We also do PPS assessments on all skilled third party payment source residents and submit them. You never know when a situation like yours will come up, the policy limits will be exceeded, and if once they actually read the documentation they will pay. We call all insurance companies for verification on admission but still have had them make a different determination on actual review. Safer and less costly to do the PPS assess.
-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Orth, Ron A Sent: Friday, March 26, 2004 8:39 AM To: '[EMAIL PROTECTED]' Subject: RE: Missed PPS assessments This is the same practice we use. There is no harm in submitting a PPS assessment for someone who is not Medicare. In fact, we code many assessments as a PPS assessment because other payors want a medicare RUG score for payment. With our current MDS system we can only get a grouper calculated RUG score if we code the assessment as a PPS. Fortunately, with our new software we can get a Medicare RUG score on all assessments completed regardless of how we code it. Ron -----Original Message----- From: carol maher [mailto:[EMAIL PROTECTED] Sent: Thursday, March 25, 2004 8:30 PM To: [EMAIL PROTECTED] Subject: Re: Missed PPS assessments I always transmit the PPS assessments that I do when I am not sure that they will need them. If there is any chance that Medicare might become the primary payor, I do PPS assessments and transmit as if they were Medicare. That way they are there if needed. ----- Original Message ----- From: <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Thursday, March 25, 2004 3:30 PM Subject: Missed PPS assessments > I thought it couldn't happen to us,but it did.RON, when you do assessments,I would assume you hold onto them and don't submit them unless they are needed.The other MDS coordinator will never use day 10 again on a non med a patient. > > /---------------------------------------------------------- > 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 -----------------------------------------------------------/ /---------------------------------------------------------- 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 -----------------------------------------------------------/
