BILLING BASED ON OFF-CYCLE MDS ASSESSMENTS
If an off-cycle assessment is performed within the assessment window of a Medicare required assessment, it must replace the Medicare required assessment. Payment will change effective with the ARD of the off-cycle assessment that "replaces" the Medicare required assessment and will continue until the next Medicare required assessment or off-cycle assessment, whichever occurs first. This policy is applied when there is a single off-cycle assessment that is performed within the Medicare required assessment window. However, when the ARD of the "replacement" (or offcycle) assessment is on one of the grace days, the payment rate changes on the day it would have changed based on the regularly schedule assessment.
Example 1:
If the ARD of an OMRA is set on day 22 of the Part A covered stay, which is within the assessment window for setting the ARD for the 30-day Medicare required assessment, it must replace the 30 day Medicare required assessment. Payment will change on day 22, the ARD of the OMRA, and will continue until the next Medicare required assessment or off-cycle assessment, whichever occurs first.Example 2:
If the ARD of an OMRA is set for day 32 of the stay and the OMRA is replacing the Medicare 30-day assessment, then the payment will change as of day 31, as if it were a regularly scheduled 30-day assessment. The payment rate changes retrospectively in this case because otherwise, there is no appropriate rate to bill for day 31. Payment based on the 14-day assessment may only go through day 30."Goche, Ann" <[EMAIL PROTECTED]> wrote:
Where would I find information on when a SC or an OMRA would change payment for MCA? I need the area where it states when a SC or an OMRA starts payment on their ARD, instead of the normal billing dates.
Thanks,
Ann
Do you Yahoo!?
Protect your identity with Yahoo! Mail AddressGuard
