Ask the Experts

Ask the expert: Medicare replacement plans

Q: We have several Medicare replacement plans. When scheduling the MDS, we are currently doing 5-day admission, 14-day, 30-day, etc., along with a Change of Therapy (COT) assessment if needed.

Is this the correct schedule? We also have several residents who are insurance primary, but have Medicare secondary. We are doing the same schedule with them. Is this correct or are we doing more than we should?

A: The Medicare PPS schedule does not apply to Medicare replacement plans. That being said, some plans want the RUG scores. Although you may not transmit replacement plan Medicare assessments to the ASAP system, your software vendor will have a solution for you to generate a RUG score and place it in the private insurance item in Section Z.

For those residents with a private insurance with Medicare as a secondary payer, it may depend on the situation. In general, it is not necessary to complete the Medicare schedule. However, if the primary insurance is because of an accident (Motor vehicle, etc), it is a good practice to follow the Medicare schedule, even though they will not be transmitted.