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Discussion

Need help on a 9 month old issue!

I need some help on this one since it is just found 9 months after the resident admitted and discharged. Mr. X admitted to our facility 3/20/12 for IV antibiotics for a post-op wound infection. On 3/26/12 he was sent back to the hospital for increasing drainage and had an I&D of the wound and returned to us 3/28/12 and stayed in our facility for wound care and IV antibiotics until 4/29/12. At the time, I did a 5 day PPS assessment for his first stay 3/20/12- 3/26/12 with the ARD 3/26/12 capturing a RUG level of CA1-10. Upon his return from the hospital I completed another 5 day PPS, as I was told he had been inpatient at the Hospital, this time again capturing a RUG of CA1-10 with his 5 day ARD 4/4. His 14 day had an ARD of 4/14 and 30 day with ARD 4/28 assessments were submitted and he discharged home on 4/29/12.

Today I get a message from our billing dept. that the 2 stays were combined into 1 account under the first stays account number because he had actually been in OBSERVATION status for his 48 hr hospital stay (the one we sent him back for) and not inpatient as originally thought. So this completely invalidates all the dates for the second stay.

I am thinking that I should first submit an inactivation record for the entire 2nd stay, since there apparently was no 2nd stay, but rather a continuation of the 1st. Then, create a correction record for the first stay and include all the days, but the 14 day and 30 day ARD dates will be different. Is this right?

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    MDS

    3/20 – Entry (valid)

    3/26 – 5-Day (valid)

    3/26 – DC tracking (invalid)

    3/28 – Reentry tracking (invalid)

    4/4 – 5-Day, should be Readm/Return (invalid)

    4/14 – 14-Day (invalid)

    4/28 – 30-day (invalid)

    4/29 – DC (valid)

    You would have to invalidate five invalid MDS. However, you cannot go back in time and create the missed assessments using the ARD window. See Clarification #8, pp 8-9

    The facility will have to take the loss and bill as:

    3/20 – 3/25 CA1

    3/26 – 3/27 (observation status = LOA, no pay)

    3/28 – 4/2 CA1

    4/3 – 4/28 No PPS assm’ts done, bill default rate only**

    **If you did an OBRA Admission MDS with ARD that fell within the window of the missed 14-day PPS, you may be able to bill the actual RUG category for days 15-30 (in your case 4/3 – 4/18). See RAI, 6-55 if you qualify.

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