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If the
16th is her last day on Medicare, you wouldn't need to do an OMRA. Just issue
her a Denial Letter. When she goes back to Medicare (assuming she is
within her 30 day window) code it as a 5-day as it is a new Medicare stay.
I was incorrect whenI told you to do a Return/Readmit to Medicare. (She would
need to actually be discharged for that assessment.) As far as OBRA assessment
schedule, if a Quarterly is coming up you can code it as a quarterly, too.
However, assuming she'll be weight bearing, a Sig change might be more
appropriate.
-----Original Message-----
From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]On Behalf Of Baker,
Margaret (SNMH)
Sent: Wednesday, January 07, 2004 1:25
PM
To: '[EMAIL PROTECTED]'
Subject: RE: going to private
pay
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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