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NACs on Vacation—Free From Guilt and Stress

By Jessie McGill, RN, RAC-MT - June 20, 2018

Sitting with your feet in the sand, sunscreen on, ready to lean back and finally start reading that book that’s been at the top of your list for weeks—it’s official, you’re on vacation! One paragraph in and you set down the book with a sigh, distracted by thoughts of work. Did Mr. Jones really discharge today as planned? Did Mrs. Elderberry refuse therapy today? Who will adjust the assessment reference date of the Discharge assessments? Will anyone remember to open an End of Therapy assessment? You grab your cell phone, knowing that if you don’t check you’ll be stressed out the rest of the day.

Is this your idea of a vacation? For many nurse assessment coordinators (NACs) it is, but it doesn’t have to be.

Here are some strategies to achieving a vacation free from work-related guilt and stress.


1.       Share the knowledge.

Oftentimes the NAC will find him- or herself being the only nurse in the facility who knows how to open an MDS assessment, complete a Medicare physician certification form, or even locate the RAI User’s Manual. This is not a good strategy for success.

Every single responsibility in the facility should have an adequately trained back-up person who can keep the process moving in the absence of the process owner. Nurse assessment coordination is no different, and you need to actively train your assigned back-up throughout the year. Ideally, the MDS back-up position will have scheduled hours to assist you weekly or monthly, to stay in practice and on top of changing regulations. The MDS back-up position and training need to be budgeted for and supported by the administrative team.

The MDS back-up needs to be proficient in OBRA and PPS MDS scheduling, coding, and scripted interviews, as well as time-sensitive billing requirements, such as Medicare physician certifications and Advance Beneficiary notices. MDS completion and transmission are also key parts of the assessment process that must continue during your absence.

If the MDS back-up is an LPN/LVN, a registered nurse with knowledge of the RAI process needs to be assigned for the completion of the assessments at Z0500. (Keep in mind that Z0500 does not attest to the accuracy of the items coded on the MDS.) Federal regulations require that an RN sign at Z0500; if an LPN/LVN were to sign there, the entire assessment would become invalid. The LPN/LVN is allowed to complete MDS scripted interviews, code the MDS, and attest to the accuracy of the items at Z0400.

In addition to a competent MDS back-up, ongoing education of the IDT involved in the MDS process helps to set the stage for your worry-free vacation.



2.        Work ahead of schedule.

Planning the schedule in advance is essential for smooth sailing while you’re away. OBRA assessments can often be scheduled, completed, and submitted before the planned time off. For example, if there are five Quarterly assessments that will reach day 92 the week of your planned vacation, you can schedule these assessments early. Federal regulations do not stipulate a “too early” date, which allows for flexibility to complete and submit these assessments before your vacation.

Even with a very competent MDS back-up, you must realize that the work pace will likely be substantially slower. The MDS back-up does not have the daily routine and practice that you have. Adjust the assessment schedule for as few assessments as possible to be completed during your time off. But keep in mind that additional assessments are unavoidable; make sure that the MDS back-up is aware that an unplanned discharge or change of therapy is likely to occur.

Don’t forget about reimbursement. If you’re in a case-mix state, you still need to be cognizant of services and cares provided to the resident that need to be captured on the MDS to ensure accurate and appropriate reimbursement. Many long-term care residents are stable, meaning the care and services provided are predictable week after week. For these residents, scheduling the Quarterly assessment two weeks earlier would likely have no impact on reimbursement.  

Assessments are not the only items that can be completed early. Medicare physician recertifications can be sent out to the physicians to be signed well before the final due date. However, be aware that the signature date drives the next recertification’s due date. OBRA and PPS assessments can also be scheduled in the software system in advance of your vacation.


3.       Plan for the worst.

Part of preparing for smooth sailing is trying to anticipate what could go wrong. We know there can be a lot of unexpected changes over the course of a week, but if we plan for the worst, we can help prevent some headaches later. For example, if during vacation week there are four residents who will need to be evaluated for a change of therapy (COT), go ahead and open the COTs for the appropriate assessment reference date now.

When you return from vacation, you can review the COTs and delete any assessment that was not required. However, if an assessment is missed or late, this will result in provider liability or default payment. Oftentimes the MDS back-up will be in the “MDS office” for only part of the time, opening the door to missing an assessment in your absence. Scheduling the COT or End of Therapy assessments in anticipation of planned or unplanned events can help avoid a payment penalty.


You work hard to keep all the wheels turning in your facility. You deserve a break—and you should take it! By diligently planning ahead, you will be able to take the stress- and guilt-free vacation you’ve been dreaming about.

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