MDS Alert

Published on Tue Jun 01, 2004 PDF

CMS addresses nitty gritty MDS and billing issues at recent SNF Open Door Forums. Ready for some RUGs refinements? Providers can look for a Centers for Medicare & Medicaid Services' report to Congress in January 2005, according to an agency representative speaking at a recent SNF Open Door Forum (ODF). CMS also tackled the provider question: If a SNF provides an end-of-life program, does that count for purposes of coding hospice care in Section Pon the MDS? The answer: To code hospice care, the hospice provider must either be licensed by the state as a hospice or certified under the Medicare program as a hospice provider.

Also, keep those ink pens flowing: CMS isn't ready to handle electronic signatures on the MDS yet, said Sheila Lambowitz, deputy director of the division of institutional long-term care and the new ODF chair.

Facilities that provide services subject to consolidated billing under arrangement must have a written agreement with the providers/suppliers providing the services or items. That's according to CMS Transmittal 183 (change request 3248), with a July 1, 2004 effective date. Read the transmittal online at http://63.241.27.79/manuals/pm_trans/R183CP.pdf.

Does your SNF know how to bill the extra RUGs payment for AIDS patients? Part Astay SNF residents with AIDS get 128 percent of their RUG payment, effective Oct. 1, thanks to a provision in the Medicare Modernization Act of 2003. To obtain the extra payment, SNFs must bill diagnosis code 042 (HIV-related illness) on the UB-92. The add-on will apply to any RUG for which a patient with AIDS qualifies, according to a CMS official.

Yet the extra payment won't begin to cover the basic SNF costs of care for such patients if they are receiving antiretroviral therapy, notes Christine Hurley, executive director of Bailey-Boushay House, a Seattle facility specializing in AIDS care. "Most patients with AIDS are dually eligible for Medicare and Medicaid."

Do you have a question about the AIDS add-on? The toll free number for your intermediary can be found online at www.cms.hhs.gov/medlearn/toll-nums.asp.