Long-Term Care

Ask the expert: HMO resident concerns

MDS 3.0 Insider, November 22, 2013

Want to receive articles like this one in your inbox? Subscribe to MDS 3.0 Insider!

Q: I live in Ohio. For a couple of years now we have completed our HMO residents in the following way:

  • We complete an admission assessment only because we are not to submit PPS assessments on HMO residents.
  • If that resident has a Medicaid number we code that in Section A. Subsequently these assessments are counted into our quarterly Medicaid-only case-mix which is RUGS 3 in Ohio.

A colleague recently questioned this practice and stated that it seems like "double-dipping” since we are getting paid from the insurance company. Is this practice legal and acceptable and if so are you able to cite where I can find documentation that it is so I can "prove” it to this colleague.

To read our Regulatory Specialist’s response, visit MDSCentral.



Want to receive articles like this one in your inbox? Subscribe to MDS 3.0 Insider!

Most Popular