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Ask the expert: Tube feeding coverage

Q: We have a lot of questions in our facility about tube feeders and Medicare Part A eligibility. Here is one example: A person getting tube fed uses 100 days of their benefit, goes off Medicare Part A, has a 60 day break in illness, and was then readmitted to hospital with a hip fracture. He […]

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. […]

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 […]

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 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 […]

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 […]