We get a lot of calls asking when a patient should be “discharged” from one chart and admitted to another chart number.  Below are examples of when to switch a chart number.

• If a patient has a PPS payer and is switching to a different PPS payer.
• If any PPS payer becomes primary, either from the patient switching payers, or a diagnosis exacerbation that causes the patient to meet the homebound criteria. A common example is switching from Medicaid Supplies to Medicare Skilled. 
• If Medicare becomes primary, and you will still be billing Medicaid for nonskilled services, you will enter those services under the Medicaid pay source and enter the skilled services under Medicare.  This will allow you to create the separate payer claims for the separate services.
• If the patient was in an inpatient facility on day 1 of a new certification period.  
• If the patient is changing from Medicaid, non-skilled services to Medicaid, Skilled services where an OASIS is required.
• If the agency finds out about a switch in payers late, you can use the feature in the link below to shift part of a patient's record to a new number. See the link below.

NOTE:  When in doubt, we recommend you contact the payer on their policies.