One of our long term residents recently went to the hospital and returned to
our facility on Medicare on 12-01-2003. He had his Medicare 5 day MDS
opened with an assessment reference date (ARD) of 12-02-2003 but it was not
also coded as an annual. His RUGS score was SE3. He remained on
Medicare until 12-14-2003. During his Medicare stay, an annual MDS was
opened with an ARD of 12-08-2003. His RUGS score was CC2. Both assessments
have been submitted.
We are wondering if this presents a problem for our billing department.
Can we justify billing Medicare at an SE3 rate for days 1-14 when another
MDS was done which RUGed out at CC2? Do we need to correct the Medicare MDS
and code it also as an annual?? And inactive the second MDS? Any ideas??
Thank you,
Terri Chriss, RN Case Manager
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