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I am not a billing person(I am a MDS coordinator) but I have a
question. A resident was discharged from Medicare due to not progressing in
therapy. At time of discharge there were no other skilling factors to proceed
with medicare coverage. during the following 7 days of observation for this
resident's sighnificant change off medicare ( we always do a SC when
resident is discharged from medicare), he picked up enough
doctor orders ( he also has DX of DM with 7 days injections, not a new
dx) to place him into a clinically complex category.. Question: The
family has requested a demand billing feeling that he should have continued
with medicare coverage after d/c of therapy because they feel he
declined because we stopped therapy. Does anyone agree that he should
have been readmitted to medicare or will Medicare agree with our
decision?
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