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 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.
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.
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.
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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.
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.