RE: Billing Question Need answer ASAP Please!

[Carrie O'Connell]

Title: Message

Here is how I see it

5-day bills 3/23/04 - 4/5/04

14- day bills 4/6/04 - 4/21/04

OMRA bills 4/22 - 5/21/04    (If they continue to require skilled care)

** Make sure to use 28 as your HIPPS

 

http://www.cms.hhs.gov/manuals/104_claims/clm104c06.pdf

 

Since 4/23 is day 32, the OMRA starts billing on day 31.  Your exact example is in the internet SNF billing section

"The ARD of an OMRA is set for day 32 of the covered Part A stay. The OMRA is the only assessment performed within the assessment window for the 30-day Medicare-required assessment, therefore, the OMRA replaces the Medicare-required 30-day assessment. The HIPPS rate code derived from the OMRA is billed beginning on day 31, since the ARD for the OMRA replacing the 30-day Medicare-required assessment was set on a grace "

Above Quote from section 30.2 – Special Billing Requirements Where a Single OMRA, SCSA, or SCPA ARD is Set Within the Window of a Medicare-Required Assessment

http://www.cms.hhs.gov/manuals/104_claims/clm104c06.pdf

Good Luck

----Original Message-----
From: Annette M. Corn [mailto:[EMAIL PROTECTED]
Sent: Wednesday, May 05, 2004 10:29 AM
To: Aanac Group
Subject: Billing Question Need answer ASAP Please!

Here is the scenario: Resident admitted 03/23 to 04/28 Medicare Days

                                 5 day done ARD 03/27 RUG RMA

                                14 day done ARD 04/02 RUG RMB

                                 Resident received last day of therapy on 04/13

                                 OMRA ARD set on day10 04/23

The question is from billing. There is one day not covered and will not be paid for. Should I have combined an OMRA and the 30 day! RMA/5 days(5 day), RMB/16days(14 day), OMRA picks up on the 23rd so we are missing payment for 04/22. Help! Today is close out for billing! What should we do? Thanks for your help! Annette