Question: What is the Level of Care (LOC) section in the Census/Rates tab used for and how does this information get entered into PointClickCare®?
Answer: The Level of Care (LOC) functionality is for the management of No Pay and Exhaust billing for residents after a Medicare Part A Skilled stay. From the information in the LOC area, the system will auto create the Medicare Exhaust claims on a monthly basis, and will auto-create the final discharge No Pay claim with the routine billing as needed. The billers can also create Monthly No Pay claims on demand.
Upon admission into PointClickCare® of a Medicare A resident, the system will auto-populate the LOC with a begin date of the Skilled level of care. PointClickCare® will auto-populate the end date for the Skilled level of care and will auto-create a new effective date for the non-skilled level IF the resident is discharged OR is cut from Medicare A when they still have benefit days available.
The ONLY time the LOC will not auto-populate is in the case of a Medicare benefit exhaust. Many times when a resident exhausts the Medicare benefits, they continue to receive a skilled level of care until the spell of illness is broken. Once it has been determined that the skilled care is no longer necessary, or the spell of illness is resolved, it is up to the clinician to manually enter the end date for the skilled stay and enter a new effective date for the non-skilled stay. Staff should not enter LOC information for residents manually except when the spell of illness is broken after a Medicare benefit exhaust.
If the LOC section displays an open skilled level of care after a Medicare Part A stay, PointClickCare® will auto-create a Medicare Exhaust claim with the routine monthly billing. If the LOC section indicates that the skilled stay has ended and the resident is no longer at a skilled level of care, PointClickCare® will either auto-create the final No Pay claim upon resident discharge or the billing staff can create the Monthly No Pay Claims on demand in the billing module.
