The RAI User's Manual, page 2-40 under "Late or Missed Assessment Criteria" states," If a late/missed assessment has an ARD within the allowable grace period, no financial penalty is assessed. If the assessment has an ARD after the mandated grace period, payment will be made at the default rate..."
Default payments are not discussed in any other context.
There was a Q&A from CMS in 5-02 that addressed this question:�
"5-105. How should an SNF bill if the assessment was completed timely, but was not submitted timely? Using the RUG-III rate determined from the assessment? At the default rate?
"At the present time, we are not applying claims processing penalties on providers who are completing the MDS in a timely manner, but who transmit the data late. The claims should be billed at the RUG-III rate for the assessment that was completed timely."
There haven't been any changes in the regs that have superseded this Q&A, but for some reason this statement has not yet made it into the manual as a clarification.�
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: Attn: Rean: Re: Way outdated MDS
Date: 2/27/04 2:54:39 AM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Rena, could you give us chapter and verse? I have also been requested to do this.
----- Original Message -----
From: Holly Sox, RN, RAC-C
To: [EMAIL PROTECTED]
Sent: Wednesday, February 25, 2004 5:59 PM
Subject: Re: Way outdated MDS
Michelle,
I tried to reply to this, but your email bounced back to me. The answer is, you cannot go back in time and do the PPS assessments. If your OBRA admission ARD is within days 1-8, you can go back and do a 5 day, using the same information, and submit it. But for the others, you will have to bill default rate to Medicare.
Rena can quote chapter and verse on the regulations regarding this. I don't have it with me at home or in my brain. ;-)
And I will certainly still be available and active on the list as well as for any questions anyone wants to send to me privately. I am going to another facility to do MDS and have less responsibility. Woo HOO!!!!
HS
Holly F. Sox, RN, RAC-C
Clinical Editor, Careplans.com
www.careplans.com
[EMAIL PROTECTED]
----- Original Message -----
From: Michelle Edwards
To: [EMAIL PROTECTED]
Sent: Wednesday, February 25, 2004 3:22 PM
Subject: Way outdated MDS
Holly,
The business office is requesting that I do a 5,14,& 30 day on a resident that was d/c'd in Sept 03. They say they need to bill Medicare and that the only way that Medicare will accept the billing is if these reports are done. She originally came in with an insurance for a car accident but they refused to pay.
I am not comfortable doing this because I was not employed here at that time and I have no clue what the woman was like. I also can find no eason to skill the lady because there are PT orders but no PT notes to be found. She has a few notes for Restorative Therapy but they are scattered. I can also find no dx for the therapies.
HELP.
TIA,
Michelle Edwards
PS
Are you still going to be availabe for questions re MDS once you change jobs?
