Online resource packed with regulatory news and expert guidance, tips & tools pertinent to professionals across the post-acute care continuum.
The American Health Care Association (AHCA) released a report today demonstrating that the long term care services are significantly underfunded by Medicaid. The report estimates that the nation will have the highest Medicaid shortfall on record for 2013—over 7.7 billion dollars. On a daily basis, the shortfall is $24.26 per Medicaid patient. This shortfall is […]
On January 14, the Centers for Medicare and Medicaid Services (CMS) replaced Transmittal 176 with Transmittal 179 to correct an error in Chapter 8, Section 30.4.1.1.
Q: My question is in regard to physician visits and certification. When a resident who is in a Medicare A stay, returns to the hospital and is admitted, does the 14, 30, 60, etc. physician visit schedule start over? I cannot locate this information. A: When a resident in a Medicare Part A stay is […]
Q: Can a resident who has had a PEG tube in place at home, with a valid 3-day hospital stay and covered for skilled services, have an EOT and continue her coverage for a PEG tube? This resident is receiving 26% calories and 501cc fluid via tube. Would the fact that she has had the […]
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 […]
Q: We have several Medicare replacement plans. When scheduling the MDS, we are currently doing 5-day admission, 14-day, 30-day, etc., along with a Change of Therapy (COT) assessment if needed. Is this the correct schedule? We also have several residents who are insurance primary, but have Medicare secondary. We are doing the same schedule with […]
Q: When a resident in a SNF exhausts their 100 days of Medicare, can they be re-skilled after a 3-day hospital stay if they have been on a tracheotomy tube the whole time? A: In order to generate a new 100 day benefit, the beneficiary needs to go 60 consecutive days without skilled care being […]
Q: I have recently started a MDS coordinator position. There are assessments that have not been completed from the beginning of September. Example: Quarterly due on 9/13/2013. The assessment has been opened but not completed. Today is the 27th. How do I even begin to do these assessments? A: The assessment you mentioned, a Quarterly, […]
Q: A resident is under Medicare Part B coverage for therapy services and then during that time has a six night hospital qualifying stay; can they come back under Medicare Part A coverage? The last time they were under Part A coverage was in 2011. A: Regardless of the Medicare patient’s payer source prior to […]
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 […]