MDS 3.0 Calendar - Nursing Home Help

MDS 3.0 CalendarName:_________________ HIC #:_________________Days Type First Day of Medicare Covered Care in Yellow Box (Format 01/01/00)Assessment 1-14 1 2 3 4 5 6 7Indicator (AI) 5-day 10/01/11 10/02/11 10/03/11 10/04/11 10/05/11 10/06/11 10/07/1110 assessment 8 9 10 11 12 13 1410/08/11 10/09/11 10/10/11 10/11/11 10/12/11 10/13/11 10/14/11AI Code 15-30 15 16 17 18 19 20 2120 14-day 10/15/11 10/16/11 10/17/11 10/18/11 10/19/11 10/20/11 10/21/11assessment 22 23 24 25 26 27 2810/22/11 10/23/11 10/24/11 10/25/11 10/26/11 10/27/11 10/28/1129 3010/29/11 10/30/11AI Code 31-60 31 32 33 34 35 36 3730 30-day 10/31/11 11/01/11 11/02/11 11/03/11 11/04/11 11/05/11 11/06/11assessment 38 39 40 41 42 43 4411/07/11 11/08/11 11/09/11 11/10/11 11/11/11 11/12/11 11/13/1145 46 47 48 49 50 5111/14/11 11/15/11 11/16/11 11/17/11 11/18/11 11/19/11 11/20/1152 53 54 55 56 57 5811/21/11 11/22/11 11/23/11 11/24/11 11/25/11 11/26/11 11/27/1159 6011/28/11 11/29/11AI Code 61-90 61 62 63 64 65 66 6740 60-day 11/30/11 12/01/11 12/02/11 12/03/11 12/04/11 12/05/11 12/06/11assessment 68 69 70 71 72 73 7412/07/11 12/08/11 12/09/11 12/10/11 12/11/11 12/12/11 12/13/1175 76 77 78 79 80 8112/14/11 12/15/11 12/16/11 12/17/11 12/18/11 12/19/11 12/20/1182 83 84 85 86 87 8812/21/11 12/22/11 12/23/11 12/24/11 12/25/11 12/26/11 12/27/1189 9012/28/11 12/29/11KeyGrey BoxesRegular assessment schedule,appropriate ARD daysPurple BoxesGrace days for regularassessment schedule ARDdaysPolka-Dot BoxesARD for regular assessmentcannot be set on these daysAI Code 91-100 91 92 93 94 95 96 9750 90-day 12/30/11 12/31/11 01/01/12 01/02/12 01/03/12 01/04/12 01/05/12assessment 98 99 10001/06/12 01/07/12 01/08/12Proprietary and ConfidentialVersion: 3.0 Modified: 08/26/2011WPS MedicarePage 1 of 2

MDS 3.0 CalendarName:_________________ HIC #:_________________EXTRA ASSESSMENTSSCSA/SCPAARD on a polka-dot day is an extra assessment anduses AI code 01EOT (no resumption) OMRAARD on a polka-dot day is an extra assessment anduses AI code 04EOT-R (with resumption) OMRAARD on a polka-dot day is an extra assessment anduses AI code 0ASOT OMRAARD on a polka-dot day is an extra assessment and usesAI code 02SOT OMRA combined with SCSA or SCPAARD on a polka-dot day is an extra assessment anduses AI code 03SOT OMRA combined with EOT OMRASOT OMRA with EOT OMRA and SCSA or SCPAARD on a polka-dot day is an extra assessment and uses ARD on a polka-dot day is an extra assessment andAI code 05uses AI code 06SOT OMRA with EOT-R OMRASOT OMRA with EOT-R OMRA and SCSA or SCPAARD on a polka-dot day is an extra assessment and uses ARD on a polka-dot day is an extra assessment andAI code 0Buses AI code 0CCOT OMRAARD on a polka-dot day is an extra assessment anduses AI code 0DCOMBINING ASSESSMENTSWhen ARD of an unscheduled assessment falls on a grey or purple day, assements must be combined. Here are some common combinations.SOT OMRA with5-day assessment14-day assessment30-day assessment60-day assessment90-day assessmentEOT-R OMRA with5-day assessment14-day assessment30-day assessment60-day assessment90-day assessmentUse AI code EOT OMRA with Use AI code SOT & EOT OMRA with Use AI codeN/A 5-day assessment14 5-day assessment 1522 14-day assessment 24 14-day assessment 2532 30-day assessment 34 30-day assessment 3542 60-day assessment 44 60-day assessment 4552 90-day assessment 54 90-day assessment 55Use AI code SOT & EOT-R OMRA with Use AI code COT OMRA with Use AI code1A 5-day assessment1B 5-day assessment 1D2A 14-day assessment 2B 14-day assessment 2D3A 30-day assessment 3B 30-day assessment 3D4A 60-day assessment 4B 60-day assessment 4D5A 90-day assessment 5B 90-day assessment 5DProprietary and ConfidentialVersion: 3.0 Modified: 08/26/2011WPS MedicarePage 2 of 2