We follow the PPS schedule for our HMO patients. We code them just in A8 like you would a Medicare PPS assessment but we code "Other per diem" in section A7 instead of Medicare per diem. We transmit them just like any other assessment and CMS ignores them if they are not the payer. That way, if we later find out that they withdrew from their HMO or the HMO did not pay for some reason, we are covered and can get paid by Medicare. Our main HMO in this area (Group Health) wants us to follow the PPS schedule and they want to know the RUG category for all of their folks so we just treat them the same.
Deanna -----Original Message----- From: Richardson, Christine [mailto:[EMAIL PROTECTED] Sent: Friday, March 05, 2004 12:37 PM To: [EMAIL PROTECTED] Subject: How to code ? Okay I have learned to always do med a assessments on res even if they are HMOs.and to transmit them Question: How do you code these MDSs? Res is HMO set ard at 5th day Do I code as a Med a 5 day or just leave it as an admission? When I do A 14 day do I code it for med A or how do I code it since she is a HMO? 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 -----------------------------------------------------------/
