PPS Seminar – Conference Room – November 19, 2007 – PPS Seminar Power Point – Thank You Slide
On November 19, 2007, we held our first Michigan seminar. The topic was “Understanding the Medicare Cost Report for Home Health Agencies”. The attendees were accountants that had an interest in preparing a Home Health Agency cost report.
Check out the pictures!
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Cost Report Seminars | 
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Posted by bschwartz
Congress enacted the Balanced Budget Act of 1997 (BBA), revamping Medicare Part A payments for SNFs. The BBA contains aConsolidated Billing (CB) requirement for SNFs. Under the CB requirement, a SNF itself must submit all Medicare Part A claims for the services that its residents receive, except for specifically excluded services listed at CMS website, which are identified by HCPCS codes.
CMS gives an overview and lists exclusions at their website at
http://www.cms.hhs.gov/SNFPPS/05_ConsolidatedBilling.asp #TopOfPage
Here are some of the more common services excluded listed at their websites:
a) Physicians’ services furnished to SNF residents. These services are not subject to CB and, thus, are still billed separately to the Part B carrier. Many physician services include both a professional and a technical component of physician services must be billed to and reimbursed by the SNF.
b) Physician assistants working under a physician’s supervision;
c) Nurse practitioners and clinical nurse specialists working in collaboration with a physician;
d) Qualified psychologist;
e) Part B coverage of home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies;
f) Hospice care related to a resident’s terminal condition;
g) An ambulance trip that conveys a beneficiary to the SNF for the initial admission, or from the SNF following a final discharge.
h) Cardiac catheterization;
i) Computerized axial tomography (CT) scans;
j) Magnetic resonance imaging (MRIs);
k) Ambulatory surgery that involves the use of an operating room;
l) Emergency services;
m) Radiation therapy services
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Posted by bschwartz
CCH, in their December 18th issue of their Medicare and Medicaid Guide,(Issue 1494), reports that CMS ruled it could recoup prior Medicare payments from the proceeds of an injured party’s award of medical expenses, even though it was the family who received the proceeds.
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Posted by bschwartz
It is already over 2 years since intermediaries, such as Riverbend, clarified the CMS criteria for claiming Medicare bad debt (uncollectible copays and deductibles.) Our experience shows that fiscal intermediaries are now auditing the submitted Medicare bad debt based upon these criteria, and cost report preparers should therefore ensurethat the Medicare bad debt meet the criteria. The following is summarized from Riverbend’s Flash 05-04, distributed in March 2005. It is recommended to read the full text.
a) The amount of bad debt should be claimed in the period that it is written of the provider’s books.
b) A bill must first be deemed uncollectible and only after reasonable collection efforts, and would therefore be premature to write off unless collection efforts have been pursued at least 120 days (since the first bill).
c) While a bill is being pursued still through a collection agency, it is premature to write it off, unless your provider can prove it was allowed to write off at such point in years prior to August 1987.
d) Reasonable collection efforts may be waived for indigent patients.
e) To the extent that Medicaid is the responsible party for the copay, even where you know that Medicaid will not pay, you must demonstrate that you billed Medicaid, and Medicaid refused to pay.
f) No Medicare bad debt may be claimed for Part B therapies.
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