Home

  • Home
    • » e-Newsletters

Q: We had a resident admitted to the hospital on his 96th Medicare day. When he returned after a three-day hospital stay, we completed a PPS readmission/return assessment to get a Resource Utilization Group (RUG) rate for the four remaining Medicare Part A days.

Julia's PPS Chat, January 21, 2004

This e-zine is brought to you by the popular newsletter PPS Alert for Long-Term Care.

--------------------------------------------------------------------------------

Welcome once again to our PPS chat!

How many times a day do you estimate something? You might estimate the length of time it will take you to complete a task, the amount of money your trip to the grocery store will cost, or how long it will take you to get to work in the morning.

This question and answer deals with estimating therapy days and minutes to obtain a RUG rate. Read on for more information.

Q: We had a resident admitted to the hospital on his 96th Medicare day. When he returned after a three-day hospital stay, we completed a PPS readmission/return assessment to get a Resource Utilization Group (RUG) rate for the four remaining Medicare Part A days.

In Section T, therapy supplement for Medicare PPS, do I estimate therapy days and minutes for the full 15 days or only the four remaining Medicare Part A days?

A: First, you were correct to complete a readmission/return PPS assessment upon the resident's return. This MDS will determine Medicare reimbursement for the final four Medicare days.

Second, you do need to fill in items T1c, estimated therapy days, and T1d, estimated therapy minutes, when you complete the readmission/return assessment. CMS has responded to similar questions by stating that Section T needs to be completed according to the item's directions.

For items T1c and T1d, consider the first 15 days after admission when coding, not just the four Medicare Part A days. In your estimation, remember to include therapy that the resident has already received in those 15 days and therapy that the resident expects to receive. This will help ensure that you receive reimbursement based on the appropriate rehabilitation RUG level for the four Medicare Part A days.

Although you will only bill Medicare for those final four days, your RUG will accurately reflect the amount of therapy already received and the expectation of future therapy.

Be sure that you're coding these items correctly so that you are reimbursed at the proper RUG rate. You will also want your estimation of the amount of revenue you are generating to be as correct as possible.

We'll be chatting again soon—