Online resource packed with regulatory news and expert guidance, tips & tools pertinent to professionals across the post-acute care continuum.
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. […]
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 […]
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 […]
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. […]
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: […]
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. […]
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 […]
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 […]
On January 9, 2018, CMS’ Innovation Center announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of […]
The Centers for Medicare & Medicaid Services (CMS) recently published an update that deleted the procedure code 97532 from the list of “Always Therapy” codes used to track the Medicare Part B therapy caps. The coding requirement change is effective for services furnished on or after January 1, 2018. CMS notes that this update contains […]