MDS/PPS Q & A 004

[Talino]

Scenario: Estimating Therapy Minutes

On day 94 of Medicare Rehab, the resident was admitted to the hosp. On return after a 3-day hospital stay you completed a PPS readmission/return assessment. When completing section T, do you estimate therapy days and minutes for the full 15 days or only the six remaining days?

[catlady, BSN, RN]

When I was doing MDS assessments for PPS, I did the assessments without regard for the number of days of eligibility remaining, up to last covered day.

I would hope, though, that the therapist might consider submitting actual minutes instead of an estimate, given that they're only going to be able to bill for six days.

[Fran-RN]

I agree with catlady. As I understand it, this would put you in the proper RUG category, which determines the rate you will be paid for the remaing days the resident is eleigble. In case mix states this would also put you in the correct RUG for them. If you only used the actual days then you would not be reimbursed properly.

[tex]

I also agree w/catlaady. Therapist needs to attempt to give actual minutes. Tex

[Talino]

When doing the estimation of rx minutes in Section T, the estimate should be based on 15 days (as the instruction says) to properly place the resident on the correct RUG level. You will be paid at this correct RUG level for the remaining 6 days.

[Fran-RN]

As usual. I don't think I made myself clear. you should use the estimate as the directions say, that will put you in the correct RUG for the proper reimbursement rate. If you put the actual minutes delivered you will not get the correct reimbursment rate.