This is from the Medicare Claims Processing Manual, Chapter 6, Section 40.3.5 at http://www.cms.hhs.gov/manuals/104_claims/clm104c06.pdf
"The exception to the general rule of not charging a utilization day for the day of discharge, death, or day beginning a leave of absence is where the patient is admitted with the expectation that he will remain overnight but is discharged, dies, or is transferred to a nonparticipating provider or a nonparticipating distinct part of the same provider before midnight of the same day. In these instances, such a day counts as a utilization day."
So, if the resident is discharged to a Medicare-participating hospital on the same day he was admitted to the SNF, the SNF cannot bill for the day.
Rena
Rena R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse Assessment Coordinators
[EMAIL PROTECTED]
Subj: RE: ADMINISTRATION DELETION OF ASSESSMENTS!!
Date: 3/26/2004 4:16:11 PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to: [EMAIL PROTECTED]
To: [EMAIL PROTECTED]
Sent from the Internet
Helen,
The facility CAN bill for day of admission even if the resident is discharged the same day. It is the only exception to the "don't bill for day of discharge" rule. So, completing an assessment will allow the facility to get paid for all the work that they did that day. As we all know , admissions take a lot of staff time resources so the facility should extract some payment for the time. By using hospital information, it is usually possible to get a good RUG payment for the day.
-----Original Message-----
From: Helen Kim <[EMAIL PROTECTED]>
Sent: Mar 26, 2004 4:05 PM
To: [EMAIL PROTECTED]
Subject: RE: ADMINISTRATION DELETION OF ASSESSMENTS!!
I don't think 5 days mds is necessary because it is for pps which is for
payment. resident admitted and discharged to hospitap at the same day and
your facility can't send bill anyways. why 5days mds is needed? And it is
not for resident's quality of care neither because resident is not there
anymore. But discharge tracking is needed to be completed.
Helen kim MDS coordinator.
>From: [EMAIL PROTECTED]
>Reply-To: [EMAIL PROTECTED]
>To: [EMAIL PROTECTED]
>Subject: ADMINISTRATION DELETION OF ASSESSMENTS!!
>Date: Fri, 26 Mar 2004 16:07:44 -0500
>
>In a message dated 3/26/2004 8:14:15 AM Eastern Standard Time, "mdsc"
><[EMAIL PROTECTED]> writes:
>
>>You did everything the same way I would have done
>>?---- Original Message -----
>> From: Eileen Hall
>> To: [EMAIL PROTECTED]
>> Sent: Friday, March 26, 2004 12:39 AM
>> Subject: PPS Question
>>
>>
>> A resident of our facility was hospitalized with R/O MI. She returned
>to the facility after a 3 day qualifying stay as Medicare. Nursing
>assessment was completed at 5pm and orders were verified and sent to the
>pharmacy. To make a long story short she fell 3 hours later and hit her
>head. She was readmitted to the hospital with traumatic head injury. I
>proceeded as follows: re-entry assessment, 5 day PPS (as she met the
>presumption of care falling into the upper 26 RUG's) a discharge return
>anticipated, all reflecting the same date of event (ARD). My Administrator
>did not want these assessments done stating it would "mess up" the Medicaid
>bedhold. I contacted the corporate office and was told that these
>assessments needed to be done. I proceeded as instructed by the corporate
>office. Today these assessments were deleted from the database (by
>Administration)
>
>
>Am I the only one who sees something unethical about Administraion
>"deleting" these assessments?
>This is WORK that someone took the time to do!!
>I'd be out the door.
>
>
>
>
>and it now looks like she still has not returned from the original
>hospitalization. Was I right in doing these assessments? Regardless of pay
>status, aren't the re-entry and discharge federal requirements at least?
