Ask The Payment Expert

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Ask the payment expert
Ask the payment expert
If we have a resident with a medical RUGs and therapy wants to pick up that resident, do we have to complete an OMRA assessment?

There is no mechanism in the rules that mandate an OMRA when you want to change from a medical RUG and now are providing rehabilitation services. One exception rule, however, is the use of a SCSA for a Medicare A resident. 
If therapy decides to pick up a resident, there has to be a reason. It is the ideal time to reassess the resident for the need of a significant change assessment.
If the resident meets the criteria for significant change, you should code the assessment as a SCSA (3) and an OMRA (8). This is an exception to the OMRA rule and can be found in the RAI manual Chapter 2, Page 39. This results in a change of payment as of the ARD for the assessment. How should our MDS be coded for residents being readmitted? That answer depends on the payer source of the resident when they left your facility and how you coded the discharge tracking MDS.
If the resident was a long-term care resident in your facility who went to the hospital and the discharge tracking form was coded as return anticipated, when that resident is readmitted to the facility as Medicare A, you would code their assessment as a five-day Medicare assessment (0,1). You would keep that resident on the same OBRA schedule they were on prior to hospitalization.
If the resident was a Medicare A resident who went out to the hospital and is readmitted Medicare A, that resident would be coded as a readmission assessment (0,5). This resident also would continue on the same OBRA schedule as long as the discharge tracking was coded as return anticipated.
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