MDS Alert

3 ways to ensure everyone is on the same payment page.

Keeping your OMRA billing straight isn't so much a matter of how you do it as finding a way that works for your facility--and then using it consistently.

For example, the MDS nurse at Dr. William O. Benenson Rehabilitation Pavilion always codes an OMRA as a "0" at AA8a and an "8" at AA8b. The person then makes a notation on the MDS to indicate it's an OMRA replacing a 14-, 30-, 60- or 90-day assessment. That way, "we know what HIPPS code to put on the UB-92," reports Nemcy Cavite Duran, RN, BSN, CRNAC, director of MDS for the facility in Flushing, NY.

Best practice: Once the MDS team completes all the MDSs and inputs them into the computer, Duran prints out all the RUG scores, the assessment reference dates and the billing dates for each assessment from start to end. She uses a separate worksheet to list residents that have OMRAs replacing a regular Medicare assessment. Duran then manually codes the correct HIPPS codes on the UB-92s, e.g., using an assessment indicator of 28 for an

OMRA replacing a 30-day Medicare assessment, 38 for one replacing a 60-day, etc.In some facilities, the MDS coordinator provides billing a copy of the front page of an OMRA assessment with a notation that it's also for the 30-day assessment, as an example, says Christine Twombly, RN, a consultant with Reingruber & Company in St. Petersburg, FL. Twombly has seen facilities develop "very thorough systems where the MDS nurse gives billing a copy of the MDS and a copy of the signed physician certification and therapy certification, along with the therapy logs ... ."

Another idea: Require the MDS nurse to sign off on billing, suggests Theresa Lang, RN, BSN, PHN, RAC-C, WCC, a consultant with Specialized Medical Services in Milwaukee. "The MDS nurse could keep a list of all OMRAs, especially those replacing a regularly scheduled assessment, to check the ARD and the HIPPS codes on the bills--and the number of days billed at the new RUG classification resulting from the OMRA," Lang says.