Tag: Medicare Part A

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: […]

CMS offers new settlement option for appeals pending at OMHA and DAB

On November 3, 2017, CMS announced that they will offer an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board. The low volume appeals settlement option (LVA) will be limited to appellants […]

20% of Medicare ambulance claims have inappropriate billing for transport

CMS reports that in a September 2015 report, the Office of the Inspector General (OIG) released results of a study of Medicare Part B ambulance claims. According to the report, almost 20 percent of ambulance suppliers had inappropriate and questionable billing for ambulance transport, creating vulnerabilities to Medicare program integrity. The OIG identified a number […]

MedPAC’s June report is in: Summary here

The Medicare Payment Advisory Commission (MedPAC) published their June Report to the Congress: Medicare and the Health Care Delivery System, in which they evaluate several Medicare payment issues in order to make recommendations to Congress. Issues addressed include: Implementation of a unified payment system for post-acute care. Given the overlap among PAC settings (skilled nursing […]

Change to Advanced Beneficiary Notice of Noncoverage

Providers should be using the updated Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, beginning June 21, 2017 (but may begin using the new forms prior to this date). There are no changes to the form itself, however, providers should take note of the new expiration date of March 2020. The ABN is issued by […]

NEW: Billing boot camp for SNFs

HCPro’s new Skilled Nursing Facility Billing Boot Camp covers the latest Medicare billing rules and regulations so that you can help your facility bill appropriately for services and prevent payment denials. The bootcamp will be held Monday, August 14 – Tuesday, August 15, from 8:00 a.m. – 5:00 p.m. Skilled Nursing Facility Billing Boot Camp provides […]

SNF Quality Reporting deadline tomorrow, June 1

Tomorrow, June 1, is the deadline for all SNFs receiving Medicare funding to have all their MDS forms for admissions/discharges happening between October 1, 2016 and December 31, 2016 completed. This requirement must be met in order to remain compliant with the SNF Quality Reporting Deadline. SNFs that do not comply with this requirement risk […]

Cardiac and orthopedic bundled payment models delayed to Jan 1, 2018

In a final rule published in the Federal Register today, May 19, the Department of Health and Human Services (HHS) finalized May 20, 2017 as the effective date of the bundled payment models and changes to the Comprehensive Care for Joint Replacement Model and delayed the implementation date of the final rule to January 1, […]

CMS seeks comment on RUG-IV replacement

On April 27, the Centers for Medicare & Medicaid Services (CMS) published an Advanced Notice of Proposed Rulemaking (ANPRM) or pre-rule in the Federal Register, seeking public comment on proposed options for revising certain aspects of the existing skilled nursing facility (SNF) prospective payment system (PPS) payment methodology to improve its accuracy, based on the […]

Hospice, hospital readmissions and penalty implications

Editorial note: This blog post has been republished from Reg’s Blog: Senior and Post-Acute Healthcare News and Topics, with permission from the author. Late yesterday, a reader posed this question to me: “When hospitals discharge to hospice and if the hospice has to readmit to the hospital, the hospital doesn’t get penalized for the readmit…Is […]