Oct 04, 2019
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The Bottom Line

Are you in compliance with Qualified Medicare Beneficiary (QMB) billing requirements? People with Medicare who are in the QMB program are also enrolled in Medicaid and get help with their Medicare premiums and cost-sharing. Medicare providers may not bill people in the QMB program for Medicare deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Providers who inappropriately bill individuals enrolled in QMB are subject to sanctions.

Sep 26, 2019
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Billing Alert for Long-Term Care

CMS announced proposed changes to the Medicare long-term care requirements that would reform “unnecessary, obsolete, or excessively burdensome” requirements for SNFs on July 17. The proposed rule, “Medicare & Medicaid Programs; Requirements for Long-Term Care Facilities: Regulatory Provisions to Promote Efficiency and Transparency” (CMS-3347-P), fueled by the Trump administration, aims to reduce red tape surrounding SNF compliance and regulations.

Sep 26, 2019
 | 
The Bottom Line

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.

Sep 19, 2019
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The Bottom Line

CMS will hold an open door forum on September 19 for SNFs and LTCs. Discussions will focus on:

  • PDPM updates
  • PBJ updates
  • MS-6058-FC Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process
  • SNF QRP resource update

If you wish to participate, dial 1-888-455-1397. Conference ID: 4676500

Aug 29, 2019
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The Bottom Line

The Revenue Integrity Symposium (RIS) will bring opportunities for financial professionals to gain knowledge in their field by learning about what other experts have to say and what best practices may be beneficial for the Patient-Driven Payment Model (PDPM) transition. This year’s symposium will be held October 15–16 in Orlando.

There are a variety of PDPM sessions that will be beneficial to finance professionals in the long-term care (LTC) continuum.

I will be speaking on changes to the LTC billing process PDPM brings, such as a focus on weekly Medicare meetings, a triple-check focus, diagnosis code reviews, rejected claims, and gap billing.

Read more and learn about AMBR discounts.

Aug 16, 2019
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The Bottom Line

A class-action lawsuit filed by 14 SNF residents in 2011 challenging the Medicare three-day rule saw its first day in court on August 12. The lawsuit addresses the rule requiring residents to be admitted to an acute-care hospital for a minimum of three days prior to entering a SNF to receive Medicare coverage. The residents were unable to use their Medicare benefit because they had been under observation in the hospital, rather than admitted.

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Featured Event

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
jfitzgerald@hcpro.com
tswartz@hcpro.com
tswartz@hcpro.com