Re: RUG payment reports

[Delores234]

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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