Ask Proactive – We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare Part A for this while she remains on Hospice?

Q: We have a resident using Hospice Services for End Stage Renal Disease that fell and broke her hip. She had a 3-day hospital stay for ORIF. Prior to the fall, she was ambulatory. She is returning from the hospital with skilled therapy orders. Can we bill Medicare...

Ask Proactive – Our facility is seeing an influx of Medicare Advantage Medical Review. Unfortunately, there have been a few denials based on the PDPM HIPPS code billed versus the HIPPS code generated from the MDS assessment. For example, the MA plan predetermined a score without comorbidity conditions COPD and Pulmonary Fibrosis. Now they have denied at the medical review because our MDS HIPPS code (KAPD1) did not match the plan’s approved HIPPS code (KAPF1). We billed as was approved, not what was MDS generated. Is there any way to overturn these decisions? We haven’t had luck so far.

Q: Our facility is seeing an influx of Medicare Advantage Medical Review. Unfortunately, there have been a few denials based on the PDPM HIPPS code billed versus the HIPPS code generated from the MDS assessment. For example, the MA plan predetermined a score without...

Ask Proactive – Default or Provider Liable? I mistakenly thought a resident qualified for the interrupted stay when in actuality they readmitted beyond the 3-day interruption window (on day 4). I failed to schedule a new PPS 5-day assessment within the required timeframe. Can I still complete the PPS 5-day for billing?

Q: Default or Provider Liable? I mistakenly thought a resident qualified for the interrupted stay when in actuality they readmitted beyond the 3-day interruption window (on day 4). I failed to schedule a new PPS 5-day assessment within the required timeframe. Can I...