Each month, around the 12th or 13th of the month, I run a report of all Medicare MDSs completed for the previous month and the beginning of the present month. ( Admissions the end of the month would have an ARD of the present month). I check each MDS in the computer for RUGS and HIPPS, see if an OMRA or Sign change is replacing a regular PPS assessment. I also make sure that if the previous assessment had a rehab RUG and the present one doesn't that I didn't miss an OMRA. I check to see if residents who were on Medicare when discharged had their first readmission PPS assessment marked as 05/Medicare return/readmission assessment and not 01 ,5- day. I look into each assessment to see if therapy was ordered and if so, were days and minutes estimated. Then , if they were, I check section P to see if the estimate makes sense (if 200 minutes were estimated and 300 were already given, I would know we missed getting an estimate from one of the therapy disciplines). If no therapy was ordered, I check to see what is coded that puts them into a top 26 RUG and compare it to what we thought would place them in the top 26 on admission---was the IV from acute coded, etc. Then I make sure that all of the assessments were transmitted and accepted into the state data base. I meet with billing and we go over the UB-92s to make sure that they have the same RUGS and HIPPS that I do. If there are any discrepancies we hold the billing until they are resolved. It is worth having the meeting. Many mistakes are prevented by having the meeting. It does take me time to prepare, but the actual meeting doesn't take long. We do it every month. I feel much more confident that everything is done to the letter of the law because of this effort. ----- Original Message ----- From: "Orth, Ron A" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Friday, February 06, 2004 11:35 AM Subject: Triple Check Proces
> Is anyone out there willing to share their pre billing triple check process > that they may use for PPS claims. If so please email to > [EMAIL PROTECTED] or you may fax to my attention at 414.908.8044. > > I am under an important mission and any assistance would be appreciated. > > Thanks > Ronald A Orth > National Director of Clinical Reimbursement > Extendicare Health Services, Inc. > (414) 908-8234 > > This communication may contain confidential Protected Health Information. > This information is intended only for the use of the individual or entity to > which it is addressed. The authorized recipient of this information is > prohibited from disclosing this information to any other party unless > required to do so by law or regulation and is required to destroy the > information after its stated need has been fulfilled. > > If you are not the intended recipient, you are hereby notified that any > disclosure, coping, distribution, or action taken in reliance on the > contents of these documents is strictly prohibited by Federal law. If you > have received this information in error, please notify the sender > immediately and arrange for the return or destruction of these documents. > > > /---------------------------------------------------------- > 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 -----------------------------------------------------------/
