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PPS Discharge Assessments: Why NACs Should Stay Up-To-Date

By Caralyn Davis, Staff Writer - January 12, 2021

Amid nationwide staffing shortages, veteran nurse assessment coordinators (NACs) often are being pulled to work the floor, and new NACs are coming on board with limited MDS training, notes Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, DNS-MT, RAC-MTA, president/CEO of Celtic Consulting in Torrington, CT. “Resident care must come first for all staff, including NACs. However, as a result of that need to prioritize care delivery and wear more hats than ever, NACs face multiple stressors when it comes to completing the MDS and the Resident Assessment Instrument (RAI) process.”


The Part A PPS Discharge assessment (i.e., the NPE item set) is an easy target for cutting corners in a time crunch, says McCarthy. “This assessment doesn’t directly impact payment under the Patient-Driven Payment Model (PDPM) in the Skilled Nursing Facility Prospective Payment System (SNF PPS) or under Medicaid case-mix systems. Nor is it used to meet OBRA regulatory requirements for assessment and care planning.”


Consequently, discharge assessments—both the PPS Discharge assessment and the OBRA Discharge assessment—are often the first MDSs to be put aside “to do later” when NACs lack adequate time to complete assessments, adds McCarthy. “Payment assessments take precedence when the biller is standing over your shoulder asking, ‘Are you done yet?’” she explains. “In addition, NACs want to stay on schedule completing the OBRA assessment cycle of three Quarterly MDSs and one Admission/Annual assessment every 12 months.”