SNF business offices all have a series of compliance checks and balances they do on a daily, weekly, and monthly basis. But do you realize you have them? And does the corporate compliance team know what you are doing so they can include your great work in their compliance program? If you are part of a larger organization and your compliance team is mostly in a different location, they may not be aware of all the daily compliance review you do. It is important to take a few minutes to document your processes to ensure that correct UB-04s are going out the door, and to share those processes with your compliance team.
There may be times during a resident’s Medicare Part A stay that an advanced beneficiary notice (ABN) is utilized. A SNFABN is a Centers for Medicare & Medicaid Services (CMS)-approved model written notice that the SNF gives to a Medicare beneficiary, or to her or his authorized representative, before extended care services or items are furnished, reduced, or terminated.
Navigating the myriad rules, policies, and special cases that shape skilled nursing facility (SNF) consolidated billing (CB)—including distinguishing between services that are included in consolidated billing and ones that must be billed for separately—can be daunting, but learning to do so is critical for facilities. Achieving compliance in the CB domain is not only requisite for receiving earned reimbursement, but it can also influence the outcome of a SNF’s Centers for Medicare & Medicaid Services (CMS) audits, as well as prevent fraud and abuse–related Medicare infractions that can carry serious ramifications, including steep penalties, exclusion from the program, imprisonment, or any combination of these.
Writing off an uncollectable debt, especially in long-term care, is not a preferred means for closing an account. Especially during this period when Medicaid and Medicare cutbacks have ensued, collecting on your accounts receivable is imperative. Yet, writing off accounts that cannot be collected does happen. To avoid having to write off an account, you should maintain frequent contact with your accounts aging document. This is an important document that you can produce with your accounting software. Watch for those accounts that go past 30 days. The longer an account is delinquent, the more difficult it is to collect, especially in totality, on the account.
Editor’s note: This article is excerpted from the book Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement, by Elizabeth Malzahn-McLaren.Throughout my years of educating providers on the inner workings of the Medicare program, whether it was a boot camp class for newcomers or a refresher course for those in the business for years, there are always instances where I am able to “myth-bust” Medicare. With any program, especially one that has been in existence for 60 years, there are bound to be some myths out there about how the program works.