how do I change an MDS assessments for Insurance?

  1. 0
    I was just notified today that a prior patient had Medicare part A while here from 2/21 to 3/3. How do I change the assessment or do I Modify it to reflect her Medicare? We had no insurance info on her at all when she was here. This was sent long ago and accepted by CMS so I am not sure how to handle this one!

    Thank you!
  2. 9 Comments so far...

  3. 1
    You cannot modify nor should you inactivate and combine a 5-day to the OBRA Admission.

    Granting you performed an OBRA Admission MDS you may be able to bill for the entire stay. See MISSED ASSESSMENTS pp 6-53 to 6-54
    andy3k likes this.
  4. 0
    Thanks Talino,
    Just to clarify... yes I did the OBRA, and there is nothing more I can or should do, correct? Our billing department seems to think I can somehow fix this and I just want to make sure That i am doing my part correctly. I did read pages 653-54. What i understand is that for billing purposes the OBRA assessment I did is what they need to use to get what payment they can. Is that right?
  5. 0
    Just make sure the ARD of that Adm MDS is within day 1-8 in order to bill the actual RUG category which will be paid to you from adm up to the day before d/c.

    If the ARD is day 9 or after, you can only bill at default (=PA1).
  6. 0
    Thank you!
  7. 0
    Just FYI, always do your admission MDS by day 8, because when this happens, you usually have a rehab rug. Even the long term care admits, because you never know who might have missed a payor source on admission.
    ST
  8. 0
    Susan,
    Are you saying that regardless of pay source or no paysource go ahead and do the OBRA assessments by day 8 also. Just in case....
  9. 1
    yep, do the admission assessment by day 8.
    crazyforthis likes this.
  10. 0
    Can you set the ARD date for OBRA NC assessments before day 14? For some reason I thought the ARD date was set at day 14 unless the resident discharged prior to day 14.
  11. 0
    Yes, you can set it any time in the first 14 days. Most people like to use day 8 just in case there is a skilled payor source. OBRA MDS coordinators like to use day 14 because it gives you a better picture for a comprehensive plan of care. Sometimes seems like the PPS coordinators and the OBRA coordinators are living in different worlds. Actually in OBRA Medicaid world it is better to use day 8 anyway, because you can usually capture a higher ADL score, as people need more help in the first few days getting settled in, and when you consider you are setting a pay rate for three months possibly, you want to capture the highest documented ADL level you can get. Happy Nurse Assessment Coordinator's Day.
    ST


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