In nearly all provider segments of health care, revenue maximization and integrity are directly tied to compliance and quality ratings. Beginning October 1, 2019, skilled nursing facilities (SNF) that failed to meet the 80% threshold reporting requirement on quality measures (QM) will experience a 2% payment reduction. The cut-off date to meet the compliance level for the quality reporting period October 1, 2018 to December 31, 2018 was May 15, 2019.
This year, AMBR for Long-Term Care is partnering with the National Association for Healthcare Revenue Integrity (NAHRI) to offer a track at the Revenue Integrity Symposium dedicated to the unique billing and reimbursement challenges in that setting.
On Monday, May 20, the Centers for Medicare & Medicaid Services (CMS) posted the MDS 3.0 RAI Manual, v1.17, containing many of the requirements that providers will need to follow to prepare for the Patient-Driven Payment Model (PDPM) effective October 1, 2019.
When the MAC denies a claim, the SNF has the option to appeal the decision through the appeals process and all requests at all levels must be made in writing. Download our infographic for help navigating the different levels and their instructions.