RE: 5 day verses admission

[Richardson, Christine]

We had the precert and even spoke to the person who gave it to us.They are still denying. We have the billing department working on it but I want to be prepared in case they  don't get it. Thanks for your input! Christine -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Sent: Thursday, February 26, 2004 12:48 PM To: [EMAIL PROTECTED] Subject: Re: 5 day verses admission HMO or not, we always follow the PPS schedule and transmit as such, including someone who leaves prior to the 14 days, providing we had enough information to complete the MDS.   HMO's are famous for not wanting to cover and dumping it back on Medicare as the primary.  So by doing it as a regular PPS (and calling in for certifications), you will have a better chance of being covered.  If you can complete the MDS, I would still send it late and code it as an Admission/5day.  In the meantime, I would appeal the HMO's decision to pay.  Work with your billing dept. on this.  They will need documentation.  Also, make sure that the HMO precerted or authorized the stay in your facility prior to admission.  That is a costly mistake if not done.  Good luck to you.   Sherri         In a message dated 2/25/04 10:15:21 AM Eastern Standard Time, [EMAIL PROTECTED] writes:  Any one who can help with this would be great.   Problem: Res admitted in November under a HMO. Admission assessment set at day 5 completed but not transmitted d/t res discharged prior to initial . Is coded for admission only. Now HMO is denying claim and says med A is primary.If I transmit now it will be late and its not coded for med A. Should I change the coding and transmit now?   Thanks in advance CAR NOTE: This e-mail message may contain information that is privileged, confidential, and exempt from disclosure.  It is intended for use only by the person to whom it is addressed. If you have received this message in error, please do not forward or use this information in any way. Delete it immediately and contact the sender as soon as possible by the reply option or by telephone at the telephone number listed (if available).  In the event you cannot fulfill your obligation or there has been any improper release of this information, please contact the Privacy Officer at Carondelet Health at (816) 943-4611.