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Ask the expert: Medicare Part A coverage for a PEG tube

Q: I have a patient that has 100 days of Medicare Part A and a percutaneous endoscopic gastrostomy (PEG) tube—the primary source of nutrition—in place since 2008 due to laryngeal cancer. All rehab therapy is discontinuing in three days. Can I continue Medicare Part A, related to the PEG tube? A: As long as 26% […]

Qualifiers for ICD-10 Diagnosis Codes on Electronic Claims

As you submit electronic claims for services, it is important for you to remember that: Claims with ICD-10 diagnosis codes must use ICD-10 qualifiers; all claims for services on or after October 1, 2015, must use ICD-10 Claims with ICD-9 diagnosis codes must use ICD-9 qualifiers; only claims for services before October 1, 2015, can […]

OIG releases new report, prompting CMS to publish new fact sheet for 3-day rule

The HHS Office of Inspector General (OIG) has released the “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations” which includes eight recommendations to CMS regarding Medicare Parts A and B: CMS should analyze the potential impacts of counting time spent as an outpatient toward the 3-night requirement for skilled nursing […]

Therapist layoffs reported as a result of PDPM

Since the implementation of PDPM on October 1, thousands of therapists have been laid off, reports Modern Healthcare. The payment system prior to PDPM, RUG-IV, allowed SNFs to bill therapy services they deemed necessary, but some took advantage by ordering superfluous therapy services to gain additional reimbursement from Medicare. PDPM seeks to stop this practice. […]

CMS releases interpretive guidelines, F-Tags for new survey process and penalty updates

The Centers for Medicare & Medicaid Services (CMS) has released revised interpretive guidelines to clarify existing requirements and provide guidance for Phase 2 of the new survey process, which includes requirements such as antibiotic stewardship, facility assessment, and QAPI. Along with a revised Appendix PP, CMS also published two documents to help providers understand revisions […]

Care area triggers, the CAA process, and how they help the IDT

Editorial Note: This post has been adapted from HCPro’s popular title Long-Term Care MDS Coordinator’s Field Guide by Carol Maher, RN-BC, RAC-CT. For content details and ordering information, visit our Marketplace! What is a care area trigger? Certain single MDS items can trigger a care area. Some care areas are triggered by comparing responses entered […]

What SNFs need to be doing right now to deal with COVID-19

Long-term care regulatory expert Stefanie Corbett chats with us on our first Post-Acute Advisor Podcast. Corbett tells us what facilities should be doing right now to prepare for COVID-19, and what to do with suspected or confirmed cases. We also discuss keeping staff safe and healthy, visitation policies, and how to keep trucking on.  

CMS releases new guidelines for SNF visitations

CMS released updated guidelines regarding COVID-19 in a March 9 memo advising SNFs “actively screen and restrict” any visitors the meet the following criteria: Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat. In the last 14 days, has had contact with someone with a confirmed diagnosis […]

CMS releases nursing home COVID-19 data and inspection results

The first round of COVID-19 data collected from nursing homes is now available on Nursing Home Compare. The data shows that as of May 31, about 13,600 (88%) of Medicare and Medicaid nursing homes had reported the required data to the CDC. Within these facilities, there are over 95,000 confirmed COVID-19 cases, and almost 32,000 […]