Mds Pps Qa 003

  1. Scenario:
    On day 93 of Medicare Part A stay, the resident was discontinued from OT due to lack of progress which will bring her RUG score at a lower rate. The 90-day assm't was already transmitted. She is eligible for continued coverage for a skilled need due to presence of a Stage III pressure ulcer and daily oxygen use.

    If I do an OMRA, the ARD would fall on day 101. What would you do?

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    About Talino

    Joined: Aug '01; Posts: 930; Likes: 347


  3. by   Catsrule16
    Continue the Medicare coverage. If it is your facility policy to complete an OMRA when Medicare coverage is complete then do so. Yhe 90 day assessment set the rate for the last 10 days of coverage.
  4. by   tex
    I have to admit I have not run into this situation, I do like your MDS ?'s, makes me look at things out of the "box". I guess I was thinking what happens after the medicare days run out at 100, then is it per diem? You still have to do a MDS for all Correct? Talino would like your answer, thank you Tex Ready for MDS 004
  5. by   Talino
    Catsrule is right... you don't have to do anything further.

    Altho I still am not sure how the FIs interpret this when technically the Rehab RUGs only applies up to the 93rd day, and a lower RUGs rate thereafter.

    According to our biller, when a bill is submitted a code is entered to reflect the case ( Rehab. d/c) and we have been paid the Rehab rate w/o a hitch.
    Last edit by Talino on Apr 18, '02
  6. by   Fran-RN
    Your facility would be paid the therapy Rug through day 100, the OMRA is what gets you out of that RUG, and you won't have to do that until day 101. 8-10 days following last day of therapy. Billing has to submit therapy hrs delivered to the FI and then they check to make sure that supports the RUG category that is reported on the MDS. The resident continues on Medicare skilled care through day 100 since they have other skilled need. Other wise you would d/c them from Medicare after therapy ends. In my state, Indiana< we have to do an OSRA after therapy is ended, also. After the 100th day of stay sound like this resident still has a need for skilled service, ie the Stage 3 ulcer and daily dressing changes. They would then revert to another pay source, medicaid,private pay etc. But for future Medicare coverage they are have not started their 60 days of wellness to start a new benefit period even if they return to the hospital. You need a system to track when the first day of wellness is in these instances. don't want to get denied payment for services delivered because they weren't eligiblew for a new benfit period.