medicare coordinator

lsyorke, RN · Nov 2, 2003

I'm assuming this is in a sub-acute facility. Medicare coordinator would be responsible for MDS(federal paperwork), care planning with the required bi-weekly multidisciplinary meetings, billing etc. I did this in a short term facility and loved it(in addition to being in charge of the 16 bed unit). I tried it in long term care and hated it. I missed the patient interaction and the tediousness of the paperwork was amazing. PM me if you have any specific questions.

bargainhound, RN · Nov 2, 2003

very tedious job with tremendous federal regulations to follow and inspectors at your heels all they way....fines/imprisonment threats, etc.

robynrn2b · Nov 3, 2003

Actually we do have an MDS coordinator also so that helps the workload. Usually about 10-20 MCare residents.

lsyorke, RN · Nov 3, 2003

If you have an MDS coordinator, just what is this other position?usually its the MDS coordinator that does the care planning etc...

Its what information you put on the MDS that justifies the length of stay and the progress at care plan meetings. I'm a little confused!

Talino · Nov 3, 2003

Some facilities do have separate positions, an MDS Coordinator who does primarily OBRA required assessments (Initial Adm., Annual, Quarterlies, SCSA), RAPs, and Care Planning; and a Medicare Coordinator whose primarily responsibility is to capture eligible residents for Medicare coverage, then conducting MDS/PPS assessments to determine amount of reimbursement. Both coordinators utilize the MDS Assessment tool.

As a Medicare coordinator, you need to know the different criteria how a resident becomes clinically eligible for Medicare coverage and how many benefit days they are entitled to. Then you will set up a schedule to perform MDS/PPS assessments as needed (5, 14, 30, 60, 90, OMRA). You must learn how to maximize Medicare reimbursement by legitimately manipulating the assessment dates and ensuring accurate MDS data entry to capture the highest possible RUGs score (= $$$$). A simple error can cause a huge loss of revenues. You will follow the Medicare resident regularly to determine eligibility until his benefits are exhausted. You will also need to notify the billing dept. when Medicare coverage is to be terminated when a resident loses that eligibility.

Since your primary responsibility is on the financial objective of the facility, you do not need to do RAPs and care planning like the MDS Coordinator does. However, since both you and the MDS Coordinator use the MDS, it is imperative that you work together to eliminate duplication of assessments and capturing changes in resident's overall condition which may necessitate a care plan revision.

But, I agree, there is no need to separate the title. An MDS coordinator should be able to do both, and a facility can have as many as needed.

robynrn2b · Nov 6, 2003

Wow!! Thanks for the info. I had my "interview" today and they will be deciding tommorow. I'm a little scared, however of being out of my comfortable "charge nurse" position. Something new is always scarey for me!!! But I guess I will never know if I will like it if I don't try it. I just hope I can learn it all. It seems SOOO complicated.

Nursie30 · Nov 6, 2003

just suggesting that you get some RAI training, and definately read the manual and refer to it constantly. A medicare book would be helpful too, there is always a question that comes up that you stumps you, know matter how long you have done MDS's, I enjoyed it while I did it, but it is a VERY stressful job.....

catlady, BSN, RN · Nov 8, 2003

My title is Clinical Reimbursement Coordinator, which ends up being very similar to the description that Talino provided. But massaging MDS/PPS is only part of what I do. I also make sure the Medicare certifications are current, keep up on Medicare consolidated billing issues, review Medicare bills to see if we were charged inappropriately, review appointments to avoid potential billing problems, educate staff on exclusions to consolidated billing issues so that the right people are paying the bills (hopefully not us!), manage the pharmacy program to reduce drug costs in our Med A census, am the point person for the Med B therapy caps, ensure timeliness and accuracy of all Medicare denial letters, provide education on nursing and CNA documentation, coordinate the weekly Medicare meeting, and a few thousand other things. I totally disagree that the titles should *not* be separated. Although I work closely with the MDS coordinator, our jobs are quite different. I don't even work within the nursing department, although I am an RN; I report directly to the administrator. And an MDS coordinator who tries to do both jobs is going to find that she/he can decide which one to do well, because they can't both be done well by the same person. You can either focus on care planning and meetings, or you can focus on reimbursement; at least in our building, there isn't time to do both. I trained our MDS coordinator; I know how to do her job, but she doesn't know how to do mine. When I first was offered the job, I couldn't imagine how it would take 40 hours a week. It does.

Nursie30 · Nov 8, 2003

Totally agree with you catlady......I was the only one doing both, when Medicare census is up, its impossible to do the job effectively, with regards to getting the most reimbursment. I too had many jobs, not only MDS/PPS, Careplaning, Medicare meetings, inservices, infection control, behavior management, Certs/Recerts, and many many more, but one person is expected to do it all, they don't understand how much more money they could put in their pockets if they would spend the extra money to hire 2 people to handle the Whole process......needless to say, I'm an LPN, and was doing an RN's job for LPN pay, overworked, underpaid, overstressed, walked out, end of story........sad, I loved doing my job too, I was very good at it, but....its a hard knock life for us nurses..........

catlady, BSN, RN · Nov 9, 2003

Bump.

This thread seems to have disappeared.

jaxnRN · Jul 14, 2004

Bump.
This thread seems to have disappeared.

Bump if anyone has any additional info!!!