Tag: prospective payment system

CCRCs should ask residents about their health plans more often

Continuing care retirement communities should ask residents about their health plans twice a year, to keep tabs on the increasing number of seniors being shifted into Medicare Advantage, an expert told an audience of long-term care professionals at the Leading Age Illinois conference Wednesday. There’s a trend of employers requiring workers to utilize Medicare Advantage […]

OIG reverses course on referral services discounts

Providers cannot use an online service that involves money for referrals within its network, federal regulators now say, reversing course on an advisory opinion that was first issued three years ago. The statement came from the Department of Health and Human Services Office of Inspector General. The notice of termination on OIG Advisory Opinion No. 11-18 was […]

Ask the expert: Part A to Part B billing

Q: When a Part A resident exhaust their Part A days and needs continued therapy under Part B, we have been writing the Part B POT and obtaining a signature by the MD. We have not billing for the Part B evaluation because it is a continuation of services. Is this correct?  Is there any CMS […]

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 […]

CMS Releases SNF PPS Final Rule for FY 2014

On August 1, 2013, the Centers for Medicare & Medicaid Services (CMS) published the final rule for the Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) for FY 2014 in the Federal Register. Effective October 1, 2013, this final rule updates the payment rates used under the prospective payment system for SNFs […]

2014 SNF Proposed Rule Analysis: Payment changes breakdown

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for 2014. CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in 2013. This is based […]

CMS Releases Proposed Rule Featuring Payment Updates for 2014

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for 2014 and would revise and rebase the SNF market basket. This proposed rule also includes a proposed policy for reporting the SNF market […]

Ask the expert: Changing of payers and PPS schedule

Q: I have always been instructed that if someone changes skilled payers, such as from a Medicare Advantage Plan to regular Medicare Part A, that the PPS schedule has to be restarted.  Someone asked me where to find the documentation for this, and I am having difficulty locating this. Can you please give me some […]