If an off-cycle assessment is performed within the assessment window of a Medicare required assessment, it must replace the Medicare required assessment. Payment will change effective with the ARD of the off-cycle assessment that "replaces" the Medicare required assessment and will continue until the next Medicare required assessment or off-cycle assessment, whichever occurs first. This policy is applied when there is a single off-cycle assessment that is performed within the Medicare required assessment window. However, when the ARD of the "replacement" (or offcycle) assessment is on one of the grace days, the payment rate changes on the day it would have changed based on the regularly schedule assessment.
Brenda Chance <[EMAIL PROTECTED]> wrote:
If you combine an omra with a routine scheduled pps assessment, then what pays for the other days left out of the billing cycle. As below, if she used 2/19 or 2/20 as the ARD that would be okay, because that would be days 30 and 31 of the billing cycle (14 day would pay through day 30 and then the 30 day/Omra would pick up on day 31). But if she used the ard of 2/22, what would pay for 2/20 (the 31st day)? I am a little confused about this? Is it this horrible respiratory gunk I have?
Thanks for the help!
Brenda W. Chance, RN, RAC-C
MDS Coordinator
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message.-----Original Message-----
From: Callie Larson [mailto:[EMAIL PROTECTED]
Sent: Monday, February 02, 2004 2:58 PM
To: [EMAIL PROTECTED]
Subject: Re: omra / 30 day help needed
Yes! It is an excellent reason to use the grace days so you can combine the 30 with the OMRA. You can use any of the three days in the OMRA window as the ARD for the combined assessment.
It may not make a difference which date you pick but check for things like MD visits and order changes and other things in Section P 1 (Special Care) that you want to use to support your skilled care RUG level. If you want to include an MD or NP visit on one of the later dates, set your ARD to allow it. On the other hand, you may want to catch a visit or a special care item that occurred at the beginning of the lookback window range so you would choose an earlier date.
Re billing: If you pick 2/19 for the ARD you will start billing using the new OMRA/30 day on 2/19. If you pick 2/20 or 2/21 for the ARD, then you will use the new RUG level beginning on 2/20 (day 31 of the stay). Thus you get the Rehab RUG level for an extra day by using a later ARD. However, if you get a higher RUG group by picking the earlier date, and you expect the resident to remain skilled for long enough to make up the difference in cost from losing that one day at the Rehab RUG level, choose the earlier date.
[EMAIL PROTECTED] wrote:Hello to the group
I need some expertise advance here because I am afraid of messing it up. Here it goes:
Part A
Admit date: 1/21
five day: 1/25
14 day: 2/1 + obra
Pt / OT to be d/c on 2/11
grace days: 2/19 ( day 8 after tx), 2/20, ( 9th day after therapy) 2/21 ( day 10 )
Could I use grace days for the omra on the thirty day assessment so to combine the assessments. Or do I have to do them separate.
If I could combine the assessments using grace days what would be correct date.
the 30 day window being : 2/10-2/18
If I could use the grace days I am guessing 2/20 ) using 2 grace days )only because of the payment cycle. Since the 30 day starts payment on the 31st for the 60 day? wright or wrong. Gosh, I hope this is clear.
thanks to all
nancy
Caroline Larson, RN, MS, RAC-C
MDS/PRI Coordinator
Fairport Baptist Homes, Fairport, NY 14450
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