented in the resident’s medical record. This includes the start and end dates of Medicare coverage, as well as any notices of non-coverage.
• Regularly review Medicare billing records to verify that the resident’s coverage status is accurately reflected in the MDS coding.

Communication:

• Maintain effective communication with the billing department and the interdisciplinary team to stay updated on changes in the resident’s Medicare coverage status.

Training:

• Provide ongoing education for staff on how to determine and document Medicare-covered stays. Ensure that staff understand the importance of accurate coding for Item A2400A, particularly in the context of reimbursement and regulatory compliance.

Conclusion

Summary: Correctly coding MDS Item A2400A is crucial for accurately documenting whether a resident has had a Medicare-covered stay during their current admission. This information is essential for ensuring proper reimbursement and compliance with federal Medicare regulations. By following the guidelines and best practices outlined here, healthcare professionals can help maintain the accuracy and integrity of the MDS assessments.

Click here to see a detailed Step-by-Step on how to complete this item set.

Reference

• CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024, Chapter 3, Section A: Identification Information, Page A-11.

Disclaimer

Please note that the information provided in this guide for MDS 3.0 Item A2400A was originally based on the CMS's Long-Term Care Facility Resident Assessment Instrument 3.0 User’s Manual, Version 1.19.1, October 2024. 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.