Effective billing begins before a resident ever steps foot in the nursing home. Verification of Medicare benefits and SNF eligibility sets the stage for proper service delivery and claims completion. Without this due diligence, SNFs may provide and bill for inappropriate care—actions that can incite a host of costly consequences.
Every spring, CMS makes available the Program for Evaluating Payment Patterns Electronic Report (PEPPER) for SNFs. The agency offers variant reports for a number of other Part A provider types, including hospitals, home health agencies, and hospices. These tools, which provide comparative billing data across a handful of setting-specific risk areas, can play an important part in a provider’s corporate compliance program. To get the most out of the report, SNFs should have a strategy in place for integrating its findings into their corporate compliance program before accessing this year’s edition.
Beginning next month, providers in 67 metropolitan statistical areas (MSA) throughout the U.S. will participate in the Comprehensive Care for Joint Replacement (CJR) model, a mandatory bundled payment program for care episodes initiated by a hip or knee replacement. The end goal: to improve the quality and coordination of care experienced during and after a joint replacement—the most common inpatient surgery for Medicare beneficiaries, and one that can carry a lengthy recovery and rehabilitation period.
Starting July 1, skilled nursing facilities (SNFs) will be required to submit staffing data through CMS’ Payroll-Based Journal (PBJ), a requirement that has finally come to fruition six years after it was finalized in the Affordable Care Act (ACA).