MedPAC publishes resource for SNFs: Payment basics

By The Bottom Line.
MedPAC released their Payment Basics for SNFs 2018 report, which provides an overview of Medicare coverage and reimbursement. You can download this resource from The Billers’ Association resource library. The report includes a map explaining how reimbursement is calculated under the current prospective payment system, Medicare daily base rates for FY19, and the RUG-IV classification system.
The initial payment rates were set in 1998 to reflect the projected amount that SNFs received in …

SNFs: Two jurisdictions announce new Targeted Probe and Educate topic

From The Bottom Line
The MACs for the J5 (Iowa, Kansas, Missouri, and Nebraska) and J8 (Indiana and Michigan) jurisdictions (WPS Government Health Administrators) announced that CMS has authorized them to conduct a Targeted Probe and Educate (TPE) review of outpatient therapy (CPT code 97110). The announcement was made on October 15 on the WPS website.
The webpage states that “This is a required process for providers identified by Medical Review. The TPE review process incudes three …

SNFs: Are you billing Occurrence Code 22 correctly?

By The Bottom Line.
In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of …

CMS publishes corrections to RUG-IV federal per diem rates & MDS item in SNF PPS final rule

By The Bottom Line.
The Centers for Medicare & Medicaid Services published the following summary of errors published in the FY2019 SNF PPS final rule:

In Tables 6 and 7 on pages 39170 through 39172, we made errors in copying values into the “total rate” column of the tables used in the final rule preamble, so the numbers in this column did not accurately reflect the total case-mix adjusted federal per diem rates.
On page 39222, we made …