TKA removed from Medicare IPO list: Implications for SNFs

Mar 22, 2019
 | 
Billing Alert for Long-Term Care

In the final 2018 outpatient prospective payment system (OPPS) rule released by CMS, total knee arthroplasty, also known as total knee replacement (TKA/TKR), was removed from the Medicare inpatient-only (IPO) list. The IPO list includes procedures that are only paid under the hospital inpatient prospective payment system.

Congress makes another attempt to eliminate three-midnight rule barriers to SNF coverage

Mar 15, 2019
 | 
The Bottom Line

This March, Congress will re-introduce legislation with bipartisan support to allow Medicare beneficiaries that are hospitalized in observation to qualify for SNF coverage following their hospital stay. Currently, under the three-midnight rule, beneficiaries mThis March, Congress will re-introduce legislation with bipartisan support to allow Medicare beneficiaries that are hospitalized in observation to qualify for SNF coverage following their hospital stay. Currently, under the three-midnight rule, beneficiaries must have been categorized as being an inpatient in a hospital for three midnights in order to qualify for a Medicare Part A SNF stay.

UB-04 series, Part 1 of 3: Monthly no-pay and expanded monthly no-pay

Mar 01, 2019
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Billing Alert for Long-Term Care

The UB-04 is a multipurpose claim form used for all Medicare providers, including home health agencies and hospitals, but not all fields apply to SNFs. SNFs must submit bills in sequence for each beneficiary they care for. Out-of-sequence bills will result in an error message similar to this: Bills for a continuous stay or admission must be submitted in the same sequence in which services are furnished. If the provider has not already done so, please submit the prior bill. Then, resubmit this bill after you receive the remittance advice for the prior bill. Billers for SNFs must understand the bill types and their codes to submit them in the correct sequence.

Take this 5-minute survey for a chance to win a webinar

Feb 15, 2019
 | 
The Bottom Line

We’re conducting a brief survey to better understand your PDPM training needs. The first five participants who take the survey will receive a free, on-demand webinar of your choice. This is a quick survey and we greatly appreciate your feedback.

 Here's the URL to take the survey. Click the link or copy and paste it into your browser: https://www.surveymonkey.com/r/B53QM5G.

Please complete the survey before Monday, February 18 to be entered to win. Thank you!

New mobile app allows consumers to see what Original Medicare covers

Feb 08, 2019
 | 
The Bottom Line

Earlier this month CMS announced the release of a new app, “What’s Covered,” that allows people to quickly look up what Original Medicare covers using their mobile device. In addition to the “What’s Covered” app, CMS is enabling beneficiaries to connect their claims data to applications and tools developed by innovative private-sector companies to help them understand, use, and share their health data through Blue Button 2.0.

Determining when to adjust or cancel a claim

Feb 08, 2019
 | 
The Bottom Line

If a provider discovers a claim was paid incorrectly or in error, it is important that he or she takes the initiative to make a correction. Adjustment claims are also appropriate to add other charges to the claim, such as if an invoice for an ancillary item is received after the billing has been completed or was simply overlooked when the claim was prepared. Keeping Medicare funds that were improperly paid is considered Medicare fraud.

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