Category: News

FREE Consolidated Billing white paper

Consolidated billing can be a complicated task. Sign up to receive a FREE white paper featuring a sample of questions and answers highlighted in a recent HCPro webcast, “SNF Consolidated Billing: Who Really Has to Pay All These Invoices?” presented by long-term care billing expert Janet Potter, CPA, MAS. The top 3 questions answered in this white paper include: Q: […]

Upcoming webcast: Nurse Leadership: Leading Change With Enthusiasm to Enhance Person-Centered Care. January 20, 2015 from 1:00 p.m.–2:30 p.m. (ET)

Nurse Leadership: Leading Change With Enthusiasm to Enhance Person-Centered Care Presented on January 20, 2015 from 1:00 p.m.–2:30 p.m. (ET) Presented by Kelly Smith Papa, MSN, RN Provide talented team members the opportunity to lead that aligns with your facility’s values. When challenges arise in a facility, nurse leaders are often called upon to lead […]

Ask the expert: qualifying stay

Q:What are the rules regarding a qualifying hospital stay at a hospice inpatient facility? Can a stay at a hospice inpatient facility be used as a qualifying hospital stay for a skilled nursing facility? A: The regulations are pretty clear that the hospice would need to meet the definition of a hospital.  Most inpatient hospice facilities […]

Ask the expert: 60 days of wellness

Q: If a hospital admission starts the 60 day spell of illness, then do days spent in the hospital not count? A: A hospital admission of 3 consecutive days is a requirement to begin a spell of illness, which is 100 SNF days in the complete spell of illness. After using the 100 hundred days, a beneficiary […]

ICD-10 and you

Is your facility ready for the transition to ICD-10? Are you still preparing? What are the obstacles you face in getting more prepared? Do you need more preparation in implementation, physician documentation, dual-coding, office management? We are working on a new ICD-10 book, due out in May 2015. Please tell us your thoughts! Comment here, or email Managing […]

Ask the expert: Medicare Advantage

Q:  We have a resident being admitted with a new G-tube, NPO status and receiving all nutrition via tube feeding.  The resident is Medicare Advantage (Humana).  Under the Medicare Benefit policy manual this would be considered a direct skilled nursing service, so we could potentially skill this resident for 100 days since it is the beneficiary’s […]

Ask the expert: Wellness

Q:  I have a resident who was readmitted to the hospital on his 60th day of his spell of wellness. Did he break the spell of wellness on day 60? Is he entitled to a new benefit period, or did he have to be on day 61 to begin a new benefit?   A: Unfortunately, it had […]

Ask the expert: Observation time

Q: Does a spell of wellness end with observation time in a hospital?   A: Technically, it ends with a hospital admission.  Observation status is not addressed as one of the two variables.  

Ask the expert: Medicare coverage

Q: If a resident used 100 days with the peg tube at another facility, stays in that facility more than 60 days after they have a 3-day hospital stay, can we pick up under Medicare and skill for PT/OT even though resident still has the peg tube? A: If the other facility is a Medicare certified facility […]

Ask our Experts about Medicare Advantage: Claims and Denials

Do you have a question about a Medicare Advantage claim or a denial? Do you have issues or concerns specifically regarding Medicare Advantage? Ask it here, and have it answered by our Medicare experts! Leave a question in the comments, or email managing editor Olivia MacDonald @