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She
had her last day of therapy yesterday the 6th. We will continue to skill
her to the 16th on various nursing loose ends. UTI, nutrition and setting
up a nursing program to continue to reinforce skills learned with rehab
including some ambulation in // bars --but at less than a restorative nursing
level. So what do I do on the 16th as the last MDS I did would cover
beyond that date. 1. Deny and just not bill starting the 16th and do
no MDS? 2. Would the return/readmit to Medicare assesment that I would do
around the middle of February be like a 5 day? 3. All this including
weight bearing rehab would be taking place within max of 90 days
from date of admission.
If
she is going to recieve any type of Rehab thru the 16th, then she would not
need an OMRA. Remember an OMRA is required when ALL therapy has been D/c'd and
resident remains on Medicare. If she has nothing to skill her ( ?any type of
nursing observation, etc...) then she would not remain on Medicare. Thus, PPS
assessments would stop. When she becomes weight bearing again and is picked up
by Rehab, she would need a Return/Readmit to Medicare
Assessment. Remember to continue the OBRA assessment
schedule
We are a
sub acute attached to an acute care hospital. So our pts go to another
level of care when they leave us. But we have a very wealthy pt who
will be Non Weight Bearing for 6 more weeks. She is reaching custodial
care projected as of the 16th. So we will issue a denial letter as of
that date and she will pay our very high daily rate to stay til she is able
to have the external fixator removed from her leg and then go back on Rehab
to learn to walk again.
My
question is this: I guess I need to do an OMRA MDS with an
effective date as of the 16th, but it will probably put her in a
billable RUG even though we have determined that there will be no
skilled need. How do I do this? Do I do an MDS and not generate
a RUG code? Or do I not do an MDS? Do I send an MDS? When
I put her back on Medicare do I do a 5 day MDS? and then a 14? Or do I do
something else? The only time we had a similar situation the pt went
to a relatives for care and then came back. So it was a DC then a
readmit to Medicare with a 5 day. I know LTC facilities do this
frequently so I need one of you to tell me what to
do.
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