Category: Ask the Experts

Ask our expert your MDS3.0 questions

Ask our Experts about Medicare Advantage: Claims and Denials

Do you have a question about a Medicare Advantage claim or a denial? Do you have issues or concerns specifically regarding Medicare Advantage? Ask it here, and have it answered by our Medicare experts! Leave a question in the comments, or email managing editor Olivia MacDonald @ omacdonald@hcpro.com.

Ask the expert: Medicare A

Q:  Does an unstageable on spine qualify someone under Medicare A for a SNF? A: Yes, location is not the issue if it is the result of pressure.

Ask the expert: COT

Q:  Regarding the COT count:  Is it correct that once a rehab RUG is no longer achieved that the 7 day COT count stops and does not begin again until 7 days following the next scheduled PPS Assessment. I was just told in a seminar on the new PPS Final Rule that the above is true, […]

Ask the expert: 100 days benefit

Q:  A resident exhausted 100 days benefit on 4/11/14. The resident stayed in an LTC setting from 4/12/14 thru 7/1/14. Then the resident was discharged to hospital 7/2/14 and returned 7/4/14, but did not qualify due to the 3 midnight rule, so we were unable to skill. Does the count for 60 days of wellness start […]

Ask the expert: comprehensive assessment

Q:  Have time work studies been done to determine the average length of time taken to complete a comprehensive assessment? A: To my knowledge, independent studies on the length of time needed to complete an OBRA Comprehensive assessment on MDS 3.0 have not been done. CMS filed timing information with OMB prior to the start of MDS […]

Ask the Expert: 100 days benefit

Q: If a resident uses their part of their 100 day benefit for a G-Tube, can we ever skill him again?   A: If a resident with a G-Tube goes 60 consecutive days without a hospital stay or any skilled service or skilled care (less than 26% of the calories goes through the tube or less […]

Ask the expert: Billing

Q: How do you bill for a patient that is admitted after a 3 day hospital stay that comes for therapy; however after being admitted to a SNF, the patient does not meet the qualifying minutes and ends up with a rehab low? A: If the patient met all the criteria for a Rehab low and […]

Ask the expert: Significant change evaluation

Q: Is there a form that helps us understand what constitutes a significant change?  The RAI to me is vague regarding Mood and Behavior.  We used to use a Briggs form that showed exactly how to know if there was a significant change in these two areas.  I understand you have to have 2 areas of […]

Ask the expert: MDS assessment

Q: Should a blood tranfusion received at an outpatient clinic be coded on the MDS for a patient during a Part A stay?   A: If the blood transfusion was received after the date of admission, regardless of where it was done, it should be coded on the MDS.      

Ask the expert: Therapy

Q: How do you bill for a patient that is admitted after a 3 day hospital stay that comes for therapy; however after being admitted to a skilled nursing facility, you find that the patient does not meet the qualifying minutes and ends up with a rehab low?   A: If the patient met all the criteria […]