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Notice: Previous FAQ's are currently under review. This page will only show FAQ's posted since Aug. 2003

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Automation/Submission
49, 42I need some advice. My facility has morphed into a large continuing care retirement community (CCRC). If I do a discharge return anticipated when a resident returns to another area, such as assisted living, independent living, or the dementia unit, then if they again need skilled care, they reenter and I do a significant change assessment or a PPS assessment. When submitted to the state they come up 'late' because often it is greater than 92 days. The state presented us with a list of late assessments when they came in for survey. What can we do to avoid this situation?  4/25/2006
Q. How long do we have to keep the state final, initial and transmission log validation reports?  2/25/2005
Q. Can I sign a computer-printed copy of MDS that is old? MDSs were done on time, signed, dated, sent, accepted, etc. Unfortunately, somewhere between RNAC and Medical Records, they did not end up in closed charts. Claims are being denied because there is no MDS in the chart. Can I print them up, sign them, put them in charts, and appeal? Or, am I out of luck?  2/25/2005
Q. I transmitted MDSs to the state today and received a warning that the state calculated a rehab RUG score on one of the assessments. Our RUG level was SE3 on this particular one.Do Ineed to worry about this?   1/24/2005
Q. I am concerned. Our server was sent out for repairs, and I have been without a computer since last Wednesday. I have been handwriting my MDSs in the interim. My concern is that when the computer comes back up tomorrow and I go to enter all the data in our computer, the system automatically puts in the dates. All my dates will be wrong, plus I cannot do RAPs until the system is up, so all my RAPs will be late as well. How do I answer to state if they question this, and will my Med A be out of compliance? Will I get default rates on those Med As?  12/13/2004
Q. I accidentally entered the ARD as 11-21-04 instead of 11-22-04 and submitted it before I realized the mistake. Can I do a modification of the ARD or not?  12/13/2004
Q. I made a mistake and transmitted an OMRA with the ARD on day 11 instead of day 10. Can I inactivate assessment and transmit it again with the right ARD or we have to take a default payment?  6/25/2004
Q. A resident developed a stage 2 pressure ulcer the day before the MDS ARD. The nurse missed coding this on his MDS. Treatment orders were in place and being carried out the day the wound was found, and a wound care plan for risk for pressure ulcers was in place and was updated shortly after the ulcer treatment was started. Do you do a modification or a significant correction assessment in this case?  6/25/2004
Bedhold Policy
Q. Our facility now has this bed hold policy of holding the bed for 10 days, and if the responsible party does not want to pay privately after the 10th day, the bed will be given to new residents. Does that mean that when the resident comes back I have to considered him as a brand new admission, meaning we will have to do an Admission assessment again even though the facility expected him to return?  5/17/2005
Q. A patient was admitted to the facility on 1/21 and transferred to the hospital on 2/6.She was not eligible for bed hold (not in facility 30 days). Would you code have discharge - return not anticipated? The patient was admitted back to the facility 3/2  6/25/2004
Billing
Our corporate Billing office says I have to go back to October and November and do 5-day assessments on residents that were only here for one day and two days over the weekends, respectively. I discharged them "8," prior to completion of initial assessment. Is this appropriate> My understanding is they would bill default. Our system does not even generate a rug level unless all sections are completed.   5/5/2009
We have a question about what types of wound care treatments you should count as medications in O1. The instructions for section O state that "topical preparations, ointments, and creams" should be counted. Does that include everything? Like Calamine lotion? Is it just prescription items or over-the-counter products as well?  9/30/2008
We had a long-term resident readmitted as Medicare Part A. We later figured out that there was no Part A benefit to access as he had previously exhausted benefits and did not subsequently have a 60-day period of wellness. The administrator now wants to bill the resident privately for the time we thought was Medicare. No advance notice of non-coverage had been given as we thought he qualified for coverage. Are there legal and/or regulatory consequences of attempting to bill privately in this situation?   4/17/2008
A resident goes to hyperbaric treatments daily via wheelchair transportation van. Do we have to pay for this transportation?   4/17/2008
A resident was admitted to our SNF on November 18 at 2 p.m. and discharged against medical advice (AMA) at 9 p.m., less than 24 hours later. I don't have to do the 5-day assessment because we don't bill on discharge day, correct?  12/4/2007
My biller asked if I have heard anything mandating the use of the new Advance Beneficiary Notice (ABN) forms with denial letters when Part A coverage ends. Has anyone heard anything?  5/23/2006
Our billing person said that Medicare rules state that if a patient is in a SNF less than 5 days, the SNF must bill with the default code. Is this true?  5/17/2006
Is there a letter available to use when the resident has reached therapy cap for Part B, letting the family know they are at the limit and asking if they want to continue therapy?  3/7/2006
Q. Is it correct to bill the default rate when an MDS is completed more than 14 days after the admission date or ARD or if an assessment is missed and transmitted more than 31 days after completion? I am right that these are the limits for "timely" completion and transmission and if EITHER occurs the default rate is the only option?  1/11/2006
Q. We had a patient last month who came to us from an acute care hospital. He had used 100 Medicare days as of some time in February of this year at another facility. He had been out of a skilled bed there for more than 60 days. We just found out from our fiscal intermediary that they were unable to bill Part A for any of his time on our unit. They said that if Part A was exhausted and he had not been out of a skilled bed or HOSPITAL bed for the 60 days, the acute care days interrupt the count toward the 60-day break. They said since he had been an in-patient at the hospital in the 60 days after MC was exhausted, he did not have another 100 days of coverage. Is this correct?  9/26/2005
Q. I know that you can count the minutes of therapy provided on the day of discharge but can you bill for them? Our therapist was told "no" so if they provide therapy on the day of discharge, they do not tally the minutes.  9/26/2005
Q. I am so confused about what I’m supposed to be doing. When someone does not meet skilled need anymore, do we give an ABN or a expedited review? I know if they use all their days you do not have to give them anything.  9/26/2005
Q. Is wheelchair transport to a physician's office an exclusion from consolidated billing?  9/26/2005
Q. When completing an assessment for a resident who goes to the hospital, I always use day prior to d/c for my "bill through" date, knowing that I can't bill for date of d/c (since the hospital is billing for this day). This usually means that my ARD is changed to date of discharge. In the past, I have always counted therapy minutes if they were actually given before the discharge since this helps to set RUG rate. Therapy is questioning me about this stating that they have been told that they just loose those minutes, that therapist does not get paid for them as they cannot bill for them. Is this correct?  6/16/2005
Q. We have a resident that we are skilling after she was hospitalized following a fall that resulted in a subdural hematoma. She is scheduled to have a follow up CT scan done at the hospital. Is the facility responsible for payment of the CT scan?  6/16/2005


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