Mds Pps Qa 003

Continue the Medicare coverage. If it is your facility policy to complete an OMRA when Medicare coverage is complete then do so. Yhe 90 day assessment set the rate for the last 10 days of coverage.

I have to admit I have not run into this situation, I do like your MDS ?'s, makes me look at things out of the "box". I guess I was thinking what happens after the medicare days run out at 100, then is it per diem? You still have to do a MDS for all Correct? Talino would like your answer, thank you Tex Ready for MDS 004

Your facility would be paid the therapy Rug through day 100, the OMRA is what gets you out of that RUG, and you won't have to do that until day 101. 8-10 days following last day of therapy. Billing has to submit therapy hrs delivered to the FI and then they check to make sure that supports the RUG category that is reported on the MDS. The resident continues on Medicare skilled care through day 100 since they have other skilled need. Other wise you would d/c them from Medicare after therapy ends. In my state, Indiana< we have to do an OSRA after therapy is ended, also. After the 100th day of stay sound like this resident still has a need for skilled service, ie the Stage 3 ulcer and daily dressing changes. They would then revert to another pay source, medicaid,private pay etc. But for future Medicare coverage they are have not started their 60 days of wellness to start a new benefit period even if they return to the hospital. You need a system to track when the first day of wellness is in these instances. don't want to get denied payment for services delivered because they weren't eligiblew for a new benfit period.