Tag: Medicare Part B

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 […]

OIG releases report on Medicare A and B redeterminations

Earlier this month, the Office of the Inspector General (OIG) released a report titled, “The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness”. According to the OIG, the Medicare appeals process serves as an important protection for beneficiaries and providers. Their study represents the first examination of redetermination, i.e., the first […]

Ask the expert: HMO coverage

Q: I am new to my current facility, but to my understanding the main biller wants us to submit all MDS assessments to CMS, even for HMOs, due to the facility not getting paid some time ago when the resident actually switched from a HMO to Medicare while they were in their 100 days. I […]

Ask the expert: Medicare coverage

Q: A resident in a SNF has not used her Medicare benefit since 2005. She was receiving rehab therapy 5x week prior to qualifying for a hospital stay. Are we allowed to skill her upon re-admission? A: Your question cannot be answered without more information.  Did the beneficiary ever go 60 days without receiving skilled […]