I think you are right about if it was done within the timeframe. If the ARD was within the window I think you would be ok for that assessment. I am also under the impression that there is no financial penalty for transmitting late. Debbie Nichols RN RAC-C ----- Original Message ----- From: "Richardson, Christine" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, February 26, 2004 12:40 PM Subject: RE: FW: Medicare verses HMO
This HMO was in place of Medicare. We had precertified her before she came in but the HMO still is denying. Since the assessment was done in the time frame I wont get a default rate will I? I thought you only got a default rate if the assessment was completed late, not with in the time frames of Medicare, not if it was transmitted late. This is info from BKD and Benedictine Health. See page 2-40 in RAI Second paragraph states "If a late/missed assessment has a ARD with in the allowable grace period, no financial penalty is assess. I do think its good advise to send a assessment on every one, requradless if HMO or not. Thank you sooo much for your input on this! Christine -----Original Message----- From: Anne Burrows [mailto:[EMAIL PROTECTED] Sent: Thursday, February 26, 2004 12:24 PM To: [EMAIL PROTECTED] Subject: RE: FW: Medicare verses HMO If I understand you correctly, you expected that an HMO would be the payor, but they say Medicare is primary. I don't know whether this person had two insurers (HMO and Medicare) or one (member of a Medicare HMO). If the person has insurance through a job, and also has Medicare, either one could be primary depending on the circumstances. The Medicare manual gives specifics. When there is doubt about which one is primary, the safest thing to do is to do the PPS assessments just in case. They should be transmitted before the deadline for transmission, or else you can bill only at the default rate if it turns out that Medicare is primary. You are in a similar situation when you believe that a person is a member of a Medicare HMO and you plan to bill the HMO. But you find out later on that he or she disenrolled from the HMO and went back to traditional Medicare. It is a good idea to do and transmit PPS assessments for members of Medicare HMOs to avoid getting caught without having done them when you find out about a disenrollment. Again, if the deadline for doing and/or transmitting has passed, you can bill only at the default rate. In your situation, you are well past the deadline for transmitting. The resident was with you in November, and the deadline for transmitting is 31 days after the completion date. Transmitting it now wouldn't help. You are still limited to billing at the default rate, whether you would transmit it or not. You also asked about changing the coding from insurance to Medicare. That would be appropriate if you were still within the window for transmitting. If there is an error and we haven't transmitted yet, we should correct the error first. >From: "Richardson, Christine" <[EMAIL PROTECTED]> >Reply-To: [EMAIL PROTECTED] >To: <[EMAIL PROTECTED]> >Subject: FW: Medicare verses HMO >Date: Thu, 26 Feb 2004 11:00:20 -0600 > > > Second try. > > -----Original Message----- > > From: Richardson, Christine > > Sent: Thursday, February 26, 2004 7:59 AM > > To: '[EMAIL PROTECTED]' > > 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 >-----------------------------------------------------------/ _________________________________________________________________ Dream of owning a home? Find out how in the First-time Home Buying Guide. http://special.msn.com/home/firsthome.armx /---------------------------------------------------------- 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 -----------------------------------------------------------/ 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 -----------------------------------------------------------/
