Find your copy of our exclusive AMBR Journal here. This quarter's issue contains in-depth features on:
MDS coordinators to take on quality
The onset of the PDPM marks another evolution for the MDS and MDS coordinators.
Experts uncover little-known risks and opportunities in PDPM
AMBR asked five long-term care experts to share key PDPM opportunities and risks that SNF providers may not have considered leading up to the transition.
Limit financial risk by enlisting billersto forecast profitability prior to admission
Determining and tracking the profitability of each potential new patient will be key to protecting the SNF’s bottom line in PDPM.
Consolidated billing made simple: Manage relationships
Proactively manage relationships with outside patients and external service providers to avoid costly consolidated billing mistakes
CMS announced September 24 that “Medicare Advantage [MA] premiums in 2020 are expected to decline 23% from 2018 while plan choices, benefits and enrollment continue to increase.” This average monthly premium will be the lowest rate in 13 years. Accompanying this announcement, for the first time in a decade, a new Medicare Plan Finder was launched on Medicare.gov.
Starting January 1, 2020, you must use the Medicare Beneficiary Identifier (MBI). We will reject claims you submit with the Health Insurance Claim Number (HICN), with a few exceptions and reject all eligibility transactions.
The Medicare Guide for SNF Billing and Reimbursement, Second Edition will help tackle the newest and most complex billing issues. This book will help billing staff understand the PDPM rate calculation methodology, identify opportunities to maximize reimbursement and accurately project revenue, correctly bill for Medicare Part A and Part B claims, and more!
Effective April 1, Medicare Advantage and Part D plans will reject or deny claims that are submitted for items prescribed or furnished by an individual or entity on the Preclusion List. The Preclusion List consists of individuals and entities that fall within either of the following categories.
In a press release dated April 1, 2019, CMS announced finalized updates to items that Medicare Advantage (MA) plans will cover for 2020, a change that the agency says will “[give] chronically ill patients with Medicare Advantage the possibility of accessing a broader range of supplemental benefits that are not necessarily health-related but have a reasonable expectation of improving or maintaining the health or overall function of the enrollees.”