Category: Billing and Reimbursement

Direct skilled services under Medicare Part A often are easy to identify because these services involve specific, complex caregiver-to-resident actions. Their “inherent complexity” means that they can “be performed safely and/or effectively only by or under the general supervision of skilled nursing or skilled rehabilitation personnel,” explains the Centers for …

The development, management, and evaluation of the resident care plan is the OBRA backbone of the Resident Assessment Instrument (RAI) process for all residents regardless of payer source, so it may surprise some nurse assessment coordinators (NACs) and directors of nursing (DNSs) to learn that care plan management and evaluation …

Since the start of the Patient-Driven Payment Model (PDPM) in October 2019, the International Classifications of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) has been thrust into the forefront of daily tasks for the nurse assessment coordinator (NAC). ICD codes were always applied in long-term care (before 2015, ICD-9-CM codes were …

Skilled nursing facility (SNF) staff must understand the intricate guidelines that regulate Medicare Part A coverage for SNF stays. Several technical requirements must be met before a resident qualifies for a Medicare Part A SNF stay. For example, the resident must have benefit days available, meet the 3-day qualifying hospital …

The 30-day transfer rule and its medical appropriateness exception typically don’t come up on a daily basis in skilled nursing facilities (SNFs), yet these requirements—and flexibilities—are a key component of the fee-for-service Medicare Part A rules for SNF coverage in chapter 8, “Coverage of Extended-Care (SNF) Services Under Hospital Insurance,” …

The Patient-Driven Payment Model (PDPM) includes four ways for a resident to classify into the Clinically Complex category of the Nursing payment component. If a resident has conditions or is receiving services that qualify for Extensive Services, Special Care High, or Special Care Low, but does not have a PDPM …