Completing a Medicare claim correctly isn’t the only requirement to ensure accurate Medicare reimbursement and compliance. Additional steps must be taken to determine that Medicare is the proper payer—or, if it is not, who is. And because medical review is becoming the norm rather than the exception, it is important that claims be triple checked prior to submitting them for payment. If an error is made, it could result in overpayment to the SNF or denial of the claim. Either way, a pattern of errors will be a red flag to the Medicare Administrative Contractor (MAC). Therefore, it behooves the SNF to review its own claims and documentation closely before submitting them. This article outlines several methods for doing so.
When will the Medicare trust funds run out? That depends on who you talk to. According to CMS, in 2016, Medicare spending was $672.1 billion or nearly 4% of the gross domestic product. This amount represented an increase of nearly 4% over Medicare spending in 2015.
Q: I have heard that the transition to the Resident Classification System, version 1 (RCS-1) will probably be introduced the same way the prospective payment system (PPS) was (with RCS-1 being introduced in increments over a four-year period). Is this correct, and if CMS chooses this route, will the PPS schedule need to be maintained for the next three CMS fiscal years?
A: There is some talk about a phase-in system, in which case, yes; the PPS schedule would be maintained for the next three fiscal years. I foresee a transition from the minimum data set (MDS) v1.15 to MDS v1.16, with all existing covered residents requiring a new MDS on October 1, 2018. The final rule on RCS-1 will have more details when it is released.
In January of this year, the Centers for Medicare & Medicaid Services (CMS) released a newly revised Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) along with newly developed, concise, and separate instructions for form completion. The revised SNF ABN has the requirements from the Denial Letters and looks similar to the ABN, with three options for Original Fee-For-Service Medicare beneficiaries to choose from.