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Q&A: On the second day of a Medicare Part A stay, a resident elected hospice and then she expired later that evening. What assessments do I need?

By Jessie McGill, RN, RAC-MT - January 31, 2018

Question A resident admitted on Medicare Part A on Jan. 23, on the second day, Jan. 24, she elected hospice and expired later that evening. She signed hospice papers on the 24th and I set a stand-alone 5-day for Jan 24., but I am not sure that is correct? What other assessments do I need?

Answer: Since the resident signed papers for hospice on 1/24, that would make 1/24 billable to hospice and not to Medicare.  Your last Medicare day would have been 1/23.

Even though you did open the 5-day, it was not set within the Medicare stay, so you cannot use that assessment. Because the Medicare stay has ended, you cannot move that assessment back into the appropriate ARD window. However, this situation sounds like it would meet the criteria as an exception to be able to bill default for the one day of Medicare. See the first exception in Chapter 6, page 6-53: The stay is less than 8 days within a spell of illness.

Since Medicare ended prior to the resident expiring, you will need to schedule a stand-alone PPS Part A discharge for 1/23.  Section GG will be skipped because the stay is less than 3 days of Medicare.

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Reviewed and revised 12/17/19

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