Cost Report Blog

RUG Rates

Presented here are the RUG rates separated by the labor and non-labor component.  For the Medicare cost report, the labor portion is adjusted by the wage index that is based on the CBSA of the facility location.  Med-Calc has a tool within the Medicare cost report software package that allows the user to calculate the rate based on the wage index provided.  For questions regarding the RUG rates, please contact us at 800 447-2540.

Outpatient therapy caps are increased to $1,840 for 2009.

For more information, please see this transmittal from CMS.

CMS has clarified in the following MLN training material that a SNF must pay for the ambulance transportation of a Medicare A patient to a doctor’s office.  More information can be found here.

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