A new MLN Matters Article MM11347 on Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2020 is available. Learn updates to payment rates beginning October 1.
This year, AMBR for Long-Term Care is partnering with the National Association for Healthcare Revenue Integrity (NAHRI) to offer a track at the Revenue Integrity Symposium dedicated to the unique billing and reimbursement challenges in that setting.
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!
Communication disconnects between the biller and other departments happen frequently. Billers do not always receive information that affects compliant billing. This may be due to fragmentization of departments, lack of meaningful Medicare utilization systems, differences in software (e.g., MDS vs. billing) that are not interoperable, or an unawareness from the interdisciplinary team (IDT) as to the importance of billers in the Medicare reimbursement process.
When a Medicare Part A beneficiary is absent but not discharged, for reasons other than hospital or other SNF admission, a leave of absence (LOA) bill is required. The day of discharge, the day of death, or the day on which a beneficiary begins an LOA is not counted as a utilization day and is not billed. The exception to this rule is when the beneficiary is admitted to the SNF with the expectation that he or she will remain overnight but is discharged, dies, or is transferred to a nonparticipating provider before midnight of the same day.
Q. Should therapy treatment practices change under the Patient-Driven Payment Model (PDPM)?
A. Even though therapy minutes are no longer relevant to the provision and payment for therapy, CMS has assumed that most therapy will continue to be provided one-on-one. SNFs with contract providers need to take great care to ensure that the contractor does not automatically ramp up inpatient therapy on a group and concurrent basis to the 25% threshold!
Unless the facility has experienced a significant change in overall case mix from when under resource utilization groups (RUG) to PDPM (fewer therapy-qualified residents), there would be no logical clinical reason to change treatment practices.
SNFs see zero reimbursement value from no-pay bills and benefits exhaust claims, so no-pay bills often go overlooked. Billers are instead looking to deal with issues that will result in cash flow for the facility. So what exactly are no-pay bills, and where does a benefits exhaust situation come into play?