The purpose of A2400 is to identify when a resident is receiving services under the Part A prospective payment system.  The question in A2400A is: 

Has the Resident Had a Medicare-covered Stay since the Most Recent Entry?

However, in reading the coding instructions, it quickly becomes apparent that the information CMS wishes to obtain is far different that whether the resident is in a Medicare-covered stay.  Today a resident can receive Medicare covered services in a myriad of ways that include Medicare Advantage, bundled payment plans, and state dual-eligible plans.   This question narrowly defines “Medicare-covered stay” as “skilled nursing facility stays billable to Medicare Part A.  Does not include stays billable to Medicare Advantage HMO plans.” (CMS, A-31)  While bundled payment plans and dual-eligible programs are not mentioned, the question is  answered “yes” only when the resident’s pay source is original Medicare Part A. 

If A2400A is answered “yes,” we must code the Start and End days in A2400B and C.  The start date of the current Medicare stay is:

New Admission:  Day 1 of Medicare Part A stay

Readmission:  Day 1 of Medicare Part A coverage after readmission following discharge

If the Medicare Part A stay is ongoing as of the assessment reference date (ARD) of the assessment or tracking record, enter dashes in the Medicare End Date. 

The end of Medicare date is coded as follows, whichever occurs first:

  • Date SNF benefit exhausts (i.e., the 100th day of the benefit); or
  • Date of last day covered as recorded on the effective date from the Notice of Medicare Non-Coverage (NOMNC); or
  • The last paid day of Medicare A when payer source changes to another payer (regardless if the resident was moved to another bed or not); or
  • Date the resident was discharged from the facility (see Item A2000, Discharge Date).

This definition makes it clear that the “Medicare end date “ for the MDS can be different from the “Medicare end date” for the business office.    The date of discharge is not a billable day on the claim, but it is used as the Medicare end date for the MDS if the discharged occurs before the other three events listed above.  There is an algorithm on page A-32 of the RAI Manual that may help to clear up any confusion over coding this date.   

The definition of “Medicare End Date” is what allows a PPS ARD to be set on a non-billable day of discharge.  Any services provided on that date that meet the coding criteria may be coded to achieve the RUG score that sets payment for the days that can be billed to Part A.    The Medicare End Date is also a critical factor in determining whether the assessment meets criteria for the Medicare Short Stay RUG designation. 

The dates in A2400 also determine the look-back periods in Section GG: Functional Abilities and Goals.   When completing Section GG at the start of the Part A stay, the three day assessment period begin with the Medicare start date in A2400B.  When a discharge Section GG functional assessment is required,  the three day assessment period is the last three days of the Part A stay, ending with the Medicare end date in A2400C.