HCPro.com: Billing Alert for Long-Term Care

It's essential to know how to correctly submit your Medicare claims in order to get the reimbursement your facility deserves. Billing Alert for Long-Term Care provides the crucial tips and strategies that billers need for success.

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July 2008 (Volume 10, Issue 7)	view entire issue

DMEPOS competitive bidding: First round begins July 1
Medicare Part B payment rates for most durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are based on historical charges, sometimes adjusted for inflation, rather than on current market prices. To correct this perceived error, the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) amended the Social Security Act to mandate that competitive bidding programs replace the current DMEPOS fee schedule payment amount for selected items.

Qualifying stay criteria not met? You still might need to submit a Part A claim
Effective July 1, the burden on skilled nursing facility (SNF) business offices to track residents and submit Medicare Part A claims to update the Common Working File (CWF) increases yet again. According to Transmittal 1450, SNFs will have to submit monthly covered claims for a new group of residents: those who require a Part A skilled level of care but aren't on Part A because they don't have a qualifying three-day hospital stay or meet the 30-day transfer criteria, says Ronald Orth, RN, NHA, CPC, RAC-CT, president of Clinical Reimbursement Solutions, LLC, in Milwaukee.

Gain control of CCI edits on Part B therapy claims
More than two years after their January 1, 2006, implementation for Medicare Part B skilled nursing facility (SNF) claims, the National Correct Coding Initiative (CCI) edits remain a thorn in the side of many SNFs, says Cindy Dunne, president of ECS Billing & Consulting, Inc., in Dublin, OH. "The CCI edits continue to be a common source of line item denials on Part B therapy claims. These line item denials can cost facilities money and often go undetected because a portion of the claim is paid," Dunne says. (Need a refresher course on how the CCI edits work?)

Learn the basics: What the CCI edits mean to you
National Correct Coding Initiative (CCI) edits are pairs of CPT or HCPCS Level II codes that are not separately payable except under certain circumstances. (CPT codes, which are copyrighted by the AMA in Chicago, are Level I HCPCS codes.) The CCI edits apply to all outpatient services provided by skilled nursing facilities (SNF) that are billed on bill types 22x (a SNF resident in a Medicare-certified unit who receives Part B services) and 23x (a SNF outpatient or resident in a non-Medicare-certified unit who receives Part B services), but they primarily affect Part B rehabilitation therapy services.

Other recently-published articles from Billing Alert for Long-Term Care:

Coding patient status on the UB-04

BAALTC Q&A

Don’t overlook condition codes

Rein in the facility census

Don’t let your billing office bypass resident resource payments

How FIs view changes in therapy services during a payment period

BALTC Q&A

CMS affirms that SNFs can charge Medicare bed holds

Late vs. missed assessments: The difference is money

New rules on default billing end CMS flip-flops

BALTC Q&A

Six steps to better Medicare coinsurance billing

Prepare for a personal funds review during survey

BALTC Q&A

Want to bill more accurately?

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