The most recent revisions to the Resident Assessment Instrument (“RAI”) User’s Manual became effective yesterday for all assessments with an assessment date on or after October 1. The significant portion of the revisions addresses changes to therapy coding and swallowing and nutrition. Continue Reading →
Tag Archives | therapy
The Centers for Medicare & Medicaid Services (“CMS”) recently released the final rule for fiscal year (“FY”) 2014 skilled nursing facility (“SNF”) prospective payment system (“PPS”) rates. These rates will take effect October 1, the start of FY 2014. Continue Reading →
Please find below the frequently asked questions (“FAQs”) the Centers for Medicare & Medicaid Services (“CMS”) recently released concerning therapy caps and advanced beneficiary notice of noncoverage (“ABNs”).
The Medicare Payment Advisory Commission’s (“MedPAC”) recent Report to Congress included a chapter dedicated to skilled nursing facilities (“SNFs”), which MedPAC reports received $31 billion in Medicare reimbursement in 2011. Recently, SNFs have been under pressure from repeated reimbursement cuts; however, MedPAC’s analysis states that SNF reimbursement is adequate. Continue Reading →
Effective October 1, new PPS rules for fiscal year 2012 require nursing homes to diligently review claims prior to submission. As previosly discussed, significant cuts in SNF reimbursement are aimed mostly at therapy services. SNFs submitting claims under the previous rules can expect high rates of denials and rejections. Even facilities billing under the new rules face denials and rejections for any errors or inconsistencies in the information submitted.
Should you have any questions, please contact:
Todd Selby at 317.977.1440 or firstname.lastname@example.org;
Brian Jent at 317.977.1402 or email@example.com; or
David Bufford at 502.568.9368 or firstname.lastname@example.org,
or your regular Hall Render attorney.
Earlier this week, we highlighted the implementation by Centers for Medicare & Medicaid Services (CMS) of enrollment revalidations and screening categories, and which categories CMS places certain long-term care providers. It is important for providers and suppliers to understand what each screening category (limited, moderate, or high) entails and be aware of any events which could elevate screening categories. While these posts focus on long-term care providers, the enrollment revalidations and screening categorizations are applicable to all Medicare providers and suppliers. Continue Reading →
Effective fiscal year (FY) 2012, The Centers for Medicare & Medicaid Services (CMS) final rule on Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2012, released July 29, reduces Medicare skilled nursing facility (SNF) Prospective Payment System (PPS) payments by 11.1%. CMS states this action was taken to “better align Medicare payments with costs” and correct an unintended spike in payment levels. Continue Reading →
Effective August 1, 2011, the Centers for Medicare & Medicaid Services (CMS) is implementing two (2) significant changes affecting skilled nursing facilities (SNFs) and hospital swing-bed providers billing for Part A claims. The changes include the following:
1. Any Part A claim reporting an End of Therapy Other Medicare Required Assessment must include Occurrence Code 16 and the date of the last therapy.
2. Part A claims with therapy units reported with revenue codes 0420, 0430 or 0440 will be changed to represent the number of days of therapy provided by discipline regardless of the number of minutes or types of therapy services. If a resident is covered under Medicare Part A from August 1 to August 4, 2011, and receives both physical and occupational therapies for each of the four (4) days, then the claim for this period should include four (4) units for physical therapy and four (4) units for occupational therapy regardless of the number of minutes or types of therapy services provided. This change does not affect therapy evaluations which will continue to be reported separately under revenue codes 0424, 0434, and 0444.
Should you have questions, please contact Todd Selby at 317.977.1440 or email@example.com, Brian Jent at 317.977.1402 or firstname.lastname@example.org, David Bufford at 502.568.9368 or email@example.com, or your regular Hall Render attorney.