RE: Readmit / deceased less than 24 hour

[Winona M. Phelps]

Hi.  Yes, you can bill under those circumstances and you should complete an MDS.  Here is the reference out of the new manual.  As far as the MD visit goes, see 3-205.  The August clarification states "Do not include physician visits that occurred during the resident's acute care stay."   http://cms.hhs.gov/manuals/104_claims/clm104c06.pdf 40.3.5 - Determine Utilization on Day of Discharge, Death, or Day Beginning a Leave of Absence (Rev. 1, 10-01-03) SNF-517.6.B, A3-3103.4 Generally, the day of discharge, death, or a day on which a patient begins a leave of absence, is not counted as a utilization day. (See the Medicare Benefit Policy Manual, Chapter 3, "Duration of Covered Inpatient Services.") This is true even where one of these events occurs on a patient's first day of entitlement or the first day of a provider's participation in the Medicare program. In addition, a benefit period may begin with a stay in a hospital or SNF, on that day. The exception to the general rule of not charging a utilization day for the day of discharge, death, or day beginning a leave of absence is where the patient is admitted with the expectation that he will remain overnight but is discharged, dies, or is transferred to a nonparticipating provider or a nonparticipating distinct part of the same provider before midnight of the same day. In these instances, such a day counts as a utilization day. This exception includes the situation where the beneficiary was admitted (with the expectation that he would remain overnight) on either the first day of his entitlement or the provider's first day of participation, and on the same day he was discharged, died, or transferred to a nonparticipating provider. Winona Phelps, RN     -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Friday, January 02, 2004 12:29 PM To: [EMAIL PROTECTED] Subject: Readmit / deceased less than 24 hour HI     I have a resident that passed away in less than 24 hours upon readmission from the hosp with MCR eligible  .  His  readmit date 12/31/03 at 11:50 am , deceased 11:55 pm same day. Billing is telling me that I do not have to do an MDS / cert  for that day because they don't charge for that day because the resident expired before midnite. If so, what happens to that day of payment?  I thought their was an exception to the rule when someone is admitted and dies within 24 hours that you could still charge for that day according to the rug. Please help,     nancy fro PA       Futhermore, could you count the physicans visit from the hosp  progress notes for section p7 on the mds if done.