Managed Medicare and HIPPS code

Experts,

          I have a resident with Aetna Managed Medicare, what assessments do I need to open. Biller needs a HIPPS code as she said AETNA adopted the PDPM rule.

Thank again for all the help from these confusion

Although the HIPPS code is required, most Medicare Advantage plans pay by levels or a pre-contracted rate. If this is the case,

Copy the Adm MDS and code it as a 5-Day. Set the ARD the same as the Adm but no later than day 8. Complete all items not included in the Adm item set. Dash-fill Section GG or select not assessed, whichever your software requires.

If there is no recent MDS to copy or a resident goes out to the hospital and returns under the MA plan, create a standalone 5-Day or even IPA. Both assm’ts will yield the HIPPS. Again dash-fill Section GG.

If the MA plan does pay according to the HIPPS code (I don’t know of one that really pays the full HIPPS rate) then you will have to complete Section GG.

As usual, do not submit these MDSs.