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Wednesday, 07 October 2009 |
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Different Medicare provider types are reimbursed under different payment methods. This bulletin applies to skilled nursing facilities only.
For a seasonal flu or pneumococcal vaccination, there is an administration component and vaccine component to be billed to Medicare Part B. The administration is billed using bill type 22X or 23X, revenue code 0771, diagnosis code V04.81 for influenza, V03.82 for pneumococcal, or V06.6 for both influenza and pneumococcal, and HCPCS Code G0008 for influenza administration and HCPCS Code G0009 for pneumococcal administration. Reimbursement is based on the Medicare Physician Fee Schedule amounts and is subject to the lower of the fee schedule amount or billed charges. If the charges are less than the fee schedule amount below, then reimbursement will be at the lower charged amount. Read full article.
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Monday, 21 September 2009 |
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The Office of Inspector General (OIG) recently released a report on the findings of their study of payments of ambulance services to Skilled Nursing Facility (SNF) residents during their Medicare Part A stay. The study reviewed 114 claims from 2006 and found that 61 (over 53%) were incorrectly paid by Part B. Those claims should have been included in SNF consolidated billing and paid for as part of the SNF per diem rate. Read full article.
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Monday, 21 September 2009 |
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The Centers for Medicare and Medicaid Services (CMS) requires skilled nursing facilities (SNFs) to submit no-pay claims when a resident no longer receives a Medicare skilled level of care but remains in a Medicare-certified bed.
Failure to submit no-pay claims may delay or reject payments for Part B outpatient claims submitted after a Part A stay. In addition, in its work plan for fiscal year 2009, the Office of Inspector General (OIG) has made it a priority to ensure that no-pay bills are being properly submitted to Medicare. We are likely to see increased scrutiny by fiscal intermediaries as well. Read full article.
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Wednesday, 16 September 2009 |
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As many of you are aware from the LTC 2009-14 bulletin that FR&R released in April, the Centers for Medicare and Medicaid Services (CMS) has implemented the Nursing Home Value-Based Purchasing (NHVBP) Demonstration in an effort to improve the quality of care provided to residents through financial incentives to providers. The program rewards facilities that improve the quality of care in four areas: nurse staffing, resident outcomes, avoidable hospitalizations, and reduction of the scope and severity of deficiency citations during inspections of the nursing home. Read full article.
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Wednesday, 16 September 2009 |
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The Department of Health and Human Services Office of Inspector General (OIG) conducted a study in order to determine the extent of inappropriate Medicare Part B payments for durable medical equipment (DME) provided to nursing home residents during non-Part A stays in 2006. Last month, the OIG released the results of a long-awaited study titled “Part B Services During Non-Part A Stays: Durable Medical Equipment.” Read full article.
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Long Term Care 
