how do I change an MDS assessments for Insurance?

  1. 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. Visit crazyforthis profile page

    About crazyforthis

    Joined: Apr '11; Posts: 52; Likes: 4
    RN Care Manager (CM); from US
    Specialty: Med/surg, CM, DM, triage, UM, MDS


  3. by   Talino
    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
  4. by   crazyforthis
    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. by   Talino
    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. by   crazyforthis
    Thank you!
  7. by   susanthomas1954
    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.
  8. by   crazyforthis
    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. by   silverbat
    yep, do the admission assessment by day 8.
  10. by   ibtootie
    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. by   susanthomas1954
    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.

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