Ask the expert: HMO resident concerns
MDS 3.0 Insider, November 22, 2013
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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.
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