Section 6102 of the Resident Protection Affordable Care Act dictates that SNFs and nursing facilities must have implemented a compliance and ethics program by March 23, 2013. The compliance program should act as a vehicle to detect criminal, civil, and administrative violations.
On June 18, the Long-Term and Post-Acute Care (LTPAC) Health Information Technology (HIT) Collaborative released the 2012-2014 Roadmap for HIT in LTPAC at the LTPAC HIT Summit. The roadmap, the fourth published since the collaborative first formed in 2005, provides a glimpse at what long-term care (LTC) facilities need to do in order to fall in line with progressive technological improvements.
At the heart of Medicare billing is the algorithmic-intensive prospective payment system (PPS), a reimbursement system that attempts to take various patient conditions and services rendered, attach scores to them, adjust them for geography, and ultimately provide payment to SNFs.
Prepayment and postpayment reviews may present a challenge for SNFs, but it's important to remember that a claim review is neither the end of the world nor the end of the game-you do have options under the Medicare appeals process.
Editor's note: This month's "Q&A" was modified from the HCPro book ICD-10 Essentials for Long Term Care, written by Karen L. Fabrizio, RHIA, CPRA. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com/prod-10188. To submit a question for upcoming issues, email Associate Editor Melissa D'Amico at email@example.com.
What is the purpose of the Medicare meeting? This meeting allows the interdisciplinary team (IDT) to review each resident and discuss his or her individual needs related to the skilled services being provided. It also allows for the opportunity to improve resident outcomes through a coordinated system of care delivery. Before we begin reviewing what should be covered during the Medicare meeting, let us discuss who should attend the meeting and how often the meeting should be held.