Tag: Medicare billing and reimbursement

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 […]

Ask the expert: ARD dates

Q: I work as a swing bed coordinator and I’m still learning the MDS. I have a patient that will be discharged on the 14th day. I set the 5-day PPS ARD for the 8th day (grace) and the next ARD for the 13th day. Do I need to submit a 14-day PPS since they are […]

Digging in deeper: MedPAC report’s SNF findings

On March 15, the Medicare Payment Advisory Commission (MedPAC) issued its annual report to Congress. In the report, MedPAC addresses the SNF PPS in Chapter 8. MedPAC states that most indicators of payment adequacy for SNFs are positive. Here are some findings published in the report: Access to SNF services remains stable for most beneficiaries. […]

HCPro’s 2013 Recovery Auditor Benchmarking Report

This year’s Recovery Auditor Benchmarking Report surveyed 325 respondents, representing both small and large hospitals, from all four Recovery Auditor regions. It may not come as a huge surprise to many that the mean theme of this year’s survey is the expanding state of the Recovery Auditors, and the fact that they continue to gain speed and extend their reach.

This theme becomes apparent almost immediately as we look at the percentage of providers that have had recoupments from automated reviews—it has risen by 14% this year. In addition, the amount of providers that have seen record requests for complex or semi-automated reviews has gone from 82% to 91%. This may not be shocking, as CMS continues to approve more issues and the scope of the RAs continues to expand, but it highlights the fact that the audits are ever-changing and will force providers to stay on their toes.

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Clarifying the Recovery Auditor-related provisions in the American Taxpayer Relief Act of 2012

by Ralph Wuebker, MD, MBA, Chief Medical Officer, Executive Health Resources There has been some confusion surrounding a possible Recovery Auditor-related provision in the American Taxpayer Relief Act of 2012, also known as the Fiscal Cliff deal. Specifically, the question of whether the Recovery Auditor look-back period was extended from three to five years was […]