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MDSRN15's Latest Activity

  1. MDSRN15

    Aetna MCR assessment needed

    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!
  2. MDSRN15

    Covid and Med A

    Experts, We have LTC residents that has contracted covid, can I use Med A benefits without hospitalization? I saw a note in this CMS, but I want to make sure. https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care If its true then I will create a 5D on the day they tested positive. Thank you and Stay SAFE
  3. MDSRN15

    IPA and restorative

    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!
  4. MDSRN15

    Managed Medicare and HIPPS code

    Hard to teach. I'll stay in my desk. Thanks.
  5. MDSRN15

    Managed Medicare and HIPPS code

    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.
  6. MDSRN15

    Managed Medicare and HIPPS code

    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?
  7. MDSRN15

    Managed Medicare and HIPPS code

    rehab expects both of us to have the same HIPPS.
  8. MDSRN15

    Managed Medicare and HIPPS code

    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.
  9. MDSRN15

    Managed Medicare and HIPPS code

    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?
  10. MDSRN15

    Managed Medicare and HIPPS code

    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
  11. MDSRN15

    PDPM Admission

    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?
  12. MDSRN15

    PDPM Admission

    Experts, For new PDPM requirement, I understand that Med A admission needs a 5 day, but do I still do an admission assessment to satisfy the OBRA schedule? If I do can I combine like before or I have to separate the assessment? Can I use the same ARD for both admission and 5 day assessment? Thank you!
  13. MDSRN15


    Experts, Resident was in and out from hospital and missed an admission assessment. Now, she is long term and needs a Q1. Can I just do a Sig. change? Please advise. Thank you.
  14. MDSRN15


    Experts, Please confirm if Section J:1400 - Prognosis should be checked-off when MD orders hospice admission. thank you!!
  15. MDSRN15

    Insurance - hospice

    5day on 4/30 not submitted?
  16. MDSRN15

    Insurance - hospice

    Experts, Not sure which assessment to open for this scenario. Patient entry - United commercial as primary - 4/25 went on hospice - 4/30 Expired - 5/1 Do I still need admission? Thank you!

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