Q&A: I accidentally transmitted a stand-alone 5-day for a resident on a Medicare Advantage plan that is being paid by RUGs. How do I fix this?

Posted By: Carol Maher, RN-BC, CPC, RAC-MT
Post Date: 02/06/2019

Question: I accidentally transmitted a stand-alone 5-day for a resident on a Medicare Advantage plan that is being paid by RUGs. How do I fix this? Also, could this have a negative effect on the QIES system if it is transmitted?

Answer: PPS MDSs that are for residents whose payer is any other payer than traditional Medicare A cannot be in the QIES ASAP system. 

To remove a stand-alone PPS assessment for a resident that is NOT traditional Medicare A from the QIES ASAP database:

1.       Print the MDS. (Don’t skip this step.)

2.       Inactivate the standalone 5-day PPS MDS.

3.       Maintain the printed hard copy MDS in the resident’s medical record with a note stating that the assessment had been completed in a timely manner, had been incorrectly transmitted to QIES ASAP, and had been inactivated from the QIES system. Hard copy MDS is the facility’s copy of the MDS completed for the Medicare Advantage stay.

If the PPS MDS for the Medicare Advantage Plan had been combined with an OBRA MDS, I recommend following these steps:

1. Print the MDS first, before doing anything else.  Do this step even if all of your records are electronic. 


2.  Modify (do not inactivate) the MDS to remove the PPS reason for assessment.


3.  Transmit the modified MDS, which will remove the PPS MDS from the data base. 


4.  Keep the printed copy in the resident’s medical record so that the PPS MDS is available in case of Medicare review.  You could scan the printed copy into the record as well, if this is how you manage documents. Note that the modification had been completed to remove the PPS from the database. 

The PPS MDS could impact both the MDS 3.0 Quality Measures and the SNF QRP Measures when that assessment should not have been transmitted or included in the measure calculations. Since the RAI Manual specifically states those assessments should not be transmitted, it could cause a survey tag.



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