When you have patients with multiple payers, be sure that Medicare and other PPS payers take precedence. In other words, the Medicare SOC date is the only SOC date that should be listed, and recerts should be done on the Medicare schedule. Other payers and doctors will get supplemental orders, not 485s.
When any patient changes from a non-PPS payer to a PPS payer (Medicare), you must discharge your chart with a discharge OASIS and create a new chart with the PPS payer primary and a new SOC OASIS with the PPS start of care date. This is so that everything is based on the 60-day cycle. You don't have to have a new permission to treat, etc. It's only a chart number to create a new episode cycle. You can use the "Re-Admit" function in the Barnestorm in this case, which will pull all of the ICDs, medications, etc.
There should only be one set of recert dates for 485s and OASIS; otherwise, the systems will register the dates wrong.
If you don't find out until later that the payer changed, you can use the "Shift" a chart number in the Admin section to move things over. You can inactivate the ones you sent on the old chart, and activate and pull things over to the new chart.
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