I agree also about the communication between the MDS coordinator and billing, and that so much can be gained by billers going to RAI seminars, and nurses going to FI billing seminars. In fact, going to MDS coding seminars is what interested me in going back to school to become a nurse!
When you have a biller that can see the importance and complexity of what the nurse must go through to maximize reimbursement, and when a nurse can see the importance and complexity of what the biller must do to complete the whole process, new-found respect for each evolves. It becomes teamwork. It's not just one guy "giving the other guy" what he needs.
Our Medicare biller sits in on the prescreenings, as well as the interdisiplinary meetings on part A residents. She takes notes on items r/t consolidated billing/coverage issues, as well as what is going on with the resident. She has a prior knowledge of what to expect when month end bills roll in from therapy, lab, pharmacy etc. She is one more check in the checks and balances. She is also the person that is called when there are questions on coverage, or how the FI may look at certain scenerios.
Yes, the MDS Coordinator and biller should compare notes before transmission to the FI - not only on rugs and modifiers, but also diagnosis codes and sequencing. If it's not possible to do it face to face, then the next best thing is the phone or fax I guess. I guess we are spoiled here... our offices are very close, and we are always comparing notes!
I'm not quite sure what exact report that was being referred too that comes from the business office, but any homemade tool of communication would do - as long as it serves it's purpose.
L Budde, RN-Reimbursements
[EMAIL PROTECTED] wrote:
BINGO! This should be MANDATORY. I believe significant revenue is lost because of the poor communication between clinical and financial staff. The best biller I know was a medical record director for one of my clients for 12 years before she started billing. She is awesome. She demands so much information before she drops a bill that she captures every cent.
Everything I know about documentation I learned over the past 24 years at BILLING SEMINARS conducted by various FIs. I find very few nurses knowledgeable about reimbursement [we will except Rena, Theresa and both Debbies] Sorry if I left someone out.
Go to every billing seminar you find, you will be bored part of the time and totally in awe most of the time. The information that bores you in the beginning will click before you know it.
My best example is how we are paid for total enteral nutrition. [not tube feeding]. It comes from the prosthetic device rule. If the enteral tube is not a prosthetic device, it is not covered. Definition of a prosthetic device is that is takes over a function of the boy. Once you know this you have no problem documenting the necessary substantiating criteria for TOTAL ENTERAL NUTRITION. Don't the MDS codes make more sense when you call it by the correct name?
Delores
Your business office should be able to provide you with that report. I think it is good practice for the MDS coordinator and billing to go over the UB-92s (the bills) before they are sent. There are many things that affect which days that the RUGS pay that you might know but the business office might not. Example--the resident was at the ER over midnight so the day cannot be billed to Medicare A. It makes good business sense for nursing and billing to talk and make sure that accurate information is being sent on the Medicare bills.
Delores L. Galias, RN, RHIT
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The information contained in this electronic message and any attachments to this message are intended for the exclusive use of the addressee(s) and may contain confidential or privileged information. If you are not the intended recipient, please notify D. Galias, RN, RHIT immediately at [EMAIL PROTECTED] and destroy all copies of this message and any attachments. Thank you for your cooperation
Linda Budde, RN
Reimbursements
Friendly Acres, Inc.
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