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Thank you for the info Rena. I have been reading
the claims manual at the address you sent. What do you think about deleting the
re-entry and discharge assessments to keep the Medicaid bedhold going? It seems
to me that the re-entry is required and so is the discharge and wouldn't that
have restarted the 8 day Medicaid bedhold anyway? By the way this resident has
been re-admitted again.
Thank You,
Eileen
----- Original Message -----
Sent: Sunday, March 28, 2004 9:55
PM
Subject: Re: ADMINISTRATION DELETION OF
ASSESSMENTS!!
Just to clarify: The facility can bill
for the day of discharge when it is also the day of admission IF the resident
expires or is discharged to a non-Medicare-participating provider.
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?
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