Triple Check
Who monitors the daily skilled documentation for skilled residents?
Who/What is the DNS or nursing designee.
What completed documents are to be scanned weekly to Tammy and Dana for review?
What are UR and CMI meeting forms.
When are CSC forms given to the BOM for Month End Close?
What is the last business day, no later than the 1st business day of the month.
What two items are needed to support a Nursing HIPPS of Special Care low for Cerebral Palsy with a GG Function Score of 8?
What are 60 days dx signed MD orders and active dx in the 7 day lookback.
A resident that is on traditional Medicare A stay has a sudden change in status and is discharged to the Hospital. The resident expires in the ER. You would complete what assessment?
What is a death in facility tracker.
Who approves delays in the Triple Check process past the 5th business day of the month?
Who/What is the VPO.
What meeting is held weekly with IDT reviewing clinical conditions, Certs, last MD visit dates, Medicare days remaining, and plans for discharge?
What is the UR/PDPM meeting.
Is the CSC form used for benefit exhaust or benefit cuts?
What is benefit exhaust ONLY
Who alerts the IDT of billing changes during the CMI meeting?
Who is the BOM.
An IPA (Interim Payment Assessment) can be combined with which other assessments?
What is NONE. A IPA is a standalone assessment.
If a resident has multiple claims what questions may be skipped on each form?
What is NONE!
What assessment changes the payment for Traditional Medicare A stays on the ARD.
What is a Interim Payment Assessment (IPA)
Is a new Certification required when a resident switches from one insurance to another. (i.e. HMO to Part A or HMO to another HMO?)
What is yes.
How far out does the CMI meeting look at residents ARD's?
What is two weeks.
Which of these ICD 10 dx codes would be utilized as an appropriate principal dx for a Right Displaced Femur Fracture with routine healing?
1. Z47.89 (Other Orthopedic Aftercare)
2. S72.141D (Displaced Right Femur fracture with routine healing)
What is #2.
If the cert/re-cert form is not completed or not signed by the MD/ARNP what happens with the claim?
What is the claim is held.
This person keeps a 3 month rolling calendar for planned DC's in an attempt to control the number of discharges on a given shift, day, and week.
Who is the Social Worker SSD
The NOMNC must be issued no less than ________ days prior to the end of a Medicare stay?
What is 2 days.
How often is the CMI meeting held in each facility?
What is at least weekly.
The acronym HIPPS stands for this?
What is Health Insurance Prospective Payment System.
When are claims created for Triple Check? And Why?
What is as soon as your therapy files are imported. So MDS and Therapy can review prior to Triple Check.
Who reviews for daily skilled charting during the UR/PDPM meeting?
Who is the DNS or designee.
This individual enters the date signed on the NOMNC/ABN form.
What is the resident or designee. STAFF MAY NOT ENTER THE DATE
What is the purpose of the CMI meeting?
What is managing the health care benefits of each resident to ensure optimization and furthermore, to ensure that the facility is reimbursed for care and services provided.
If a resident is on a traditional Medicare A stay and switches to a Managed Care stay, the MDS coordinator would complete these assessments.
What is a NPE & a new 5d HDNS.