Tag: Medicare

Ask the expert: Physician visit schedule

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 […]

Ask the expert: PEG tube coverage

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 […]

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 […]

Ask the expert: Medicare replacement plans

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 […]

Ask the expert: Skilled care confusion

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 […]

Ask the expert: Late OBRA assessments

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, […]

Ask the expert: Medicare Part A coverage requirements

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 […]

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 […]

CMS releases new article on dual eligible beneficiaries

The Centers for Medicare & Medicaid Services (CMS) released a new article titled “Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries”. The article finds that among dual eligibles and non-dual eligibles, the average number of diseases and case-mix scores are higher for long-term care (LTC) […]