Major category V: Therapy services included in consolidated billing

May 02, 2019
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The Bottom Line

Therapy services under major category V are included in the SNF daily rate and accounted for on the consolidated bill for beneficiaries who are in the midst of a Part A stay. However, once a beneficiary who also has a Part B plan exhausts his or her Part A benefits, the SNF must begin billing therapy services to Part B.

Stark Law tagged as barrier, CMS to perform top-to-bottom review

May 02, 2019
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The Bottom Line

During her speech at the National Association of Accountable Care Organizations Spring 2019 Conference, CMS Administrator Seema Verma referred to the Stark Law as an outdated regulation that “addressed real issues regarding the potential for financial incentives to inappropriately influence how physicians make decisions” when it was enacted 30 years ago, but that serves little purpose under a value-based system.

Proposed SNF payment rule for FY2020: What you need to know

May 02, 2019
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Billing Alert for Long-Term Care

During a Skilled Nursing Facilities (SNF)/Long Term Care Open Door Forum (ODF) held Tuesday, April 23, 2019, Centers for Medicare and Medicaid Services (CMS) officials discussed the Proposed Fiscal Year 2020 Payment and Policy Changes for Medicare Skilled Nursing Facilities (CMS-1718-P) published in the Federal Register on April 25, 2019.

Recent action on Biller’s Talk

May 02, 2019
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The Bottom Line

Your fellow billers want to hear from you on AMBR’s talk forum, Biller’s Talk. A member recently asked, “I have heard this both ways: For a skilled resident - g tube feeding and skilled care. For a new gtube, once the nutrition and tube is operationally stable, then can cut from skilled care to utilize remaining days at another date. OR, for a new gtube, when skilled, must exhaust 100 days if feedings remain at 26% and 501cc. Is there a specific reference for this?”

PBJ and SNF QRP submissions due May 15

Apr 25, 2019
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The Bottom Line

Staffing data from Jan 1 through March 31 must be submitted no later than 45 days from the end of the quarter. The final submission deadline for this quarter is May 15, 2019. On a SNF open door forum held earlier this week, officials instructed facilities to review their monthly provider preview reports in their CASPER folder for feedback on their most recent submission.

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.

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