What happens if you miss a COT?

By: May 2nd, 2012 Email This Post Print This Post

Q: What happens if you miss a COT? For example, our 5-day was an RHB with an ARD of Nov. 4, 2011 and we missed doing a COT on Nov. 11, but we did a 14-day on the 11th for an RVB. What do we bill and when does the billing begin?

A: There can be a large number of consequences for missing a COT assessment, ranging from provider liability, default, or in your case missing revenue. I will assume that Nov. 11, 2011 was also the day the COT assessment was due. An interesting situation presents itself to you if the COT and scheduled assessment are due on the same day. If the scheduled assessment is open and the ARD is selected (i.e., Nov. 11), then the scheduled assessment can negate the need for the COT. Or, on the other hand, the facility can combine the COT with the scheduled assessment (see p. 16 of the CMS Policies and Clarifications from the Nov. 3, 2011 SNFPPS National Provider Call). With your scenario, the bill would show:

  • Days 1-14 = RHB for a federal rate of $375.95 x 14 days = $5,263.30 (assuming that the ARD date was set for day 7 of the stay)
  • Days 15-30 = RVB for a federal rate of $415.13 x 16 days = $6,642.08 (pending no additional therapy changes)
  • TOTAL = $11,905.38

However, had you combined the COT with the 14-day, your bill would have looked as follows:

  • Days 1-7 = RHB for a federal rate of $375.95 x 7 days = $2,631.65 (assuming that the ARD date was set for day 7 of the stay)
  • Days 8-14 = RVB (COT) for a federal rate of $415.13 x 7 days = $2,905.91
  • Days 15-30 = RVB for a federal rate of $415.13 x 16 days = $6,642.08 (pending no additional therapy changes)
  • TOTAL = $12,179.64 (an increase in revenue of $274.26)

In your scenario, it would have been beneficial to combine the assessments.

 

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