We haven’t heard a word from them.
There was a good article about them in the most recent PPS Alert I got that
made me a little nervous so I passed it on the our Administrator. Haven’t
heard anything back from him.
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED] On Behalf Of stephanie
deon
Sent: Monday, February 02, 2004
9:58 AM
To: [EMAIL PROTECTED]
Subject: Re: demand billing
Faye have you heard when the New
Medicare Letters are going to be made available from the Empire Medicare
intermediary?? Just like previously have heard about them, But I haven't seen
them yet.
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----- Original Message -----
Sent: Monday,
February 02, 2004 9:52 AM
Subject: Re: demand
billing
----- Original Message -----
Sent: Monday,
February 02, 2004 9:43 AM
Subject: RE: demand
billing
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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