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.
Review these Consolidated Billing Case Studies that illustrate common circumstances that can affect a SNF’s billing practices for beneficiaries who receive services from outside entities during a Part A stay.
We’re adding a new member benefit to your AMBR membership: A quarterly journal featuring timely compliance updates, expert analysis, and strategies for tackling the top challenges facing long-term care professionals.
I.I. Additional surgery HCPCS exclusions: All of the HCPCS listed on the Update File for consolidated billing Category 1 are exclusions, except for minor surgical procedures. Minor surgeries listed on the file are included in SNF consolidated billing and are the responsibility of the SNF. These procedures are considered minor because they may be safely performed either in the physician’s office or in the SNF. Some examples of included minor surgical procedures include toenail debridement, application of certain types of casts, and blood transfusion.
Navigating the myriad rules, policies, and special cases that shape SNF CB—including distinguishing between services that are included in consolidated billing and those that must be billed for separately—can be daunting, but learning to do so is critical. CMS’ charts published in their revised SNF PPS booklet can help billers easily determine whether institutional or professional services are included or excluded from CB. Download these mapping tools for determining institutional services and professional services under CB.
Background: To illustrate the different billing requirements that apply to professional and technical components of a service, consider Malcolm, a beneficiary who visits the physician office in the midst of a Part A SNF stay to receive a chest x-ray. The physician performs the x-ray, then interprets the results. The administration of the x-ray constitutes the technical component, whereas the interpretation of the results represents the professional component of the total x-ray service.
In preparing for the holiday festivities, it is essential for friends and family to understand that even if their loved ones are in a nursing home or skilled nursing facility (SNF), they can still partake in the holiday parties and goodie exchanges without putting their Medicare coverage at risk. Identifying the specific effects that a beneficiary’s leave of absence (LOA) can have on billing has long been hazy territory for SNFs, however, as they sometimes confuse Medicare’s consolidated billing (CB) requirements with internal definitions and policies they’ve developed for a beneficiary’s temporary exit from the facility.