May 24, 2019
 | 
The Bottom Line

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!

May 16, 2019
 | 
Billing Alert for Long-Term Care

The UB-04 is made up of form locators (FL), or boxes to be completed. Some of the FLs are required, some are optional, and some are not used in the SNF setting. If any required pieces are missing, the claim will not pass the system edits when it is submitted to the MAC. Although most Medicare billing is done electronically and the UB-04 is completed largely by the billing software, it is important for Medicare billers to be familiar with the pieces of information required on the claim and how to complete the form.

May 16, 2019
 | 
The Bottom Line

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.

May 03, 2019
 | 
The Bottom Line

In our first edition of the AMBR Journal, we interviewed AMBR advisory board member Maureen McCarthy, RN, BS RAC-MT, QCP-MT, DNS-MT, about her experience working as a biller in long-term care. McCarthy is now a successful business woman, president a consulting company, and an expert in her field. Here’s what she had to say about billers who want to network more and communicate with their peers, but aren’t sure where to start.

May 03, 2019
 | 
Billing Alert for Long-Term Care

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.

May 03, 2019
 | 
The Bottom Line

The 837I (Institutional) is the standard format used by institutional providers to transmit health care claims electronically. The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. In addition to billing Medicare, the 837I and Form CMS-1450 may be suitable for billing various government and some private insurers.

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Tuesday, October 15, 2019 - 07:00

2019 Revenue Integrity Symposium

The 2019 Revenue Integrity Symposium covers topics essential to revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings.

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jfitzgerald@hcpro.com
Karen A. Thomas
Victorine Courtois