Insurance plan - What to open?

[Cecilianurse]

Experts,

I have a long term resident that went out to hospital and his Horizon plan kicked in(dx of CHF, had IV in hosp). Our billers said they need RUGS to get paid. Last assessment of Q2 on 4/18.

I am following the PPS schedule, but for the

5D - I will do a Q3 ----- THIS IS MY QUESTION. CAN I DO THIS?

14D - 14D

30D - 30D - both will not be submitted to CMS, but will give me the RUG.

THANK YOU VERY MUCH!

[Talino]

That's perfectly fine. But is there a need to do Q3 one month so soon? Otherwise - 5D, 14D, 3Q (30D).

[Medicarenurse1]

While observing on the 5 day, check for change of condition that might be long term. As a full assessment of course that would re-set your quarterly schedule.

[Medicarenurse1]

ALSO, you should not transmit any assessment that is strictly for insurance (non Med-A) reimbursement, so you may be looking at doing the 5 day, not transmitting, then doing a quarterly or Sig Change (OBRA) that needs to be transmitted. If you did a DCRA, your OBRA schedule extends by the number of days out of the facility.

[Cecilianurse]

I will only complete the 5D, 14D, 30D...not transmitting. With regard to the quarterly, there is no need for it. IV was only done in hospital and CHF dx is not new.

Thank you!!!!