|
--- Original Message -Payment is not made
under PPS unless a covered day can be billed. Also, if no-payment is possible
under ---PPS, billing is not allowed for ancillary services. Ancillary charges
for these days have been included in the PPS rates for days ---that can be
billed.
What does this mean? If we do
not complete the assessment we cannot bill default?
Michelle
----
Sent: Friday, January 02, 2004 3:23
PM
Subject: Re: Readmit / deceased less than
24 hour
The answer to your question about billing for
the day has already been answered with the posting of the relevant section of
the new online Medicare Claims Processing Manual. I am posting it again,
though, because I wanted add one more paragraph that contains some information
that this section in the Medicare SNF Manual did not contain. I think
it's interesting.
<<
Chapter 6 - SNF Inpatient Part A Billing
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.
Payment is not made under PPS unless a
covered day can be billed. Also, if no-payment is possible under PPS, billing
is not allowed for ancillary services. Ancillary charges for these days have
been included in the PPS rates for days that can be billed.
>>
Rena
Rena R. Shephard, MHA, RN, FACDONA,
RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj: Readmit / deceased less than 24 hour
Date:
1/2/04 12:30:50 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
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.
|
