Our reimbursement specialist says we’ve missed several opportunities to code IV fluids given at the hospital on the 5-day PPS assessment. How is this information reported and supported?
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 incomplete measures
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Mar 04, 2024
I reviewed the Q4 2023 Facility Level Quality Measure report for my facility and noticed several measures are displayed as “I” for incomplete. Can you explain why?
Ask the paymenyt expert … about demand bills
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Feb 01, 2024
Under what circumstances are we required to submit a demand bill for a patient?
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 … about payment reductions
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
Oct 10, 2023
Q: How do I know what determines my 2% annual payment reduction? I’ve received a non-compliance letter citing MDS reporting requirements, but it doesn’t provide details.
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 … 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 VBP incentive pay
By
Eleisha Wilkes, RN, RAC-CTA, RAC-CT, DNS-CT
May 03, 2023
How should we manage SNF value-based purchasing measures to receive incentive payments?
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?