Case study: Challenges facing SNF Medicare billers

May 16, 2019
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The Bottom Line

Communication disconnects between the biller and other departments happen frequently. Billers do not always receive information that affects compliant billing. This may be due to fragmentization of departments, lack of meaningful Medicare utilization systems, differences in software (e.g., MDS vs. billing) that are not interoperable, or an unawareness from the interdisciplinary team (IDT) as to the importance of billers in the Medicare reimbursement process.

UB-04 series Part 3 of 3: Leave of absence

May 03, 2019
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Billing Alert for Long-Term Care

When a Medicare Part A beneficiary is absent but not discharged, for reasons other than hospital or other SNF admission, a leave of absence (LOA) bill is required. The day of discharge, the day of death, or the day on which a beneficiary begins an LOA is not counted as a utilization day and is not billed. The exception to this rule is when the beneficiary is admitted to the SNF with the expectation that he or she will remain overnight but is discharged, dies, or is transferred to a nonparticipating provider before midnight of the same day.

Q&A: Therapy will still tie into your bottom line under PDPM

Apr 25, 2019
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Billing Alert for Long-Term Care

Q. Should therapy treatment practices change under the Patient-Driven Payment Model (PDPM)?

A. Even though therapy minutes are no longer relevant to the provision and payment for therapy, CMS has assumed that most therapy will continue to be provided one-on-one. SNFs with contract providers need to take great care to ensure that the contractor does not automatically ramp up inpatient therapy on a group and concurrent basis to the 25% threshold!

Unless the facility has experienced a significant change in overall case mix from when under resource utilization groups (RUG) to PDPM (fewer therapy-qualified residents), there would be no logical clinical reason to change treatment practices.

TKA removed from Medicare IPO list: Implications for SNFs

Mar 22, 2019
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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
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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.

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