Billing Exceptions Report

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    I'm new to Medicare MDS Please help...I recieved a billing exceptions report and I'm not sure what I'm supposed to do with it..On one it says that there is no RUG score found, this was an OMRA/EOT, but resident was on for skilled nursing for recent G-tube, I did the EOT/60day on day 57(4/22/11), the BER is saying no RUG for 4/26/11 the resident died on 5/2. the only day not covered is the 26th....I'm SOOOO confused..

    On the 2nd one I did early assessment did 14 day on day 9 the only days billed default where day 15 and 16, is there anything that can be done with this?????
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    I'm new to Medicare MDS Please help...I recieved a billing exceptions report and I'm not sure what I'm supposed to do with it..On one it says that there is no RUG score found, this was an OMRA/EOT, but resident was on for skilled nursing for recent G-tube, I did the EOT/60day on day 57(4/22/11), the BER is saying no RUG for 4/26/11 the resident died on 5/2. the only day not covered is the 26th....I'm SOOOO confused..
    ‘need add’l info -

    • Day 1 of Med A - 00/00/00?
    • What is the latest date entered in O0400 (A6,B6, or C6)?
      Is the ARD of EOT/60 = 1-3 days after that O0400 date?


    On the 2nd one I did early assessment did 14 day on day 9 the only days billed default where day 15 and 16, is there anything that can be done with this?????
    If the ARD (day 9) is incorrectly entered, but the assessment data was derived from a correct lookback date (day 11), you can submit a correction request – “X0100.3 Inactivate existing record”. Enter the correct ARD (day 11). Submit. But if day 9 was the actual lookback start date for the assm't, the facility will have to accept the default payment for those 2 days.
    Chin up and poohmdsnurse like this.


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