Re: Question about PPS MDS

[keri sullivan]

You only need to complete a PPS assessment for the days you will be billing Medicare. The state probably recommended doing a few assessments in case the HMO is not truly the primary payor so you'd have a RUGs class to bill Medicare. Some facilities complete PPS assessments for all HMOs "just in case". Your billing office should know who's paying. There are a few other times that Medicare may pay after and HMO/Private insurance. There are some insurances (generally pension plans) that pay a certain amount (usually $10,000) then Medicare becomes the primary payor. Also, if the resident has terminated their HMO then Medicare may start paying as the primary. I recommend you check with the billing office to clarify the resident's current payor source.   ----- Original Message ----- From: Patty Beeken To: [EMAIL PROTECTED] Sent: Tuesday, March 30, 2004 10:02 AM 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 -----------------------------------------------------------/