Advance Beneficiary
Notice (I think since this is a new �word for me! lol!!)
Actually we always
just called them Medicare cut letters here. The latest PPS alert I got
had a nice article on them. Appear to be two-1 for technical
ineligibility on admission, 1 for not medically necessary/not skilled care.
-----Original
Message-----
From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of m silberg
Sent: Saturday, January 31, 2004 1:49
PM
To:
[EMAIL PROTECTED]
Subject: Re:
demand billing
I agree with you. By the way, what are
ABN letters?
I would
not change my decision just because you will get a category. For
multiple reasons such as condition is chronic but stable, insulin qd is not a
skillable service your intermediary may agree with your decision. If you
tell someone Medicare will pay and they don�t you are financially liable and
will sustain a loss. However, this is why we do the next appropriate MDS
on everyone we cut ( off rehab do the OMRA and sometimes depending on how much
time it covers the next regular PPS and if not rehab the next regularly
scheduled PPS assessment). We submit them but use the RUGS category on
our demand bill so if by chance the FI disagrees with us we get reimbursed at
the correct rate. We do not get many of our decisions overturned but
when we do the loss by accepting default rate is unacceptable to our
administration. It is a little extra work but worth it in the end.
Demand bills are the reason I am so excited about the new ABN letters.
The old ones are not clear and I do not believe people really understand what
they are checking. The new ones are much clearer and I hope will cut
down on Demand bills. I don�t begrudge anyone their rights but they are
a pain.
-----Original
Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Ann Schoeny
Sent: Monday, February 02, 2004 8:03
AM
To: [EMAIL PROTECTED]
Subject: RE: demand
billing
You
need to do an omra and continue to assess him on a medicare schedule.He will
likely be eligible for more medicare. This has happened to us and we just
rescind the Medicare cut.
-----Original
Message-----
From: Deb
Wilmhoff [mailto:[EMAIL PROTECTED]]
Sent: Saturday, January 31, 2004 4:56
PM
To: [EMAIL PROTECTED]
Subject: demand
billing
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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