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BALTC Q&A

Billing Alert for Long-Term Care, October 1, 2008

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

Q. I am an MDS nurse at a long-term care facility, and I have a conflict with our billing department about the type of assessment necessary for it to bill and get paid for services under the Medicare Part A program. A resident who was admitted to our facility qualified for Part A skilled services, and he was receiving all three therapy disciplines on a daily basis.

The first MDS assessment was prepared and resulted in a resource utilization group [RUG] of RUC [ultra high rehab, high].

At the end of the second month, physical and occupational therapy were discontinued. Only speech therapy is being provided now, in the third month. The resident is still at the RUC RUG level for part of the third month based on the assessment that was done that included all three therapy disciplines.

Our billing department says it submitted our claim to Medicare this month, and it was denied because we did not have therapy services for at least two therapy disciplines.

I know the assessments we have done are correct, but how can our billing department process the claim for Part A payment when the RUG category is for two or more disciplines but we are only providing one therapy discipline?

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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