MDSRN15

Experts, Clarification please! I have a stage 3 sacral pressure ulcer that healed 2 years ago, now I have a new redness on the sacrum, is it the same Stage 3? OR a new pressure ulcer. Thank you!

Can you clarify the use of the extra 100 days under the 1135 waiver. * Resident has exhausted her 100 days. *Just went out again for new pacemaker, can I use the extra 100 waiver without any covid dx? Separate question: * Do I do an EOP for the 100th day? FYI, I created another 5day with day 101 as day1 as per CMS, just not sure of the EOP. Then, what will be the start of Med A on the new 5D. Thank you!

No dc on 3/15 with interrupted stay checked off then re-entry with an ARD of 3/21 ???? I'm so confused with rules

Experts, Need some help with setting ARDs: Entry 3/14 DC to hospital 3/15 Interrupted stay Came back 3/17 THANK YOU

Thank you!

Experts, Need help on how to set an assessment with this unique scenario. 1. LTC resident got an authorization from Aetna Mcr to cover her recent Covid with symptoms. 2. Hospitalization was waived as per CMS guideline. 3. What assessment do I open to get reimbursed? I'm assuming a 5 day without submitting, but kept in system which will capture the GG on it. OR.....? Thank you!

Experts, Can adding 6 days of restorative for a Med A patient affect an IPA? Not sure if it will increase reimbursement or at least stay on the same HIPPS payment without the 2% reduction. Thank you!

Hard to teach. I'll stay in my desk. Thanks.

I wish I can paste an image, but I did created an admission assessment and I have an icon that can calculate a PDPM and RUG at the same time on this assessment. So, I can create a 5D with a HIPPS, submit to biller and its ok to have an admission submitted to CMS. Its same rule when we had RUGs. ? Its already January and this is still giving nightmares. Im just glad that I have this forum to go to and have Ms.Talino's expertise. Thank you.

Since our United plans pay using PDPM, then I have to create an admission then a stand alone 5D with GG filled out, please confirm. Wouldn't it be fraud since I'm submitting a different information to CMS and I'm billing a different one?

rehab expects both of us to have the same HIPPS.

I can calculate it automatically in my system. Did not combine assessment. So, when I create a standalone 5D as you stated I should dash-out GG, but rehab factors it out to create their HIPPS.

Follow-up on this Ms. Talino: 1. Received a letter from United MCR plans that they will use PDPM rules for billing. 2. Rehab follows PDPM and sets more minutes. Rehab then bills on a higher rate. 3. Submitted an admission assessment to CMS and created a 5Day that's just in my system. 4. Admission and 5Day assessments created with two different HIPPS because of Section GG. Question: a. Which one do I give the biller? The one I submitted to CMS or the 5D in my system? b. Which one should rehab follow, my HIPPS admission or my 5 day?

Experts, I have a resident with Aetna Managed Medicare, what assessments do I need to open. Biller needs a HIPPS code as she said AETNA adopted the PDPM rule. Thank again for all the help from these confusion ?

Another follow-up with regard to setting ARD: If it is a Managed Medicare, do I separate admission from 5 day assessment? Or I can combine too?