CMS has confirmed that they are processing claims and eligibility requests with the Medicare Beneficiary Identifier (MBI), showing that providers are successfully using the new number. This week the agency began mailing new Medicare cards to people who live in Wave 6 states, which include Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, and Wyoming.
Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five (5) levels in the Medicare A and B appeals process. Standard appeals give the resident the opportunity to have the SNF's decision that care will not be covered by Medicare reviewed after the care is rendered. Beneficiaries who elect this second appeal option should be cognizant of the possibility of financial liability if the appeal is not successful.
Join us in Chicago on Monday and Tuesday, August 13-14, to attend our SNF Regulatory Update Boot Camp! This event covers the industry changes that impact your clinical and financial operations while providing strategies for achieving and sustaining compliance in the future marketplace. Attendees can expect to learn best practices for leading and managing facilities to avoid survey issues, claims audits, and improper Medicare payments.
The Patient-Driven Payment Model (PDPM), as proposed, is designed to replace the current SNF payment methodology known as RUG-IV. Unless date changes, etc. are made by CMS post commentary review, the effective date of the change (from resource utilization groups to PDPM) is October 1, 2019. PDPM as an outgrowth of the initially proposed resident classification system (RCS) and received commentary is a simplified payment model designed to be more holistic in patient assessment, capture more clinical complexity, eliminate or greatly reduce the therapy focus by eliminating the minute levels for categorization, and simplifying the assessment process and schedule (reducing to three possible assessments/MDS tasks). Below is a summary of PDPM core attributes/features as proposed. Click here to access the PDPM Calculation Worksheet for SNFs that provides additional details beyond the reference points below.
CMS has started mailing new Medicare cards to people with Medicare who live in Wave 2 states and territories: Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, and Oregon. CMS continues to mail new cards to people who live in Wave 1 states, as well as nationwide to people who are new to Medicare.
Completing a Medicare claim correctly isn’t the only requirement to ensure accurate Medicare reimbursement and compliance. Additional steps must be taken to determine that Medicare is the proper payer—or, if it is not, who is. And because medical review is becoming the norm rather than the exception, it is important that claims be triple checked prior to submitting them for payment. If an error is made, it could result in overpayment to the SNF or denial of the claim. Either way, a pattern of errors will be a red flag to the Medicare Administrative Contractor (MAC). Therefore, it behooves the SNF to review its own claims and documentation closely before submitting them. This article outlines several methods for doing so.
The Billers’ Association is seeking long-term care managers, revenue cycle enthusiasts, and billing professionals to join our growing ad-hoc list of experts interested in contributing to articles in our monthly publication, Billing Alert for Long-Term Care. This digital newsletter provides expansive regulatory coverage, including MDS changes, reimbursement issues, and expert advice and analysis to help improve job performance in all aspects of the revenue cycle management system.
For years, confusion has surrounded the conditions under which older adults can receive physical, occupational and speech therapy covered by Medicare. Services have been terminated for some seniors, such as those with severe cases of multiple sclerosis or Parkinson’s disease, because therapists said they weren’t making sufficient progress. Others, including individuals recovering from strokes or traumatic brain injuries, have been told that they reached an annual limit on services and didn’t qualify for further care.
CMS started mailing newly-designed Medicare cards with the new Medicare Beneficiary Identifier (MBI), or Medicare Number. People enrolling in Medicare for the first time will be among the first to get the new cards, no matter where they live. Current Medicare beneficiaries will get their new cards on a rolling basis over the coming months. CMS will continue to accept the Health Insurance Claim Number (HICN) through the transition period.
CMS will host a Special Open Door Forum to give providers an opportunity to ask questions about the New Medicare Card Project on Tuesday, March 20 from 2:00pm-3:00pm, ET. Providers are encouraged to use this call to get answers to questions and get prepared to accept the new Medicare Beneficiary Identifier starting April 1, 2018.