How has the COVID-19 Pandemic Changed How you Bill for your SNF?

Format: On-Demand Webinar
Presenter: Tricia G. Tuttle, BS, MM, CPC, CPB, CEMC, AAPC-Approved Instructor
Duration: 60 minutes

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Course Description

“In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare-covered SNF stay be included in a bundled prospective payment made through the Part A Medicare Administrative Contractor (MAC) to the SNF. These bundled services had to be billed by the SNF to the Part A MAC in a consolidated bill. No longer would entities that provided these services to beneficiaries in an SNF stay be able to bill separately for those services. Medicare beneficiaries can either be in Part A covered SNF stay which includes medical services as well as room and board, or they can be in a Part B non-covered SNF stay in which the Part A benefits are exhausted, but certain medical services are still covered though room and board are not.” –

This webinar will discuss Consolidated Billing Requirements for Skilled Nursing Facilities.  This will include how to bill for separate Part A and Part B services and what is included in each for your facility and providers.  When your resident is involved in physical therapy, speech therapy, and occupational therapy, how do you bill for those services? When does the Patient-Driven Payment Model (PDPM) payment model come into play for your inpatient admissions, and when and how do you bill for Part B services?  What can your SNF provider bill for?  What about the RN’s/LPN’s/CNA’s in your facility? They may all be providing services to your residents, but what can you separately bill for, and what is included in consolidated billing?  In addition, what items or services might be Excluded from billing? Have you considered Physician “Incident-to” Services?

The Patient-Driven Payment Model applies to Medicare part A patients (or services) and SNF Consolidated Billing applies to Part B patients (or services) How does the selection of admitting and primary diagnosis coding affect what payment you receive under PDPM?  Do you have an interdisciplinary team that reviews all parts of the treatment plan?  What resources do you have and how do you use them in working with your providers to select the reason for admission to your facility. We will also explore what happens when a resident exhausts his or her benefits.  How are you tracking this information?  We will learn about special billing situations and what to consider when a Medicare resident re-admits within 30 days of a prior stay. Special billing situations include LOA, Forced Discharge, Nonskilled Discharge, Demand Billing, Medicare Advantage Plan Billing, No Qualifying Hospital Stay, Same-Day Transfer, Disenrolled from Medicare Advantage Plan and Convert to Fee-for-Service while SNF Inpatient, Disenrolled from Medicare Advantage Plan after SNF Discharge and Converts to Fee-for-Service Payments, and finally, Disenrolled from Medicare Advantage Plan.

Provider-initiated discharges for coverage reasons associated with SNF and in-patient swing bed claims require Expedited Determinations Notice. A Medicare beneficiary, or a representative, can appeal provider service terminations to a Quality Improvement Organization (QIO) through the Expedited Determinations process. This comes with reporting requirements. What are those requirements?

Learning Objectives:

  • What is meant by Consolidated Billing
  • Why has CMS made changes to how it pays for SNF services
  • Develop confidence using the CMS website to identify authoritative sources of information
  • Patient-Driven Payment Model
  • What services can physicians and other qualified health care providers bill for
  • Understand Physician Initiated discharges for coverage
  • Pandemic Waivers and telehealth services

Areas Covered in the Session:

  • Bundled billing
  • Patient-Driven Payment Model
  • PDPM Resources
  • CMS Website for resources
  • Medicare Part A and Part B
  • Special Billing Situations
  • Expedited Determinations

Suggested Attendees:

  • SNF Administrators
  • Hospital Administrators
  • SNF Coders and billers
  • Nursing Staff
  • Therapists
  • Direct care staff
  • Rehabilitation Managers
  • Nurse Managers
  • Social Workers
  • Registered Nurses (RN)

About the Presenter:

Tricia has more than two decades of experience in medical billing, coding, auditing, consulting, teaching, and mentoring.  She started her career in the field of workers’ compensation as an adjuster and transitioned to coding after almost ten years in that role.  Tricia is a Coder and Auditor for a large multi-state Healthcare System and is also a billing instructor teaching our future generations of billers and coders.

Tricia is the owner of a Consultancy Firm teaching, mentoring, training, and coaching aspiring coders.  She lives and works in the beautiful State of Alaska and is presently serving on the AAPC Chapter Association Board of Directors in addition to being the President of the Anchorage, Alaska AAPC Local Chapter.  She provides virtual and in-person presentations on a multitude of topics and concepts as well as virtual and in-person training and study courses (PMCC), she is also available to provide exam review sessions, both in-person and virtually. You can also find some of her work in the AAPC Healthcare Business Monthly Magazine as she is a published author and contributor on a regular basis, sharing her knowledge and expertise in the field.

System Requirement

Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

For more information you can reach out to the below contact:
Toll-Free No: 1-302-444-0162

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