As this is not a Medicare recepient,satisfying PPS requirements are not necessary. It
doesn't matter if they are in a Medicare bed, you are only required to satisfy OBRA
requirements so you are correct in assuming you need to complete an admission (14) day
assessment and quarterlies. There is no ceiling on the number of days they can stay,
that is up to how long the private insurance wants to pay, you can be assured they
will be requesting weekly updates. There are many cases where private insurance is
paying the per diem (auto accidents, workmen's comp, etc.). This payer source needs to
be identified on A7. Hopefully the negotiated rate is high enough that it covers all
costs for this resident. My only question is if they are not receiving skilled care
what is the purpose for the stay? By no skilled criteria, do you mean by nursing and
therapies? And if it truly is neither it doesn't make any sense for the resident to be
there unless this is a situation where they were receiving therapy and for some reason
(ie: reached max potential till the next physician appt.)it was discontinued and they
are waiting it out?
>>> [EMAIL PROTECTED] 03/10/04 08:00AM >>>
Am sending this message again hoping for some help. I did not get any
responses the first time.
I eval'd a patient for our unit that has private insurance. She did not meet
the criteria (Medicare guidelines) for skilled care but the insurance
company wanted her moved and they would pay a negotiated rate. I've never
had this particular problem, usually the patients meet skilled criteria, so
I am not sure what is correct. I know that a MDS must be filled out on all
residents day 14 regardless of payor source, but meeting the skilled
criteria bothers me. We are a Medicare certified unit only. Rena, do you
have any thoughts on this.
Libby Cawthorn, RN
Director/MDS Coordinator SNF
TJ Samson Community Hospital
1301 N. Race Street
Glasgow, Ky. 42141-3483
Fax# 270-651-4786
Phone# 270-651-4783
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