Vol. 20, Issue 10, October 26, 2018
Oct 26, 2018
Billing Alert for Long-Term Care

The Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of healthcare services provided to Medicare beneficiaries and the identification of underpayments to providers; by doing so, the Centers for Medicare & Medicaid Services (CMS) can implement actions that will prevent future improper payments in all 50 states.

Oct 19, 2018
Billing Alert for Long-Term Care

Coding tells the detailed story of your facility’s patient care, morbidity, and sometimes demographic information. ICD-10 coding in long-term care has several purposes, including to:

  • Collect diagnostic and statistical data
  • Support clinical decision-making
  • Verify medical necessity
  • Validate need for supportive procedures, treatments, and therapies
  • Support reimbursement for services provided
  • Determine RUG scores
  • Correctly code diseases on the MDS, UB-04, medical reports, therapy treatments, and ancillaries
Oct 12, 2018
Billing Alert for Long-Term Care

Under CMS’ new payment model to be implemented October 1, 2019, the Patient-Driven Payment Model (PDPM), clinical complexity will be the focus of increased payment opportunity. Facilities will receive greater reimbursement for more acute (sicker) patients, such as those with certain cancers, HIV/AIDS, multiple pressure ulcers, and morbid obesity.

Such residents tend to have greater care costs (drugs, equipment, supplies, etc.). Consolidated billing (CB) requirements describe what care costs are covered by the skilled nursing facility (SNF) prospective payment system (PPS) and occasionally Medicare Part B.

Oct 05, 2018
Billing Alert for Long-Term Care

As clinical teams work diligently to educate their residents about the flu, and offer and/or administer the influenza virus (or flu) vaccination to residents, the billing team should ensure that costs for the vaccination are captured and revenue is not left on the table for the billable service.

Medicare Part B pays 100% of flu vaccine costs, including costs associated with its administration. Part D benefits do not cover these costs. Payment is made on a cost basis for the vaccine and is based on the physician fee schedule for the administration. Deductibles and coinsurance do not apply to influenza, pneumococcal, or hepatitis B vaccines.

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