Ask the payment expert… about the SNF 5-Claim Probe and Educate Reviews
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Apr 12, 2024
In an attempt to lower the skilled nursing facility improper payment rate, CMS implemented the SNF 5-Claim Probe and Educate Review, wherein the Medicare Administrative Contractors (MACs) conduct reviews...
Ask the payment expert … about appealing Medicare repayments
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Nov 07, 2023
Q: My facility is going through a Medicare UPIC review and received several denials followed by a demand letter requiring repayment. What are options for appealing and paying?
Ask the payment expert: What does MDS item Z0400 have to do with supporting cognitive impairment for...
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Jul 01, 2021
What does MDS item Z0400 have to do with supporting cognitive impairment for PDPM?
Ask the payment expert … about overpayments
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Apr 10, 2023
Are the timeframes for investigating and repaying Medicare overpayments changing?
Ask the payment expert … about an LPN’s MDS role
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Jun 09, 2023
Q: We’ve been trying to fill an open MDS position and have an LPN applicant who would be great in the role. Can an LPN fulfill requirements and sign assessments?
Ask the payment expert about … consequences of MDS dashes
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Mar 12, 2023
Q: What are the concerns or consequences of dashing items on the MDS?
Ask the payment expert … about MDS payment implications
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Sep 12, 2023
Q: Are changes to the Patient Driven Payment Model expected with the revised MDS in October?
Ask the payment expert: What can we do to ensure we’re being reimbursed accurately?
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Oct 01, 2021
We’re seeing some Medicare Advantage plans change to payment by “levels.” What can we do to ensure we’re being reimbursed accurately?
Ask the payment expert: What has changed now that data is based on an entirely different payment model?
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Jun 02, 2021
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) gathers data on billing patterns of U.S. SNFs. So, what has changed now that data is based on an entirely different payment model?
Ask the payment expert: Can we use a 3-day stay waiver more than once for same patient?
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Sep 11, 2022
Q: Can the 3-Day Qualifying Hospital Stay waiver be used more than once for the same person?