Vol. 18, Issue 4, April 29, 2016
Apr 29, 2016
Billing Alert for Long-Term Care

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed Fiscal Year (FY) 2017 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). On April 28, 2016, CMS held an Open Door Forum to discuss the following items included in the proposal:

  • SNF PPS proposed FY 2017 rates
  • SNF VBP Program potentially preventable readmission measure
  • SNF Quality Reporting Program (QRP) proposes additional policies and measures
  • SNF Payment Models Research (PMR) update
Apr 22, 2016
Billing Alert for Long-Term Care

This Q&A is adapted from HCPro’s January 13, 2016, webcast, with Melissa Korey and Janet Potter, CPA, MAS, at Marcum, LLP

Q: Can you give an example of a circumstance when a resident would choose not to elect their Medicare benefit?

A: One example is if a husband and wife are living together in the nursing facility, in the non-certified section, and one of the spouses would qualify for Medicare, but they don’t want to leave the room to move to a certified section. Another example could be if an individual has Alzheimer’s or another dementia-type issue, and it’s better for their overall care to stay in the same room and not be relocated for the time period.

 Read more.

Apr 15, 2016
Billing Alert for Long-Term Care

A new contractor and a new set of rules signify an upgrade from the previous program, but concerns linger about exactly what will be reviewed. New updates to manual medical reviews (MMR) of therapy claims will likely have therapists and LTC providers breathing a sigh of relief—and then quickly bracing for a new round of audits.

Apr 08, 2016
Billing Alert for Long-Term Care

In early 2014, the Centers for Medicare and Medicaid Services (CMS) released clarifications for its Medicare Benefit Policy Manual that would change how long-term care facilities documented therapy, especially surrounding the long-practiced “improvement standard”—which contradicts Medicare law. The clarifications were required due to the landmark case of Jimmo v. Sebelius.

Apr 01, 2016
Billing Alert for Long-Term Care

Although the final rule offers more clarification on when the 60-day clock starts ticking, new questions have emerged about what constitutes ‘reasonable diligence’. In February, CMS published its long-awaited final rule on returning Medicare overpayments to the government within 60 days, a provision that has elicited much controversy and provider confusion since its inclusion in the Affordable Care Act (ACA). But federal officials may have created dozens more questions for every question CMS answered in the latest final rule.

Quarterly Member Calls

Members-only calls

Enjoy upcoming and past Quarterly Calls with your AMBR Membership! Click here!

Access sample white papers, tools, analysis, and resources.

Featured Event

Tuesday, October 6, 2020 - 07:00

2019 Revenue Integrity Symposium

The 2020 Revenue Integrity Symposium covers topics essential to revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings.

AMBR Forums

To participate in the AMBR forum discussions, you must be a member of the AMBR community. Please subscribe today or login for access.