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 …

Florida Governor warns that SNFs and ALFs have “no excuse” if caught unprepared for Hurricane Michael

Last year, Hurricane Irma knocked out power to a nursing home in Hollywood, Florida. Without a functioning generator, 14 residents died. According to CBS News, Gov. Rick Scott is warning facilities to prepare in order to avoid a similar tragedy:
“If you’re responsible for a patient, you’re responsible for the patient. Take care of them,” Scott said. “That means you need to make sure that you have back up generation power or you shouldn’t be taking …

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 …