Tag Archives | therapy

Details on MedPAC Report on SNFs

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 →

Providers Face Greater Risk of Claim Denial Under New PPS Rules

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 tselby@hallrender.com;
Brian Jent at 317.977.1402 or bjent@hallrender.com; or
David Bufford at 502.568.9368 or dbufford@hallrender.com,
or your regular Hall Render attorney.

What Risk Categories Mean to Providers and Suppliers

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 →

Medicare to Cut $3.87 Billion in Skilled-Nursing Facility Pay

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 →

Medicare Issues Therapy Billing Guidance

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 tselby@hallrender.com, Brian Jent at 317.977.1402 or bjent@hallrender.com, David Bufford at 502.568.9368 or dbufford@hallrender.com, or your regular Hall Render attorney.

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