In such a case, we would treat him as though he is Medicare A doing the MDS
on a PPS schedule in case we needed to submit to Medicare later. Although
this is extra work, we don't want to bill default and can't do the MDS after
the fact. Having good preadmission information upfront and the name and
number of the insurance claims office for the MVA often helps in obtaining
information, also.
We do this when in doubt with MCO patients also.
----- Original Message -----
From: "Brenda L. Graham" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Monday, October 27, 2003 7:58 AM
Subject: RE: HMO & Medicare........When to RUG
> Follow the Medicare A PPS schedule for the MDS process.
>
> -----Original Message-----
> From: [EMAIL PROTECTED] on behalf of [EMAIL PROTECTED]
> Sent: Fri 10/24/2003 9:12 PM
> To: [EMAIL PROTECTED]
> Cc:
> Subject: HMO & Medicare........When to RUG
>
>
> All thoughts & opinions will be appreciated. Scenario....Resident arrives
MVA ins. His secondary ins. is Med A as he is over 65. We think he may or
may not have met his cap for insurance while in the hosp. How can I RUG him
to capture his stay while in SNF? Many times, we don't find out the cap has
been reached till many months later. The default rate is so low. There
must be a way to capture the true RUG scores while he is with us just in
case we need to bill Med A.....Any ideas? Thanks to all. What a great
group!
>
>
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