Effective April 1, Medicare Advantage and Part D plans will reject or deny claims that are submitted for items prescribed or furnished by an individual or entity on the Preclusion List. The Preclusion List consists of individuals and entities that fall within either of the following categories.
Download the first issue of AMBR Journal! In this issue we discuss how to focus on new incentives under PDPM without scrapping therapy; how to get your compliance and ethics program into shape before November 1; ICD-10 training for your staff; a breakdown of consolidated billing, category I; and what billers can do to properly handle long-term care insurance policies.
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?
by Deborah Collum, national director of revenue cycle management at Covenant Retirement Communities and AMBR Advisory Board member
Implementing a revenue cycle management (RCM) model in your facility will help you streamline your billing process to prepare for the Patient-Driven Payment Model (PDPM) to be implemented October 1, 2019. If your billing office still follows an accounts receivable (AR) model that only focuses on outstanding accounts, you’re not alone—but it may be time for a change.
The “Consolidated billing made simple” series delves into the ins and outs of consolidated billing. This series will untangle CMS regulations and give billers a solid understanding of the rules so that they can apply them appropriately.
It’s not common for SNFs to admit residents with a long-term care insurance policy, so billers are often at a loss when one comes across their desks. Just like with any healthcare insurance plan, it’s important that billers know what these policies are, what they cover, and how to bill the insurance companies.