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!
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 Patient-Driven Payment Model (PDPM) goes into effect October 1, 2019—just six months away. The new model bases reimbursement on the patient’s needs and acuity rather than the volume of services provided.
As a member of the Billers’ Association for Long-Term Care, you have access to our talk forum, where billing professionals can ask and answer questions to help each other solve billing and reimbursement challenges. A recent biller brought up a good question: Do you therapists bill the time they participate in the SNF care plan meeting?
I.I. Additional surgery HCPCS exclusions: All of the HCPCS listed on the Update File for consolidated billing Category 1 are exclusions, except for minor surgical procedures. Minor surgeries listed on the file are included in SNF consolidated billing and are the responsibility of the SNF. These procedures are considered minor because they may be safely performed either in the physician’s office or in the SNF. Some examples of included minor surgical procedures include toenail debridement, application of certain types of casts, and blood transfusion.
New CMP amounts that have been adjusted for inflation and are effective October 11, 2018 were announced in a final rule published by CMS on January 22, 2019. The adjusted amounts apply to CMPs assessed on or after October 11, 2018. For SNFs, NFs and SNF/NFs, the CMP Analytic Tool instructions and calculations will be updated to reflect these changes. Appendix A of the final rule announcement contains the new rates, which have seen an increase.
As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption. That would be the International Classification of Diseases 11th Revision, otherwise known as ICD-11, which was released by the World Health Organization (WHO) in June after a decade in development. And U.S. officials are already considering a switch to the codes—for use on death certificates.