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However, if therapies are provided on the day of
discharge, and the ARD is set to be equal to day of discharge, the way the
regulation is now worded, it muddies the allowance for to include these therapy
minutes (i.e., ancillary billing - assuming it affects the RUG category) when
therapies are provided on day of discharge.
----- Original Message -----
Sent: Monday, January 05, 2004 12:05
PM
Subject: Re: Readmit / deceased less than
24 hour
Any time that a day is billable, you can choose
to bill the default. In the case in question, since the resident died,
the day can be billed under Part A even though it is the day of discharge as
well as the day of admission.
The last paragraph of the excerpt I cited
in my previous e-mail refers to days that are not billable to Part A. It
answers a question that arises frequently: How can we get paid for
therapy services or IV fluids/meds and supplies that were administered on the
day of discharge? The answer as reflected in the cited material
is: If we can't bill the RUG rate for the day (because the resident was
out of the bed at midnight, so we can't bill for the preceding day, or because
the resident was discharged and the day of discharge is not billable), we
cannot bill for the ancillaries, either.
This isn't a great
surprise, because under PPS, everything is included in the per diem - we no
longer are paid separately for Part A ancillaries, such as rehab, etc.
But it is good to see it in the manual.
Rena
Subj: Re: Readmit / deceased less than 24 hour
Date:
1/5/04 6:59:02 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to:
[EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
--- Original Message -Payment is not made under PPS unless a
covered day can be billed. Also, if no-payment is possible under ---PPS,
billing is not allowed for ancillary services. Ancillary charges for these
days have been included in the PPS rates for days ---that can be billed.
What
does this mean? If we do not complete the assessment we cannot bill
default?
Michelle
----
From: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent: Friday,
January 02, 2004 3:23 PM
Subject: Re: Readmit / deceased less
than 24 hour
The answer to your question
about billing for the day has already been answered with the posting of
the relevant section of the new online Medicare Claims Processing
Manual. I am posting it again, though, because I wanted add one more
paragraph that contains some information that this section in the Medicare
SNF Manual did not contain. I think it's
interesting.
<<
Chapter 6 - SNF Inpatient Part A Billing
40.3.5 - Determine Utilization on Day of Discharge, Death, or Day
Beginning a Leave of Absence
(Rev. 1, 10-01-03)
SNF-517.6.B,
A3-3103.4
Generally, the day of discharge, death, or a day on which a
patient begins a leave of absence, is not counted as a utilization day.
(See the Medicare Benefit Policy Manual, Chapter 3, "Duration of Covered
Inpatient Services.") This is true even where one of these events occurs
on a patient's first day of entitlement or the first day of a provider's
participation in the Medicare program. In addition, a benefit period may
begin with a stay in a hospital or SNF, on that day.
The exception
to the general rule of not charging a utilization day for the day of
discharge, death, or day beginning a leave of absence is where the patient
is admitted with the expectation that he will remain overnight but is
discharged, dies, or is transferred to a nonparticipating provider or a
nonparticipating distinct part of the same provider before midnight of the
same day. In these instances, such a day counts as a utilization day. This
exception includes the situation where the beneficiary was admitted (with
the expectation that he would remain overnight) on either the first day of
his entitlement or the provider's first day of participation, and on the
same day he was discharged, died, or transferred to a nonparticipating
provider.
Payment is not made under PPS unless a covered day can
be billed. Also, if no-payment is possible under PPS, billing is not
allowed for ancillary services. Ancillary charges for these days have been
included in the PPS rates for days that can be billed.
>>
Rena
Rena R. Shephard, MHA, RN, FACDONA,
RAC-C
Chair, American Association of Nurse Assessment
Coordinators
[EMAIL PROTECTED]
Subj: Readmit / deceased less than 24 hour
Date:
1/2/04 12:30:50 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to:
[EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the
Internet
HI
I have a
resident that passed away in less than 24 hours upon readmission from
the hosp with MCR eligible . His readmit date 12/31/03
at 11:50 am , deceased 11:55 pm same day. Billing is telling me that I
do not have to do an MDS / cert for that day because they don't
charge for that day because the resident expired before midnite. If so,
what happens to that day of payment? I thought their was an
exception to the rule when someone is admitted and dies within 24 hours
that you could still charge for that day according to the rug. Please
help,
nancy fro
PA
Futhermore, could
you count the physicans visit from the hosp progress notes for
section p7 on the mds if done.
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