I would have resident or responsible party sign a release of medical info and send to hospital and last nursing home to get medical records ASAP. Her thirty day window starts from the last medicare covered day, so if she was in SNF receiving Med A coverage till 4-15 and the hospital and SNF records support the need for skilled care, and she still needs that care, you should be okay. Her thirty day window would have begun 4-15. You did say she was receiving PT at home? That is where your referral came from? Your PT who saw here in her home? Don't just assume you have no grounds for coverage, check out the medical records first. Was she receiving daily skilled services at home? Perhaps some home health care? If so get their records too. Then make your decision. Family probably should have been notified that they may be responsible for payment if no skilled need verified or identified. Good luck.
----- Original Message ----- From: "Laura A. Donaldson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Friday, April 30, 2004 8:38 PM Subject: Re: Admit From Home- Am I missing something? > Resident was admitted to another SNF prior to going home, not here. Because > we don't have any hospital records, have no idea what hospital admission was > acutally for.... I don't believe admissions actually accepted her and now it's > my responsibility to deal with family when MCR isn't paying. Also, physician > at our facility is not her PCP. Imagine that! > > Laura Donaldson, RNAC RAC-C > > dfrias wrote: > > > I may be missing something here....but to be readmitted within the 30 day > > window of a previous MC stay that resident must show a need. The need > > appears to be a respite for the daughter...not a medical necessity stay for > > the resident. Furthermore....I think its a bit presumptious of a physician > > to automatically write therapy orders for a resident on a respite admit; > > this appears (not saying it is) but APPEARS to be a fraudulent case. I > > have found most physician have not a clue on MC required guidelines and > > usually a physician will want to keep a family member happy....so how can > > they work the system and keep the family happy??? By doing what this > > physican has done....the risk taker is the facility. > > > > Another question...was this person under MC in your facility after the > > original hospital stay? OR did this person go straight home...if this > > person was D/C'd home did the physician write an order prior to D/C that > > this resident would most likely require skilled care within the next 30 > > days? > > > > Debbie (The Nose) > > > > ----- Original Message ----- > > From: "Laura A. Donaldson" <[EMAIL PROTECTED]> > > To: <[EMAIL PROTECTED]> > > Sent: Friday, April 30, 2004 4:03 PM > > Subject: Admit From Home > > > > > Help..... > > > > > > Admission Director accepted resident for respite care (daughter having > > > minor surgery) and told family she would qualify for Medicare A based > > > upon being within "30 day window". When she arrived late yesterday, > > > she had no paperwork from hospital, only list of meds, diet, routine, > > > etc. from daughter. Called MD and he faxed medications with order for > > > speech and PT. > > > > > > Today, I asked admission director for some sort of "official paperwork" > > > from hospital or MD with regard to discharge date from hospital. Our PT > > > had referred her (she was a home pt of his) and he had informed the > > > admissions director she was in the "30 day" window. She took the > > > resident based on his info! > > > > > > Hospital wouldn't provide info (HIPAA) and SNF has not provided us info > > > either. PT finally came up with a copy of admission face sheet his home > > > agency that indicated resident was discharged from hospital on 3/30, > > > admitted to another SNF on 3/30 , went home on 3/15 and was admitted to > > > us on 4/29. > > > > > > If I calculate right, the first day of the "30 day window" from > > > hospital stay is 3/30; therefore, she was admitted to us on day 31. (29 > > > days in April, 2 days in March). ST and PT were both evaluated and > > > treated today. > > > > > > Informed family that according to our calculations and info provided, I > > > would need to issue a denial letter based on not having 3 day qualifying > > > stay while we attempt to get the days accurately. > > > > > > Was this correct? > > > > > > /---------------------------------------------------------- > > > 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 > > -----------------------------------------------------------/ > > /---------------------------------------------------------- > 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 -----------------------------------------------------------/
