Q: When will the reimbursement rates begin decreasing?
A: After the 20th day of a resident’s stay, the PT/OT rate components will decrease by 2% every 7 days. The NTA rate component will be reduced after the third day of a resident’s stay by two-thirds of the initial NTA rate component amount.
Medicare documentation must provide accurate information to support the necessity of skilled services provided to a resident. Nursing documentation is vital and must reflect the reason for admission to skilled services, the delivery of skilled services, and justification for skilled services to continue. All of these elements, combined with the documentation within the entire medical record, help to justify and support your Medicare claim.
The interplay of Medicare billing and fraud seems like a perennial hot spot among SNFs. When an internal audit reveals potentially fraudulent discrepancies between care rendered and services billed on Medicare claims, determining the next steps can be tricky. Correcting faulty practices that led to the lapse is a given, but are broader legal actions necessary?
Many staff members in a skilled nursing facility (SNF) have contributed to the minimum data set (MDS) under the current SNF prospective payment system, but few are able to explain how that documentation converts to a dollar amount or understand how the Centers for Medicare & Medicaid Services (CMS) defines a RUG rate. To help providers prepare for the transition from RUG-IV to CMS’ new Patient Driven Payment Model (PDPM), a calculation worksheet has been made available so staff will be able to explain how care services translate into reimbursement rates by the new payment model’s implementation date, October 1, 2019.