Vol. 19, Issue 10, October 27, 2017
Oct 27, 2017
Billing Alert for Long-Term Care

Or, could this be the beginning of the end for bundled payments?

Within the last few days, CMS/HHS sent a proposed rule to the Office of Management and Budget (OMB) that would cancel the planned January 2018 rollout of the (mandatory) cardiac and traumatic joint repair/replacement bundles. Specifically, CMS was adding bypass and myocardial infarction DRGs to the BPCI (Bundled Payments for Care Improvement) along with DRGs pertaining to traumatic upper-femur fracture and related joint repair/replacement. The original implementation date was March, then delayed to May and again delayed to October; it now stands at January 2018. Additionally, the proposed rule includes refinement proposals for the current mandatory CJR bundles (elective hip and knee replacements). It is widely suspected that the mandatory nature of the CJR will revert to a voluntary program in 2018.

Oct 20, 2017
Billing Alert for Long-Term Care

In many nontraditional environments, the rise of credentialing is outstripping the development of regulatory and accreditation standards, leaving organizations with scant guidance on how to foster consistency across their spectrum of services and align their vetting practices with setting-specific needs. 

The long-term care industry is a prime example of this incongruity. Because broad-based vetting standards for nursing homes are few and far between, practices can vary depending on a facility’s size, financial position (e.g., for profit, not-for-profit), affiliation (e.g., independent, hospital-based, member of a health system), and scope of service delivery. “It’s kind of all over the place,” says Susan M. Levy, MD, CMD, a nursing home medical director in Delaware and the immediate-past president of AMDA—The Society for Post-Acute and Long-Term Care Medicine. 

Oct 13, 2017
Billing Alert for Long-Term Care

Since its introduction in the skilled nursing facility (SNF) setting, consolidated billing (CB) has been one of the most routine yet misunderstood methods for SNFs to secure Medicare reimbursement.

To better grasp the complex principles, regulations, and systems that surround consolidated billing, SNFs must first have a solid foundation in Medicare Part A coverage and criteria. Without a basic understanding of this powerful insurance plan, SNFs risk committing or contributing to a number of punishable payment offenses, including improper billing, over- and underpayments, fraud, and abuse-related Medicare infractions that can carry serious ramifications, including steep penalties, exclusion from the program, imprisonment, or any combination thereof. 


The below Q&A contains questions that have been transcribed from our live webinar show, “Consolidated Billing for SNFs: A Close Look at the Five Major Categories,” hosted by expert speaker Janet Potter, CPA, MAS, senior manager, advisory services for Marcum LLP, and from frequently asked questions included in Potter’s new book, Medicare Guide for SNF Billing and Reimbursement. For more information on CB for SNFs, listen to the on-demand show or purchase our newly released Medicare billing guide.

Oct 06, 2017
Billing Alert for Long-Term Care

Currently, Medicare pays for services provided by skilled nursing facilities (SNF) under the Medicare Part A SNF PPS benefit on a per diem basis using the RUG-IV grouper. The most significant driver of this reimbursement model is the amount of therapy (days and minutes) provided to a Medicare resident, regardless of outcomes achieved. Through the years, many providers, government entities, and advocacy groups alike have voiced concerns over inappropriate incentives in this current reimbursement model. Caregivers of all types complained about a system that “de-incentivizes” an individualized approach to therapy treatment. Nurses felt their residents’ care was usurped by a system that didn’t consider their overarching needs. Not surprisingly, this led to overutilization; CMS estimates that in 2016, 11% of Medicare fee-for-service (FFS) dollars were paid incorrectly ($41.1 billion), with $2.8 billion of that amount being paid to SNFs for services almost entirely related to therapy.

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