Category: Skilled Nursing Facility

CMS Proposes Fiscal Year 2016 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities

On April 23, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2016 proposals are summarized below.  Proposed Changes to IRF […]

CMS proposes new rule for Medicare program

According to the Federal Register, CMS is proposing a rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it includes a proposal to specify a SNF all-cause all-condition hospital readmission measure, as well as a proposal to adopt […]

Ask the expert: Tube feeding

Q: Regarding tube feeding, I have a resident who resides in a SNF, she receives only flushes, no nutrition via PEG tube. She was skilled for a tube in the past (2013), but has not received any nutrition for a year; does she qualify for another benefit period? She is still receiving flushes with occasional feeding. […]

SNFs, Therapy Contracts and Fraud: Redux by Reg Hislop III

Yes another SNF, another therapy contract and more fraud settlements.  The only thing that isn’t different is the contractor – RehabCare once again (a coincidence?…not likely). In news released late last week, a Maine SNF settled with the Department of Justice for $1.2 million, allegations of improper Medicare billings for “unnecessary, inflated, and unreasonable” therapy […]

Ask the expert: Ambulance billing

Q: I work in ambulance billing.  I know that under Original Medicare, many non-emergent transports of bed confined and non-wheelchair patients is billable to the SNF.  Is the same true for Medicare Advantage plans? Also, is there some way to tell when to bill the SNF?   A:  Medicare Advantage plans are not subject to consolidated billing […]

Ask the Expert: Restraint use coded on MDS

Q: We have had residents who are inmates of the sheriff’s depart.  Because of being in the custody of the sheriff’s department the resident has to be handcuffed to the bed or w/c at all times.  They usually are not in restraints due to the facilities policies, but due to sheriff’s department policy.  How should this […]

New Affordable Care Act initiative to encourage better oncology care

According to a press release that went out on Feb 12, 2015, The U.S. Department of Health and Human Services (HHS) announced a new multi-payer payment and care delivery model to support better care coordination for cancer care as part of the Department’s ongoing efforts to improve the quality of care patients receive and spend […]

Ask the expert: 100 day Medicare benefit

Q: If a stroke patient uses 100 Medicare days in a skilled nursing facility, and then after 60 days of wellness, incurs a new hospital stay for a kidney infection, could the patient qualify again for the 100 days of Medicare in a skilled nursing facility? A:  After using the 100 Medicare Part A SNF benefit, and […]

Upcoming webcast! WEBCAST REBROADCAST: SNF Consolidated Billing: Who Really Has to Pay All These Invoices?

Tuesday, February 24, 2015 1:00 p.m.-2:30 p.m. ET When a vendor invoice is received, are you confident with your skilled nursing facility consolidated billing processes and knowing whether or not it should be paid? Join expert Janet Potter, CPA, MAS, for this 90-minute webcast to review the five major categories of skilled nursing facility consolidated […]

Upcoming webcast! SNF Therapy Contracts: Implementing a Shared Risk Arrangement to Reduce Citation Risk,Tuesday, March 10, 2015

Upcoming webcast! SNF Therapy Contracts: Implementing a Shared Risk Arrangement to Reduce Citation Risk. Tuesday, March 10, 2015: 1:00 p.m.–2:30 p.m. (ET) The use of contracted therapists in your SNF immediately increases your citation and criminal risk in terms of billing and liability. In this 90-minute webcast, expert Reginald M. Hislop III, PhD, discusses how to […]