Tag: billing

Ask the expert: Medicare Advantage 100 days of Skilled Nursing

Q: If a beneficiary changes from one Medicare Advantage plan to another-do they automatically get 100 new days of Skilled Nursing? MAO’s do not report days paid to the Common Working file and unless the SNF informs the new plan of days paid under another plan or that the beneficiary has had previous stays, we […]

Medicaid Fraud Control Units recover over $10 million in 2013

Medicaid Fraud Control Units recovered about $10.3 million from nursing facilities in FY 2013, according to an annual report issued Friday. Practically every state operates a fraud control unit, and the report from the Department of Health and Human Services Office of the Inspector General compiled results from all of these units. The investigations included: Allegations of […]

Ask the Expert: Observation status

Q: A nursing home sends a SNF patient to the emergency room, after a fall.  A small scalp laceration is sutured, and a CT scan of the head shows no abnormality.  The patient is stable, and a decision is made by the treating physician, that the patient can return to the nursing home.  The patient’s primary […]

New Medicare notices gives seniors a tool to help fight against fraud

Medicare beneficiaries will start receiving a redesigned statement of their claims for services and benefits that will help them spot potential fraud, waste, and abuse, according to a recent press release by the Centers for Medicare & Medicaid Services. The redesigned notice will make it easier for people with Medicare to understand their benefits, file […]

Overpayments resulting from improper claims for ambulance services

On November 6, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 1311, which offered guidance on the contractor claim data, identified by suppliers, which were billing ambulance claims for SNF to SNF transfer separately under Part B. This was resulting in overpayments. As a result of overpayment for a transport between two SNFs […]

Ask the expert: 5-day assessment

Q: Is it necessary to complete an admission assessment and a separate 5-day assessment for residents with managed care that require RUGs for billing?  Since the admission assessment contains the same item set as the 5-day assessment is that enough for billing? A: Your software vendor should be able to assist you with this question. Technically, […]

CMS issues ICD-10 split claims billing instructions

CMS issued a MLN Matters article that offers instructions that clarify the policy for processing claims for certain institutional encounters that span the ICD-10 implementation date of October 1, 2014. Skilled Nursing Facilities (Inpatient Part B): Bill type: 22X Use FROM date Require providers split the claim so all ICD-9 codes remain on one claim […]

CMS releases clarification about physician delegation in both SNFs and NFs

CMS has released a Medicare Learning Network (MLN) Matters article titled “Physician Delegation of Tasks in Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs)”. The information affects physicians, non-physician practitioners (NPPs) and providers who bill for services related to beneficiaries in SNFs and NFs. CMS is clarifying the regulatory differences concerning physician delegation of tasks […]