Re: Billing question

[Holly Sox, RN, RAC-C]

Terri, This should not be a problem.  This situation occurs occasionally with my assessments. The billing is only done based on the assessments coded as PPS.  You could have done the annual along with the PPS, but since it wasn't, and both have been submitted, I would just leave it alone.   As far as payment goes, the way I see it, these things balance out, and that's the way the system is designed to work. It's a PROSPECTIVE payment system.  Unless Madame Cleo has gotten out of jail and is working for a facility somewhere, no one really knows how to predict the resources that will be used. It is always an estimate, and sometimes it works in CMS's favor, sometimes in the facility's favor. I have had RUG level of CA1 on a resident, who required IV meds the very next day.  We lost money on that one.  Someone else, had a Very  High rehab rate, but started refusing therapy and received less than the expected number of minutes. We saved money on that one.   Your payment was made based on the residents expected needs as of the ARD. Your facility is entitled to that payment as long as the assessment was completed accurately and in good faith.   Hope this helps. HS Holly F. Sox, RN, RAC-C Clinical Editor   www.careplans.com   [EMAIL PROTECTED] ----- Original Message ----- From: Chriss, Theresa M. To: '[EMAIL PROTECTED]' Sent: Wednesday, January 07, 2004 11:44 AM Subject: Billing question 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 /---------------------------------------------------------- The Case Mix Discussion Group is a free service of the  American Association of Nurse Assessment Coordinators       "Committed to the Assessment Professional" Be sure to visit the AANAC website. Accurate answers to your          questions posted to NAC News and FAQs.     For more info visit us at http://www.aanac.org -----------------------------------------------------------/