Each year, the OIG identifies healthcare programs that are vulnerable to fraud, waste, and abuse through erroneous claims. Using claim sampling techniques and audits, the OIG identifies billing vulnerabilities and
concerns specific to SNFs. Results of these vulnerabilities are published as reports or listings of common errors and should be analyzed to determine whether they are concerns for your facility.
AMBR members have access to the new and improved members forum, where members can chat online about billing topics and find answers and advice as well as share best practices and experiences. Recently, members have discussed:
Billing for therapy on discharge day
Billing for the time therapists care plan
If you would like to join these conversations or start your own, sigin in here. The log in is the same as your AMBR log in credentials.
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
When it comes to knowing the difference between inclusions and exclusions in Consolidated Billing (CB), it can be extremely confusing for SNFs. Let’s first break it down by the basics. Included refers to items or services that are included in CB and for which the SNF must pay the outside vendor for specific services they provide. Excluded refers to items or services that are excluded from CB and may be billed by the outside vendor directly to Medicare Part B. Sometimes these items or services are also referred to as carve-outs.
The Revenue Integrity Symposium (RIS) brings together some of the industry’s leading experts to train on the most relevant, hot-button issues in long-term care (LTC). It also helps establish a sense of community between providers, fostering opportunities for networking and relationship-building. This year’s symposium will be held October 15–16 in Orlando.
Facilities are required to use modifiers for HCPCS code R0075 (transportation of portable X-rays). The Centers for Medicare & Medicaid Services (CMS) created the modifiers so that a facility can report the number of residents served during a single trip. You should use these codes only if the X-ray equipment was actually transported to the nursing home.