The following Q&A was written by Reginald Hislop III and adapted from
HCPro’s July issue of Billing Alert for Long-Term Care. For more information,
visit http://hcmarketplace.com/billing-alert-for-long-term-care-1 or call
customer service at 800-650-6787.
With the October 1 implementation date of ICD-10 now on a fast track to fruition—and no further delays in sight—even the most committed holdouts in the provider community have kicked off initiatives to ensure staff, outside business partners, and workflows can withstand the major coding transition. To ensure that preparations made over the past months (or years) ultimately pay off, SNFs should start laying the groundwork for regular facility-wide audits of ICD-10 systems in the aftermath of implementation—a proactive approach that can help providers verify the strength of ongoing transition efforts and catch any snags before they disrupt essential facility processes.
Medicare billing is a domain rife with payer offshoots and evolving regulations that can be difficult to navigate without a strategy to weather claim scrutiny and withstand the gaze of CMS’ various auditing contractors.Enter the triple-check process, a time-tested internal auditing strategy used by proactive long-term care providers to facilitate billing accuracy and compliance the first time a UB-04 claim form is submitted. As its name suggests, triple check is a layered verification process that involves staff members from billing, nursing, and therapy departments—the three core disciplines required to submit a clean claim. But this sturdy foundation is also pliable, allowing a facility to easily adapt the procedure to the various types of claims it files.
Editor’s note: This article is excerpted from the book Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement, by Elizabeth Malzahn-McLaren.Throughout my years of educating providers on the inner workings of the Medicare program, whether it was a boot camp class for newcomers or a refresher course for those in the business for years, there are always instances where I am able to “myth-bust” Medicare. With any program, especially one that has been in existence for 60 years, there are bound to be some myths out there about how the program works.
The Office of Inspector General (OIG) released its fiscal year (FY) 2015 Mid-Year Update last week. The update summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs during the current fiscal year and beyond.