Qualifying hospital stay

Specialties MDS

Published

Specializes in LTC-Geriatric-PPS-MDS.

Scenerio: Patient admitted to hospital already under hospice care with Dx CHF endstage and Endstage Cirrhosis.. The hospital D/C summary ( because supposedly the H&P was not ready per Medical records )-- states that the resident admitted to the hospital due to caregiver crisis and inablity to care for her self at home... Then states they continued all her outpatient medciations and searched for SNF facility to continue her hospice services.

IS THIS A QUALIFYING HOSPITAL STAY FOR PART A? Part of me says NO.

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Specializes in LTC-Geriatric-PPS-MDS.

The patient is Able to perform all her own ADLS, Ambulates independantly without balance issues at this time as well... ( supposedly in the hospital she was dependant with all adls per progress notes )

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Specializes in Gerontology, Med surg, Home Health.

Did they have a 3 midnight stay? You can skill them for two weeks to develop a plan of care. I think.

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Specializes in LTC-Geriatric-PPS-MDS.

They had a 3 day stay-- what im worried about does it follow this:

In order to qualify for post-hospital extended care services, the individual must have been an inpatient of a hospital for a medically necessary stay of at least three consecutive calendar days. In addition, effective December 5, 1980, the individual must have been transferred to a participating SNF within 30 days after discharge from the hospital, unless the exception in 20.2 applies.

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Scenerio: Patient admitted to hospital already under hospice care with Dx CHF endstage and Endstage Cirrhosis.. The hospital D/C summary ( because supposedly the H&P was not ready per Medical records )-- states that the resident admitted to the hospital due to caregiver crisis and inablity to care for her self at home... Then states they continued all her outpatient medciations and searched for SNF facility to continue her hospice services.

IS THIS A QUALIFYING HOSPITAL STAY FOR PART A? Part of me says NO.

There's no mention of any change of status/decline, or any skllled services or even evaluations being ordered. Seems like the hospital stay was custodial, and not a qualifying stay that would allow for billing to MED-A. Talk to hospice about whether they might pay for evaluations, and ask your admission coordinator or BOM if they might have more information. If none of the above pans out, the place might face a private pay situation, that might end up as 'no-pay'.

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Specializes in LTC-Geriatric-PPS-MDS.

Yeah- My corporate consultant said that it didnt seem like a qualifying stay either. I issued a ABN and now the patient is appealing.. sigh

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I issued a ABN and now the patient is appealing.. sigh

Too bad it couldn't have been issued in 'advance' of the actual admission, eh? I've seen plenty of patients and families get 'mighty worked up' over those forms. Are you the chosen representative to follow those through, and deal with any possible 'getting worked up' by the patients or their reps?

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Specializes in LTC-Geriatric-PPS-MDS.

Ha! she mustve knew she wouldnve won cause she went home before the determination from QIO..interesting. I have been trying ti make my administrator and Admissions coordinator aware of the implications of not TELLING the PPS Coordinator and giving me the appropriate paperwork prior to admissions.. (patient admitted without even a H&p or d/c summary-- really ****** me off)

But yes, Im the one who usually deals with the families after ABNs are issued.

Had a recent issue to a family who schooled me on how our nurses suck on documentation (which was true) as the patient was telling the daughter she wasnt sleeping, the daughter told the nurses for over a week-- but until the daughter told me nothing happened-- patient ended up with Pneumonia and Acute renal failure because nurses pretty much just thought it was behaviors...

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Does your AC act independently, or are other chiefs (DNS, BOM, rehab, MDS) consulted about potential admits? Sometimes discussing potential admits can prevent these situations, that ultimately are a waste of time in admitting the patient, an ordeal for the patient, and also a loss of revenue (if a deposit isn't required) if the patient leaves and/or refuses to pay. Then again, some places will admit anyone that has a pulse, and deal with coverage or payment issues after the fact.

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Specializes in LTC-Geriatric-PPS-MDS.

the A/C believes she knows everything... barely consults anyone else. The DON only looks at the hospital info just to make sure theres nothing medically we cant handle (our DON has zero knowledge of the rules of Med A-- yet she believes she knows all as well)... which leaves me frustrated and looking like im just "causing trouble" when I point out that we just wasted time and money on an admit that is unskillable (It has happened 4xjust within the past 8 months!) My corporate consultant has questioned why this is happening... and i refuse to take the responsibility of such screw ups..

My corporate consultant is coming in this mon/tues and im pretty sure its to discuss this case with our administrator... because she was NOT happy that this happened...It does affect my numbers as a PPS coordinator as well ;(

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