Claims Review
Consolidated Billing
ORT
Reimbursement
Skilled Coverage
100
Documentation did not indicate participation in medically stable patients receiving therapy; No gains due to declines in physical conditions; Medically stable and reached potential.
What are the three primary reasons claims were denied based on the documentation?
100
I went into effect January 1st and really cut into your pockets on part B therapies
What is Multiple Procedure Payment Reduction MPPR?
100
I monitor the performance of the FFA’s and provide oversight for the BOM’s in the Pinon communities.
Who is Tracy Nickelson?
100
This RUG needs only 1 person to occupy and 150 minutes of time.
What is Medium?
100
A Stage II wound can stand alone as skilled care and qualify someone for Medicare A.
What is no?
200
This group of contractors was developed because of the improper FFS payments discovered by CMS.
Who is CERT?
200
Everyone wishes I were a covered service but unfortunately, I am excluded and can be pretty pricey.
What is Radiation?
200
I review personal records and ensure compliance with current employment laws and workers compensation.
Who is Sarah Bogucki?
200
Captures the best RUG and only needs 7 days of information to do so.
What is ARD?
200
These 4 team mates make or break your financial backbone and need daily attention in your charting.
What is Bed Mobility, Transfers, Toileting, Eating?
300
The Medicare Integrity Program unleashed this new group leaders.
Who is MACS – Trailblazers?
300
These 2 parts of a bill component need to be looked at when someone goes out for a procedure because you only have to pay for one of them.
What are Technical and Professional components?
300
I review POC’s for 2567 and assist with Policy and Procedure Development.
Who is Mary Gillette?
300
These 2 guys can’t mix company with any other assessments.
What is Entry tracking and Discharge tracking?
300
This piece of the record is reflective of personal needs and individualized approaches.
What is the Care plan?
400
Atypical billing patterns, Consistent errors in billing and coding compared to one another, Unusual billing services and codes.
What are the three red flags CMS uses to identify claims for review?
400
4 services that providers can bill separately for when their resident is in a covered skill stay.
What are physician professional services; certain chemo drugs; administration of chemo drugs; prosthetic devices, ambulance services to and from hospital for dialysis; initial ambulance and discharge ambulance (as long as not to another SNF); radioisotope services?
400
I bring in the bags of cash.
Who is Heather TerHark?
400
Therapy treatment time that overlaps between residents during the same time.
What is Concurrent therapy?
400
This after dinner staple helps the team organize their thoughts into the written word.
What is P(problem) I (intervention and assessment) E (Evaluation and plan)?
500
This group of fine upstanding inspectors are rewarded for having “good cause” to take your money.
Who are the RAC Auditors?
500
This was created in 1998 to avoid duplicate services (made it so vendors couldn’t double dip).
What is Consolidated Billing?
500
I review reasonable revenue rates, PPDs, unusual fluctuations and revenue and expense trends.
Who is Mary Fuentes?
500
1 – discharged from Med A on or before day 8; 2 – only 1-4 days of therapy and have started the last 4 days of the skilled stay; 3 – Assessment must be coded as a SOT OMRA; 4 – PPS 5 day readmission/return must be completed; 5 – ARD must be on or before the 8th day of the stay; 6 – ARD of the SOT OMRA must be the last covered Med A day; At least 1 discipline must continue with minutes through the last day of the stay.
What are the 7 requirements of a Medicare Short Stay Assessment?
500
This official recognition clearly indicates that post hospital extended care services are required because of your residents need.
What is Physician Cert?
M
e
n
u