Managed care

This is called Medicare Advantage Plans (MAP) which a patient had previously enrolled in to avail of Medicare benefits rather than the traditional Medicare fee-for-service, as you call it, Medicare A.

It is important to know how the MAP contractor pays for skilled services rendered by the SNF. Some have a predetermined rate that your billing dept. must be aware of prior to admitting the patient. Others may require the completion of MDS to determine payment based on RUG scores (these MDSs are not required to be transmitted but kept on file for the contractor's reference).

The MAP can deny coverage at a certain point even if the SNF believes skilled service is still necessary, making the patient financially responsible thereafter. Hence, regular communication with the contractor (usually by a biller) is necessary. Often, these MAP limitations drive beneficiaries to disenroll from the plan and switch to traditional Medicare. When this happens, the MDS Coordinator must be alerted immediately so a required MDS/PPS assm't can be conducted timely when traditional Medicare takes over.

Cost primarily plus add'l benefits - Medicare Advantage vs Original Medicare sample only.

Yes, I feel your pain. You are doing CASE MANAGEMENT!!!!!! Why facilities think that MDS co-ordinators can do managed care case management is a huge mystery to me. Many of these plans do not follow medicare guidelines, and you end up becoming the bad guy who has to go in and tell someone who can barely crawl to the bathroom on all fours that they now qualify for a "lower level of care" because they have junk for insurance.
I realize I am venting, but the point here is that these plans are not paying as well as Medicare, and they are costing the facility big buckets of money when they pay by level instead of RUG, and they have to turn over in 14 to 21 days usually despite the fact that they may have a dense stroke that will require 6 months of daily rehab to be able to possibly feed themselves!
Give me straight Medicare, and I will make your facility a profitable place, but when you bring in the expensive managed care patients, and you pay me to stand around a fax machine all day, your facility will be losing money.I HATE MANAGED CARE!!!!!!!!!!!!!!!!!!

If you've never had any training in case management, it is an abomination that they expected you to do this under the guise of MDS. I'm laying odds it was a Kindred facility?

Just a few comments--on what kind of leg are you looking to stand? You got fired because they wanted someone else. Most places can fire you for just about any reason. I have a union in my building but until the probationary period passes, I can fire someone because I don't like their socks! (not that I would, but you get the point.)
I agree....sounds like a Kindred facility. I was the PPS MDS coordinator for a very busy Kindred facility. We averaged between 25 and 28 Med A patients. I was extremely well organized and had no problem managing the load. Then they decided that I should take over as managed care coordinator as well. We had 5 different contracts with at least 10 different forms and ways to communicate updates. I finally told them it was folly to expect one person to do both so the ADON got the managed care stuff. When I was promoted to ADON, I got the job back. You have to be really organized to do the job and make sure you know what day the update is due and what each insurance company expects. Honestly it was one of the most difficult jobs I had.