Angela,

 

My opinion is that you are going to have to do a change in payer, new contract, etc - and create OASIS’ to match up with your dates (D/C 11/30/14 and re-admit 12/1/14) that way you can get the new claim key code and episode dates you will use for traditional Medicare.  Medicare 60 day episode will then start 12/1/14.  You will get flagged for late OASIS but should be able to document why, in case that chart is ever audited by Medicare.

 

If you have any OASIS submitted already that will interfere, you will need to reject those first.  Be cautious as rejecting and late submissions will quite likely red flag you and you should expect that this chart will be called for review.

 

In deciding if this is the way to go be sure the amount you will recover will be worth the time spent and that the chart will be able to stand up to an audit.

 

These is my thoughts and I am very curious what other’s opinions are regarding this situation.

 

 

 

We have a client who was admitted in October for therapy only under Medica MSHO – Medicare level. She apparently sold property and her county worker was unable to tell us exactly what insurance she was going to continue to be on. So we had her and her daughter sign an ABN incase her new insurance would not cover it.

We found out today that her Medicare went into effect on 12/1 and we never discharged and re-admitted due to not knowing we needed to.

 

Can we bill all of it PPS?

 

Can we bill privately for any due to her having Medicare?

 

Can we bill part to the Medica Medicare and starting 12/1 bill Medicare PPS?

 

We don’t know what to do here?

 

 

 

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