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Q: We recently experienced a computer hardware problem and were unable to transmit our PPS MDSs in a timely manner. The MDSs were completed on time, they just were not transmitted. Does this mean we have to bill at the default rate?

Julia's PPS Chat, October 29, 2004

Welcome once again to our PPS chat!

Have you ever had a problem with your computer? Or was the problem with the user of the computer? I'm sure everyone has experienced these two situations. What do you do, however, when you're not able to transmit your MDSs timely-and you are sure it's not a user problem?

Read on to find out the answer-

Q: We recently experienced a computer hardware problem and were unable to transmit our PPS MDSs in a timely manner. The MDSs were completed on time, they just were not transmitted. Does this mean we have to bill at the default rate?

A: No, you would not bill at the default rate-you would submit your claims with the correct Resource Utilization group (RUG) rate for each MDS. An MDS must be transmitted within 31 days after completion. However, if it is not transmitted within that time frame, you will still be paid at the RUG rate for that MDS.

CMS provided clarification of this situation in the May 2002 Q&A set. The agency stated, "At the present time, we are not applying claims processing penalties on providers who are completing the MDS in a timely manner, but who transmit the data late. The claims should be billed at the RUG-III rate for the assessment that was completed timely."

In order to prevent delays in transmission, however, it is important to transmit your MDSs on a regular basis, preferably at least once a week. If you are doing weekly transmissions and a computer problem does arise, you then have three weeks before you could possibly miss the 31-day transmission deadline.

Transmitting less often results in a shorter time period for the computer to be down before you exceed the 31-day deadline. Maintain a regular schedule of MDS transmissions so that you know you are meeting the transmission requirement.

We'll be chatting again soon-