MDS Alert
Coding For Dollars: Make Sure Your SNF Gets The Extra Payment For Residents With AIDS
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A $100 RUG will net $228 with the RUG Add-On. Make Sure Diagnosis Makes It to Billing
What's in a diagnosis code? A hefty RUG add-on for residents who have AIDS, effective Oct. 1, that's what.
Your SNF will receive payment for whatever RUG the resident with AIDS qualifies for based on his MDS assessment - plus an additional 128 percent. That would come to a total of $228 for a RUG that, for example, pays $100, a Centers for Medicare & Medicaid Services technical expert confirms for Eli.
What to do: To take advantage of the additional payment, code human immunodeficiency virus (HIV)-related disease (042) on the UB-92 for a Part A resident with AIDS. AIDS does not have to be the primary diagnosis, notes Andrew Cutler, principal, FR&R Healthcare Consulting in Deerfield, IL. And if it is a secondary diagnosis, list it anywhere in fields 68 to 75 on the UB-92.
Code 042 excludes V08 (asymptomatic HIV infection status) and 795.71 (nonspecific serologic evidence of HIV), so those diagnoses will not qualify for the add-on.
"You have to make certain that AIDS is something that you're actually treating and documenting," advises Cutler, who predicts that facilities that bill the add-on may end up being audited by their fiscal intermediary at some point.
Check State Confidentiality Requirements
Recording the diagnosis on the Medicare claim (UB-92) gets you the add-on. But watch out for state confidentiality laws prohibiting facilities from putting a diagnosis of HIV-related illness on the MDS. For example, providers in Illinois cannot include that diagnosis on the MDS, confirms the RAI coordinator for that state.
A current listing of RAI coordinators and their phone numbers and e-mail addresses can be found on the MDS 2.0 Website: www.cms.hhs.gov/medicaid/mds20/raicoord.pdf.
Legal tip: "Facilities would be prudent to get an analysis of what the state allows in terms of HIV confidentiality provisions," suggests attorney John Lessner with Ober/Kaler in Baltimore.
If your state prohibits coding HIV on the MDS, make certain you're coding HIV-related illness on the UB-92. Cutler recommends having nursing staff review hospital charts on transfer to look for AIDS diagnoses. Then flag that information in the record without putting it on a face sheet, Cutler advises. That way your billers will know to review the file to find the AIDS reference.
With a 128 percent boost to reimbursement at stake, the extra effort is worth it.
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