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Q: Our business office manager wants to attend the daily Medicare meeting. However, she does not bill Medicare-the corporate office does the billing. Should she still attend this meeting?

Julia's PPS Chat, February 2, 2005

Welcome again to our PPS chat!

It's hard enough getting other staff members to attend daily Medicare meetings. But what if you're not sure whether they need to be there?

Read on for a case scenario-

Q: Our business office manager wants to attend the daily Medicare meeting. However, she does not bill Medicare-the corporate office does the billing. Should she still attend this meeting?

A: Yes, she should definitely participate in your Medicare meeting. Even though she personally does not complete the Medicare billing, she still needs to know the payer status of all residents in your building.

Let's use this possible scenario to explain why she should attend. On the first of the month, you admit a resident who will be paying privately for nursing home care. In the middle of the month, this resident is admitted to the hospital, stays for four days, and returns to the nursing home covered by Medicare Part A.

If your office manager did not know that the resident was readmitted as a Medicare beneficiary, she would erroneously charge the resident the private rate for the entire month, less the hospital days. This could result in your collecting payments both privately and from Medicare, which would be fraudulent.

Encourage your business office manager to attend your Medicare meetings and be sure to discuss which residents are currently covered by Medicare Part A so that she is aware of the payer status. Also discuss anticipated discharges from the Medicare program and possible new admissions.

Review the current Resource Utilization Group levels and your schedule of MDS assessments. Make sure your meeting is productive and provides the information needed for all the attending staff to ensure continuity of care.

We'll be chatting again soon about the automated correction policy-