Re: MEDICARE VS. INITIAL

[RRS2000]

It is not permitted to do a modification of the Reason for Assessment. See page 1-11 of the Provider Instructions for MDS Correction Policy at http://www.qtso.com/download/mds/PrMn1002.pdf.   You can resubmit the assessment using the new Reason for Assessment, but that will work as a 5-day assessment ONLY if the initial Admission assessment contained all of the components required for the 5-day, including Section T, since it is not permitted to go back and construct the assessment once the observation window has closed. 

There is a provision in the regulation to be able to utilize the RUG from the initial Admission assessment for billing under some circumstances.  I recommend that your facility contact your FI for details.

Rena

Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]

Subj: MEDICARE VS. INITIAL
Date: 1/8/04 5:33:01 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
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Good morning,  I have a resident who was admitted on 12/6/03  and she had a private insurance with the authorization number so I did an initial assessment on 12/17/03 and submitted it to the state.  At the end of the month when we tried to bill the insurance they refused as they said she has Medicare primary.  Upon further investigation she is.  So my questions are do we have to take the default rate for the 5 and 14 day or can I do a correction on the initial MDS and resubmit as a medicare assessment? Thanks for the help.

 

Dena J Babcock RN