MDS Alert
ASNF Resident Without a 3-Day Qualifying Hospital Stay Goes O ff a Medicare Advantage Plan -- Now What?
Question: What should a SNF do when a patient covered by a Medicare Advantage plan (without a three-day prior hospitalization) goes off the plan and back on traditional Medicare fee-for-service overage for the remainder of his Part A skilled stay? Answer: "All the SNF need do is continue billing on the traditional claim for the next month's service, and include Condition Code '58' (Terminated Managed Care Organization Enrollee), to indicate the patient was disenrolled from an MA plan and the three-day prior [hospital] stay requirement was not met," says Victor Kintz, MBA, CHC, LNHA, RACCT, CCA, managing director of operations for The Polaris Group based in Tampa, Fla. "Of course the facility will also need to include the MDS RUG information on the traditional fee for service Medicare claim, along with appropriate charges. It is for this reason that the facility will ant to continue and follow the Medicare PPS MDS schedule for [residents who are on] Medicare Advantage plans," adds Kintz.
MDS Alert
- Compliance:
3 Ways MDS Nurses Can Keep F Tags at Bay
Find out how one facility gets charts in tip-top shape for survey day. When MDS [...] - Payment Trends:
Beware: RACs May Be Triggering MAC Attacks
If you do get a notice of a probe review, don't do this. SNF providers [...] - Compliance:
Be On Your Toes When Handling MAC/FI Probes
Failing to include the right MDSs can cost you big time. What you don't know [...] - Case Study:
Avoid Pitfalls Identified in This SNF's Probe Review
Shore up these 4 areas before it's too late. The best time to prevent payment [...] - MDS 3.0:
Show Physicians the Benefits of Participating in the MDS 3.0
A medical director highlights where physician input can improve the RAI process. The MDS 3.0 [...] - Pain Management:
Don't Let Wound Pain Be a Drain on Resident and Survey Outcomes
Identify and address these underlying causes, including 2 psychosocial factors. There's no magic formula for [...] - Medicare Part C:
Make Sure You're on the Same Page With Medicare Advantage Plans
Take heed: Some plans may require frequent recertifications for skilled care. Failing to nail down [...] - MDS 3.0 Training:
Benefit From These Inexpensive Training Tips for MDS 3.0 Interviews
Tap these knowledgeable resources. Mastering the MDS 3.0 interviews will help ensure your RAI process [...] - What Do You Think?:
ASNF Resident Without a 3-Day Qualifying Hospital Stay Goes O ff a Medicare Advantage Plan -- Now What?
Question: What should a SNF do when a patient covered by a Medicare Advantage plan [...] - Diagnosis Coding:
Get a Sneak Peek at the New ICD-9 Codes
Check out these new codes for cognitive problems. If you're hoping the new slate of [...] - Care Plan Tool:
Consider This Risk-Driven Pressure Ulcer Prevention Tool
Link strategies to the various risk factors identified by the Braden scale. Braden I ntervention [...] - MDS, Payment & Research News to Use
CMS recently provided a heads up on its plans for managing the legislated RUG-IV delay. [...] - TEST YOURSELF Answers:
(Surgical Wound Care Coding and RUGS cores)
Here are the answers to the "Test Yourself" feature in MDS Alert, Vol. 8, No [...]
