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Discussion

Not OBRA after all

Resident admitted 2/13 for wound care for an ORIF wound infection and IV antibiotics. Injury was presented as work related even though the resident has MCR, and the claims adjuster preauth'd his SNF stay. I went ahead and set day 8 (2/20) for ARD. OBRA Eval completed and submitted 2/26 (yesterday- day 14) with HIPPS code -60. This morning, Workers Comp is denying the injury is work related and denying the claim in its entirety. Today is day 15, so if I modify it and resubmit it as PPS, I will now have to use todays date as the ARD and it will be considered late...correct?

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    There is no need to make a correction. You meet the "exception" to the rule of Missed Assessment (see RAI p 6-54)

    Use the RUG category generated by the OBRA Adm MDS using the same HIPPS code 60 to bill for days 1 - 14.

    Do the 14-day no later than 3/3.

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