In response to recent CMS announcements regarding COVID-19, Team TSI has instituted additional coding alerts that are designed to inform providers to potential issues related to COVID-19 and updated CMS guidelines or waivers that may have an impact on MDS coding as well as resident care and services. These alerts are in no way meant to suggest or imply a change in coding is warranted; simply to alert providers to review the most recent CMS guidelines and waivers that may be in effect.
In response to the temporary waiver of the 3-day prior hospitalization requirement for coverage of a skilled nursing facility stay:
- The assessment indicates that this is an entry record and that the resident has a Medicare number (A0600B), but there is no coding to indicate the start of a Medicare A stay (A2400A). Please review the most recent CMS guidelines in response to COVID-19 and any temporary waivers to evaluate if the resident meets the conditions of the waiver to participate in Medicare A.
In response to the temporary waiver of beneficiaries who have recently exhausted their SNF benefits (spell of illness):
- The MDS has been coded as a SNF Part A PPS Discharge Assessment with the resident remaining in the facility. If this is in response to benefits exhaustions (i.e., 100 days) but resident continues to receive skilled services, please review the most recent CMS guidelines in response to COVID-19 and any temporary waivers to evaluate if the resident meets the conditions of the waiver to participate in Medicare A.
In response to the newest recommendations from CMS to reduce risk of transmission, specifically directed at cancelling group activities:
- The MDS has been coded as the resident having received Group and/or Concurrent Therapy (O0400A, B or C) in the last 7 days. Please review the most recent CMS guidelines in response to COVID-19 for delivery of therapy services.
In response to an MDS indicating an active Coronavirus infection where isolation has not been coded:
- Resident has been coded for Coronavirus (B97.29) in Section I, but has not been coded for isolation for active infections disease (O0100M2). Consider screening for isolation and ensuring care plan and proper precautions are in place in accordance with the most recent CMS Guidelines in response to COVID-19 and ensure coding is accurate.
SHP will continue to closely monitor recommendations coming from the CDC as well as transmittals and guidance issued by CMS and if appropriate, develop additional coding alerts that may assist a provider in identifying potential issues or opportunities and responding as appropriate.
SHP remains committed to serving those who serve others and we thank you for continuing to place your trust in us. Please feel free to reach out with any questions or specific needs related to COVID-19 and continued CMS communications.
**SHP acquired Team TSI, a leader in long-term care analytics, in 2020. Now the combined entity delivers a best-in-class solution for SNFs and other LTPAC providers. Learn more about IntelliLogix™.