You can't inactivate the 30 day and send an OMRA as the 30 day was a valid assessment AND the resident was still receiving therapy (I'm basing that on your time frame below, ie. the 30 day paid thru 11/10). You also cant' go back and complete a 60 day....you are stuck with what you have as far as assessments go.
Per Transmittal 18 when an OMRA is not completed you get paid the rehab rate through day 8 after all therapy stopped, counting the first day of no therapy as day 1.
What your biller needs to do is change the UB to show defualt days starting with day 9 after all therapy stopped.
If therapy was given on 10/31 default would be 11/9 - 11 as she was d/c'd 11/12. The HIPPS code would be AAA00 (that is zero zero). Some FI's do not require a service date for default days and some do. Our FI does and has told us if no assessment was completed to use the first day of default as the service date. Your bookkeeper will need to check with your FI for their preference.
From Transmittal 18 -
- All Rehabilitation Services Discontinued With No Other Medicare Required Assessment (OMRA)/Other Skilled Services Provided--If the provider discontinued all rehabilitation services at some point during the payment period but did not complete an OMRA as required by Medicare 8-10 days after therapy is discontinued, pay at the HIPPS code billed for eight days after the date the
rehabilitation services were discontinued, then at the default rate for the remainder of the payment period, as long as skilled need remains.
"Chriss, Theresa M." <[EMAIL PROTECTED]> wrote:
Here's our situation:
We have a resident whose 30 day assessment paid us thru 11-10. She stopped
having therapy on 10-31 and was being skilled only on her IV AB. She was
dc'd from the facility 11-12. We just discovered a few things as we were
denied payment due to the therapy being stopped for over 10days without us
doing an OMRA. Also, we missed a 60day assessment on her to pay for that
last day before she was dc'd.
Does anyone know what we should do to correct all this?? I'm thinking just
do a correction on the 30day making it an OMRA, and then ?? on that last
day. I think we can still do it, send it down to state late. It's not a
state required assessment, so getting dinged on it shouldn't matter too
much. Then it'll be there for our billers who are just now billing for Nov.
What do you all think??
THANKS ALOT!
TERRI :0)
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