When we have residents who are HMO and MCR we treat them as if they are MCR
and we do the PPS schedule. In one case the primary ins denied the claim
and we ended up billing MCR and luckily since we had done the assessments
MCR paid.
Debbie Nichols RN RAC-C
----- Original Message -----
From: "Richardson, Christine" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Sent: Thursday, February 26, 2004 7:58 AM
Subject: Medicare verses HMO
Hope some one might have had this problem.
Problem: Res admitted in November under HMO.ARD set at day 5 but was not
transmitted d/t res discharged prior to initial assessment.
Now HMO denying claim, says Medicare is primary. The assessment was
completed in the correct time frame but wasn't transmitted. It is coded for
Insurance and no Medicare.
Should I leave it the way it is? Change the codes to reflect Medicare need?
Do I call some one since it will be transmitted late?
I really, really need help!
Thanks in advance
Christine Richardson LPN/CRNAC
Nursing Assessment Coordinator
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.
/----------------------------------------------------------
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
-----------------------------------------------------------/
