Re: Can rehab minutes be counted in this case?

[Pat Hovde]

I agree with Carol's response in this case, I would also set the ARD as day 2 with projected minutes generating a Rehab RUG. While the RAI manual does not spell this out, the PPS final rule does in it's discussion of presumption of coverage. I have an excerpt from this document below as well as some instruction for how to bill this: From PPS Final Rule, Vol 64, No. 146, Page 41666   "when the initial Medicare (that is, 5-day) required assessment results in a beneficiary being correctly assigned to one of the upper 26 RUG-III groups, this effectively creates a presumption of coverage for the period from admission up to, and including the assessment reference date for that assessment, and the coverage that arises from this presumption remains in effect for as long thereafter as it continues to be supported by the actual facts of the beneficiary's condition and care needs." The following is found on page 7 of the CMS "Billing and Processing" information at this URL:    http://cms.hhs.gov/medlearn/SNFbilling.pdf     5-Day Presumption The SNF PPS Final Rule allows for "presumption of coverage" on the initial 5-day assessment done for Medicare immediately following the beneficiary�s discharge from the hospital. If the beneficiary scores into the TOP 26 RUG III Groups, that beneficiary is "presumed covered" until the assessment reference date (ARD of that 5-day assessment. If the beneficiary is no longer skilled following this presumptive period, code your initial claim as follows: . Submit a covered claim for all days up to the ARD of the 5-day assessment (day 1-8)         .If ARD is = to day 1, there is 1 covered day         .If ARD is = to day 8, there are 8 covered days . Enter occurrence code 22 (and date) = to the ARD of the 5 day assessment         .If ARD is day 1, occurrence code 22 = day 1         .If ARD is day 8, occurrence code 22 = day 8 . All days following the ARD "CUT" day would then be non-covered .Submit separately as a demand bill if beneficiary or his representative makes a request for intermediary review .Use the HIPPS code from the 5 day assessment for the balance of the billing block .If the beneficiary continues to be receiving covered care following the ARD of the 5-day assessment, Medicare billing continues as long as skilled care continues. . Bill all 14 days of the 5-day assessment as covered days as long as the beneficiary remains technically and medically eligible . Do the next scheduled assessment to determine continued Medicare clinical eligibility   Hope this is helpful,   Pat Hovde ----- Original Message ----- From: carol maher To: [EMAIL PROTECTED] Sent: Saturday, January 31, 2004 10:45 AM Subject: Re: Can rehab minutes be counted in this case? This is a very interesting question and one that I look forward to seeing replies from others. The manual is not clear on how to proceed with this one.  I would treat this as I would a resident who transfers on day 2 of the stay.  I would set the ARD on day 2 since that is his last covered day and complete the assessment as a return readmission assessment.  I would use estimated minutes to get a rehab RUG, but the highest level you could get would be a High using estimated minutes.  I don't think that it would be acceptable to use minutes AFTER the end of skilled services to get a higher RUG, but am anxious to see if others agree or disagree. ----- Original Message ----- From: Olga Lawrence To: [EMAIL PROTECTED] Sent: Saturday, January 31, 2004 12:03 AM Subject: Can rehab minutes be counted in this case? I know this question has come up in the past...  Part A resident was recently admitted to us after several "in-and-out" transfers (to the acute care hospital and back to SNF) ; the hospital recently had resident on "swing status" and resident  now has only "2" Part A days remaining at this time.     PT and OT services will be working with him at "very high" level;  can I still capture the minutes delivered on days 3, 4, 5, and 6 ,even though they are not covered by  Part A , in order to RUG him at "RVB" for his remaining "2" days?  Thanks to all! Do you Yahoo!? Yahoo! SiteBuilder - Free web site building tool. Try it!