Since you know that the 26th was the last covered day by insurance, I would start the
PPS cycle again with 3/27 as day 1 for PPS and do another 5 day coding this as
Medicare --AA8a=0, AA8b=1. Then proceed as if 3/27 was the first day in the facility
for Medicare purposes. This is all assuming that the resident continues to require
skilled services. The original 5 and 14 day assessments were done in case the
insurance company does not pay for those days. Since they are telling you that they
are no longer the payor, I would start the PPS cycle beginning with that day.
-----Original Message-----
From: Patty Beeken <[EMAIL PROTECTED]>
Sent: Mar 30, 2004 6:02 AM
To: [EMAIL PROTECTED]
Subject: Question about PPS MDS
Hello,
I should probably introduce myself since I have only been on this list a
very short time. I have been lurking here for a couple of week and have
already picked up a lot of very good information. I am an LPN MDS
coordinator for a Long Term Care facility in Council Bluffs, IA. I have been
doing MDS for about 6 years.
However, I have an MDS question that has never come up before for me.
We have a resident who was admitted with an HMO insurance. She has Medicare
as a secondary Payor. The family told us at on admission that her insurance
was probably not going to pay for her whole stay. I called the State and
asked them how to proceed with MDS and they advised me to do the 5 day and
14 day MDS and just mark the private insurance as payor.
I recieved a call on Friday 3/26 that her insurance was no longer goingt to
pay after that day. I am a little unsure how to proceed here with the PPS
MDS do I just do the 30 day when it is time in the sucession we have already
started? and let the billing office worry about when the billing days
begin?
Patty Beeken LPN MDS
Midlands Living Center
2452 North Broadway
Council Bluffs, IA 51503
712-323-7135
/----------------------------------------------------------
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
-----------------------------------------------------------/
