RE: demand billing

[Faye Jones]

I would not change my decision just because you will get a category.  For multiple reasons such as condition is chronic but stable, insulin qd is not a skillable service your intermediary may agree with your decision.  If you tell someone Medicare will pay and they don’t you are financially liable and will sustain a loss.  However, this is why we do the next appropriate MDS on everyone we cut ( off rehab do the OMRA and sometimes depending on how much time it covers the next regular PPS  and if not rehab the next regularly scheduled PPS assessment).  We submit them but use the RUGS category on our demand bill so if by chance the FI disagrees with us we get reimbursed at the correct rate.  We do not get many of our decisions overturned but when we do the loss by accepting default rate is unacceptable to our administration.  It is a little extra work but worth it in the end. Demand bills are the reason I am so excited about the new ABN letters.  The old ones are not clear and I do not believe people really understand what they are checking.  The new ones are much clearer and I hope will cut down on Demand bills.  I don’t begrudge anyone their rights but they are a pain.   -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Ann Schoeny Sent: Monday, February 02, 2004 8:03 AM To: [EMAIL PROTECTED] Subject: RE: demand billing   You need to do an omra and continue to assess him on a medicare schedule.He will likely be eligible for more medicare. This has happened to us and we just rescind the Medicare cut. -----Original Message----- From: Deb Wilmhoff [mailto:[EMAIL PROTECTED] Sent: Saturday, January 31, 2004 4:56 PM To: [EMAIL PROTECTED] Subject: demand billing I am not a billing person(I am a MDS coordinator) but I have a question. A resident was discharged from Medicare due to not progressing in therapy. At time of discharge there were no other skilling factors to proceed with medicare coverage. during the following 7 days of observation for this resident's sighnificant change off medicare ( we always do a SC when resident is discharged from medicare), he picked up enough doctor orders ( he also has DX of DM with 7 days injections, not a new dx) to place him into a clinically complex category..   Question: The family has requested a demand billing feeling that he should have continued with medicare coverage after d/c of therapy because they feel he declined because we stopped therapy. Does anyone agree that he should have been readmitted to medicare or will Medicare agree with  our decision?

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