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Content Section
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Issue 2006-05, May 2006
Skilled Nursing Facilities Helpful Hint for Avoiding Denials
MDS
- Inappropriate altering of documentation (e.g., Assessment Reference Date (ARD) on Minimum Data Set (MDS))
- Lack of RN assessment coordinator signature/credentials on MDS (section R2a)
- Blank areas on the MDS (e.g., ARD)
Medical Record
- Nonsubmission of all or requested pieces of medical record needed to support rendered services (e.g., hospital d/c summary)
- Inadequate documentation regarding skilled services
- Inadequate documentation regarding therapy progression
UB92
- MDS section P and/or T do not support the RUGS category billed or the actual therapy minutes provided
- UB92 service dates do not correlate with the ARD of MDS
Medical Records Should Clearly:
- Demonstrate clinical condition of the patient
- Support that skilled services are needed on a daily basis
- Demonstrate therapy is being provided by a qualified therapist
- Document progress being made
- Support the MDS/UB92 utilizing the billing dates/ARD
- Illustrate reasonable & necessary services
- Include all documentation requested on the Additional Development Request (ADR) for the claim and look back periods requested
- Arrive at Empire Medicare Services in a timely manner (per ADR)
- Illustrate errors corrected appropriately (crossed off with one line, dated & initialed)
UB92 Should Always:
- Include service dates that correlate with the ARD on the MDS
- Illustrate HCPCS codes that support the RUGS category supplied on the MDS
- Verify the units for each claim period billed
- Include all data elements
- Show the Revenue Code 0180 for leave of absence (LOA) days
- Utilize correct modifiers (especially for Other Medicare Required Assessments (OMRAs) done on grace days)
MDS Information Must Be:
- Verifiable & consistent with the clinical condition documented in the medical record
- Fully completed
- Dated & signed (hand signatures also on electronic copies)
- Provided for all dates of services in the claim period requested and the look-back period
- Corrected appropriately (crossed off with one line, dated & initialed)
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