We had a resident discharge AMA after a 6 day stay. An ARD was chosen (day 8) but he left before it was reached. The nurses had done good documentation, good assessments, etc. The MDS nurse at the time missed doing the 5 day. She did a discharge before initial assessment. It is now about 4 weeks later. The powers that be said we can't do an assessment at this point b/c the mds nurse didn't assess. We do assessment all the time without assessing b/c of situations like these (resident leaves before ARD reached, came in on Fri and discharged on Sun, etc). Can't really find any info on CMS website with this specific problem. Anyone have any insight?
it is now about 4 weeks later. the powers that be said we can't do an assessment at this point b/c the mds nurse didn't assess.
resident expires or is discharged
if the beneficiary dies or is discharged before the eighth day of covered snf care following the initial admission from the qualifying three-day hospital stay a snf must prepare an rai as completely as possible to assign a hipps rate code for medicare payment purposes within the required assessment schedule. if no rai is completed under these specific circumstances, the snf may submit a claim using the hipps default rate code. a stay of less than eight days that does not meet these requirements requires the completion of an mds to receive payment; the snf cannot bill the default code.
since there was no assessment done, you cannot even bill at default. the facility will have to eat the bill.
Last edit by Talino on Apr 11, '10
: Reason: typo