Another MDS would not have helped you out. The FI is saying that they do not see any
skilled services. If there had been other skilled services coded on the MDS, the
payment RUG would have been downgraded to the RUG that they saw. Example--instead of
paying you at the RMC RUG you were expecting, they could have paid you at the
Clinically complex RUG for tube feeding without aphasia. Your hope is for a good
appeal of the therapy provided. Often, the therapy was necessary, but the
documentation didn't support it. You might need to work on tightening up your
documentation.
-----Original Message-----
From: Holly McGran <[EMAIL PROTECTED]>
Sent: Feb 3, 2004 10:39 AM
To: "AANAC List Serve (E-mail)" <[EMAIL PROTECTED]>
Subject: Medicare denial
We recently (actually a year ago) had a resident who was denied Medicare for
about 22 days - their (FI) reason was that the Physical therapy was not
medically necessary. My question is we have not received any payment for that period -
we are appealing, but what happens now - if they still deny her - can she still be
covered under another RUG score. Should we
have done another MDS at the time of the denial - but that does not make sense
to me? Does any body have any
experience with this? Thank you in advance.
Holly QI in CT
/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
