I am not referring to other insurance, only Tricare. In Early 2003 we received a letter from Tricare and had to sign a new contract with them. Basically we were informed us recent federal legislation required implementation of SNF PPS effective 8/1/03. One of the main changes was the SNF benefit was now identical to the Medicare SNF benefit. Requiring the 3 day hospital stay, skilled criteria, etc. MDS' must be completed and transmitted just as if the resident were MC. But Tricare (formally Champus) has unlimited days and becomes the primary payer after MC if the beneficiary does not have other health insurance. So they gave us a set of HIPPS codes for MDS' beyond 100 days. I have the letter that gives more details if you would like me to fax it to you. Sheila
Subject: PRIVATE INSURANCE I have a question. As of now on private pay patients I only do MDS on the 14th day. If they leave prior to 14th day MDS is not done.We have 5 private insurance (Tricar one of them) that is requesting RUG's just like we do it on Medicare (5 day 14 day), because it was in our contract. and that was ok... but now somebody called me form the billing office telling me that I have to submit and transmit them, meaning the 5 day also.... Is there any new rule out there that we have to transmit 5 day private pay patients....???Please advice... Thank you. Noralyn Cayetano RN MDS Coordinator Long Beach Memorial Medical Center (562)933-9084 ____________________________________________________________________ Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Sign up for your free MemorialCare Medical Information and Access Card at http://www.memorialcare.com/apps/AccessCard/AboutCard.cfm /---------------------------------------------------------- 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 -----------------------------------------------------------/
