Category: Billing

CGS to hold webinar about RAPs

By Home Health Line. Medicare Administrative Contractor (MAC) CGS is holding a webinar 1 p.m. to 2 p.m. EST Nov. 15 to discuss a transmittal that provides instructions to MACs about monitoring home health agencies’ misuse of requests for anticipated payment (RAPs). “We will discuss the implications to you as a home health provider,” CGS’ […]

Tip: Audits and the False Claims Act’s far reach

If the results of an internal audit determine that Medicare was billed inappropriately, the provider is in potential violation of the False Claims Act, which describes a violator as any entity or person that causes the federal government to make payments for goods or services that are a) not provided, b) provided contrary to federal […]

CMS releases updates to billing for flu vaccine

by The Bottom Line Flu season is August to April. Make sure you’re prepared to start billing for the influenza virus vaccine by staying up to date on the latest code and payment allowance updates. So far, CMS has released the following two notices: 1. Payment allowances for the influenza virus vaccine are updated on […]

Resources for a smooth transition to PDPM

Brought to you by Biller’s Association for Long-Term Care. As SNF and nursing home providers familiarize themselves with CMS’ new Patient Driven Payment Model (PDPM), The Bottom Line is here to keep you educated and up to date on the latest resources, guidance, and best practices as they are made available. Here are this week’s […]

Two strategic responses to bundled payment models

Source: HealthLeaders Media Medicare’s bundled payment programs are profoundly impacting the way acute-care providers are working with their post-acute care partners. Hospitals and health systems participating in federal hip and knee replacement bundles are adopting two post-acute care strategies: limiting referrals to skilled nursing facilities and integrating with SNFs. For hospitals, establishing strong relationships with […]

Free webinar on PDPM

The new SNF payment rule is final. Learn what you need to do to prepare in HCPro’s FREE webinar. When: Wed, Aug 22, 2018 1:00 PM – 1:30 PM EDT Register here. The Patient-Driven Payment Model (PDPM) is designed to replace the current SNF payment methodology known as RUG-IV. The effective date of the change […]

Flowcharts to help you with the Medicare appeals process

Brought to you by Biller’s Association for Long-Term Care. Once an initial claim determination is made, beneficiaries, providers, and suppliers have the right to appeal Medicare coverage and payment decisions. There are five (5) levels in the Medicare A and B appeals process. Standard appeals give the resident the opportunity to have the SNF’s decision […]

CMS proposes to resume pre-claim demo, potentially expand it to more states

Brought to you by Home Health Line. CMS is seeking public input into relaunching a pre-claim review demonstration for home health services. States that are potentially affected are located within the Medicare Administrative Contractor (MAC) Palmetto GBA’s jurisdiction. “CMS proposes initially implementing the demonstration in Illinois, Ohio, North Carolina, Florida and Texas with the option […]

CMS shifts from denials to RTPs for home health claims with no matching OASIS

The following story is from Home Health Line. Home health agencies will now have their claims returned when Medicare systems fail to match those claims with a corresponding OASIS assessment. Based on new requirements that went into effect in April, agencies started receiving denials when a claim was submitted, but a matching OASIS could not […]

Home health device provider to pay for improper billing

Apria Healthcare, which makes home healthcare devices, has been ordered to pay $750,000 to resolve obligations that they billed patients that were already covered by MassHealth, Massachusetts’ state insurance program. The State Attorney General’s office told WWLP.com that between December of 2011 and April of 2017, some 1,000 MassHealth members were inappropriately billed, and of […]