Tag: Medicare billing and reimbursement

New change request outlines rebuttal process for providers with deactivated Medicare billing

CMS has issued a change request outlining the rebuttal process for providers or suppliers whose Medicare billing has been deactivated. CR 10978 provides instruction to Medicare Administrative Contractors (MACs) to advise providers of rebuttal rights and how to receive and process rebuttals. The change request takes effect Dec. 31, 2019. Providers can submit a rebuttal […]

Medicare improperly covered ambulance rides from hospitals to SNFs

The OIG reports that Medicare improperly paid $1.9 million to ambulance providers for transport from hospitals to SNFs from 2014 to 2016. As a result of this former study, the OIG released an updated report on September 11 regarding hospital-to-SNF transfer billing practices. The OIG audited 99 ambulance providers from 2015 to 2017 and found […]

SNF PPS final rule published, new payment model to begin October 1, 2019

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register yesterday evening, the Patient-Driven Payment Model (PDPM)—the new case-mix methodology to replace RUG-IV)—is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. […]

CMS updates to Medicare manuals could impact reimbursement

In an MLN Matters article dated March 16, 2018, CMS instructed providers to make sure their billing staff are aware of changes made to Medicare manuals. CMS stated that these updates to the Medicare manuals are intended only to clarify the existing content and to correct various omissions and minor technical errors. No policy, processing […]

RCS-1 draft model calculation worksheet

SNF providers are on the edge of their seats as they anticipate CMS’ consideration of a replacement for the Resource Utilization Group (RUG) system, which will change the way facilities are reimbursed for SNF Medicare Part A residents beginning as early as FY2019. The Resident Classification System, Version 1 (RCS-1) will be the most significant […]

New CMS policy could change inpatient rehab denial trend

In the past, Medicare contractors have been allowed to deny a claim for inpatient rehab if the required three-hour minimum of direct care mark was missed by mere minutes, even if the additional minutes were made up on a subsequent day. Now, however, due to new guidance released by CMS, this denial trend could change. […]

Ethical principles for long-term care billers

The following post is an excerpt from Medicare Guide for SNF Billing and Reimbursement by Janet Potter, CPA, MAS, and Frosini Rubertino, RN-CNE, CDONA/LTC, CPRA. The following ethical principles are based on the core values of The Billers’ Association for Long-Term Care. They apply to all members. Long-term care billing professionals shall do the following: […]

Who needs to prepare for RCS-1?

On July 31, 2016, CMS announced that the payment levels currently used in the prospective payment system (PPS), resource utilization group (RUG) IV, will be replaced in FY2019 by the resident classification system (RCS-1). This replacement is currently scheduled to be implemented by October 2018. This will be a complicated and significant change for providers. […]

Two-year budget deal repeals therapy caps, cuts skilled nursing spending by $1.96 billion

Last week, President Donald Trump signed a two-year federal budget deal that left long-term care providers sighing with relief at the repeal of therapy caps for Medicare Part B beneficiaries retroactive to January 1, followed by a sigh of disappointment with a $1.96 billion cut to skilled nursing facility (SNF) spending. The cuts include a payment […]

Revised SNFABN mandatory for use beginning May 7, 2018

CMS is releasing a newly revised skilled nursing facility advanced beneficiary notice (SNFABN) along with newly developed, concise and separate instructions for form completion.  The revised SNFABN has the requirements from the denial letters and looks very similar to the ABN with 3 different options. CMS will be discontinuing the 5 SNF Denial Letters and […]