HMO patients

  1. Experts,

    I'm just want to confirm if I'm doing this correctly.

    For HMO or insurance residents, I know you only create an admission assessment as per requirement. Sometimes there are insurance companies that asks for a 14 and 30, so I just create assessment for everyone, but I only submit the MED A 14d&30d. Now my question is if they leave early (ex.5days), do I have to submit an assessment to CMS?

    Thank you.
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    About MDSRN15

    Joined: Feb '15; Posts: 49; Likes: 1


  3. by   Talino
    Correct, you follow what each insurance requires. However, you do not submit any of these assessment types to the QIES.

    For stays less than 14 days, when no Adm MDS is completed, you must perform a PPS MDS to get the HIPPS code (Z0100A) for billing purposes but not submitted.

    Another way is to combine a 5-day with the D/C MDS (the D/C MDS alone will not generate the HIPPS code). Once the MDS is complete, obtain the HIPPS, print/copy or save the MDS. Remove the 5-day and submit the MDS as a D/C only.