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Kathy, the following cite is from section 30.1 of
chapter 6 of the new medicare claims processing manual:
AI codes are only used for billing Medicare for
covered SNF Part A stays. To the extent possible,
every combination of reasons for RAI assessment relevant for payment under
Part A PPS has been captured by the HIPPS AI
codes. However, to avoid undue complexity and because the information is not relevant for
payment, there are some combinations that are not specifically identifiable using the
codes. This means that although there
are instances in which all of the information contained on the long term
care resident assessment instrument is not
captured by the HIPPS AI code, it is still an accurate code for billing purposes. From the standpoint of
Medicare payment, it does not matter if Medicare-required assessments are also used to fulfill the
clinical requirements for an SCSA or a Quarterly
Assessment.
----- Original Message -----
Sent: Wednesday, December 17, 2003
3:39 PM
Subject: RE: Hipps modifiers
None of the modifiers in the manual correspond with this particular
situation ( Quarterly/5 day).
Kathy
A current list of HIPPS modifiers can be
found in the RAI User's Manual, pages 6-5 and 6-6.
Rena
Rena
R. Shephard, MHA, RN, FACDONA, RAC-C
Chair, American Association of Nurse
Assessment Coordinators
[EMAIL PROTECTED]
Subj: RE: Hipps modifiers
Date: 12/17/03 12:15:52
PM Pacific Standard Time
From: [EMAIL PROTECTED]
Reply-to:
[EMAIL PROTECTED]
To: [EMAIL PROTECTED]
File:
winmail.dat (5444 bytes) DL Time (TCP/IP): <1
minute
Sent from the Internet
The HIPPS code
for this scenario is "01". We have created a grid for
quick
reference from the PPS Final Rules. I would share it if
anyone wants it.
For others, look to the PPS Final Rules (July 1999)
for HIPPS coding.
Jane Craven, RN, C.
Sr. Consultant, Nursing
Services
Tendercare (Michigan) Inc.
-----Original Message-----
From:
[EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
Behalf Of
CAROLYN ORTTEL
Sent: Wednesday, December 17, 2003
2:27 PM
To: [EMAIL PROTECTED]
Subject: Re: Hipps modifiers
Fro medicare, I
believe you would code 0/1 for 5-day PPS
>>>[EMAIL PROTECTED] 12/17/03 12:43PM
>>>
>
>
>Need help with
this situation.
>
>I
had a resident who was readmitted from the hospital
to
medicare. Her 5
>day assessment
fell in the time period that her quarterly
was due.
She
>was not a signficant change. She
just needed PT/OT for
endurance. That
>was the only change. She stayed on medicare for 7
days.
When I opened
>the assessment, I coded
it for quarterly and 5 day. When
I transmitted
to
>state it was accepted. Now in closing
the end of month
for billing, the
>software
did not pull a Hipps modifier. I can't find a
Hipps modifier
for
>this. Help!!
>Would I manually enter 5/1?
>
>
>Kathy Vogt,
RN
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