Effective April 1, Medicare Advantage and Part D plans will reject or deny claims that are submitted for items prescribed or furnished by an individual or entity on the Preclusion List. The Preclusion List consists of individuals and entities that fall within either of the following categories.
The Department of Labor has published three Notices of Proposed Rulemaking (NPRM) regarding the minimum salary requirement for an employee to qualify for overtime, which forms of payment can be included and excluded in the “time and one-half” calculation when determining workers’ overtime rates, and clarifications of and revisions to the responsibilities of employers and joint employers to employees in joint employer arrangements.
Review these Consolidated Billing Case Studies that illustrate common circumstances that can affect a SNF’s billing practices for beneficiaries who receive services from outside entities during a Part A stay.
SNFs see zero reimbursement value from no-pay bills and benefits exhaust claims, so no-pay bills often go overlooked. Billers are instead looking to deal with issues that will result in cash flow for the facility. So what exactly are no-pay bills, and where does a benefits exhaust situation come into play?
In a press release dated April 1, 2019, CMS announced finalized updates to items that Medicare Advantage (MA) plans will cover for 2020, a change that the agency says will “[give] chronically ill patients with Medicare Advantage the possibility of accessing a broader range of supplemental benefits that are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees.”
Download the first issue of AMBR Journal! In this issue we discuss how to focus on new incentives under PDPM without scrapping therapy; how to get your compliance and ethics program into shape before November 1; ICD-10 training for your staff; a breakdown of consolidated billing, category I; and what billers can do to properly handle long-term care insurance policies.