Harmony Healthcare Blog

Establishing the Medicare Denial Management Process

Posted by Kris Mastrangelo on Wed, Feb 05, 2014

It is common practice for facilities to receive communications from Medicare review agencies requesting proof of the provision of skilled services.  Understanding the process and managing these inquiries in a timely and detailed manner is critical in order to minimize recoupment of Medicare Revenue. 

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Topics: Denial Management

Medicare & Medicaid Integrity Issues: Who Is Auditing Us Now?

Posted by Elisa Bovee on Wed, Aug 28, 2013

In the ever changing world of Medicare review contractors, it can be hard to tell who’s auditing us now.  New Program Safeguard Contractors (PSCs) are continually being developed while others fall to the side.  To help keep you up to speed, here is some background information along with a recent update from CMS Program Integrity. 

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Topics: CMS, Denial Management

ICD-10 in the SNF - Be Prepared

Posted by Kris Mastrangelo on Wed, Jun 26, 2013

The implementation date of the ICD-10 transition has been delayed until October 1, 2014.  It is recommended that providers gear up for the transition by taking a look at the ICD-9 codes most commonly used in their facility and problem-solving what ICD-10 code(s) will most likely replace them.

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Topics: CMS, Denial Management

MDS and UB-04 Review: A 3 Point/Triple Check System

Posted by Kris Mastrangelo on Wed, Jun 19, 2013

It is recommended that the MDS and Rehabilitation Department, in conjunction with the Billing staff, utilize the 3 point check system to review each Medicare beneficiary’s UB-04 claim prior to the submission of the bill to Medicare. The 3 point check process includes review of:

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Topics: Denial Management

Modifying the PPS Assessment Reason for Assessment After Transmission

Posted by Kris Mastrangelo on Sat, Jun 15, 2013

Providers have long struggled with items that may not be modified on the MDS 3.0 assessment.  Occasionally, a typographical or data entry error will cause an assessment to be submitted with the Reason for Assessment (RFA) coded incorrectly in one of the many fields in Section A0310A-G.  Providers only option was to inactivate the assessment with the error and complete a new assessment when the error was discovered with the current date as the ARD.  If the resident was no longer covered under Medicare Part A when the error was discovered the facility would be unable to replace the inactivated assessment.  

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Topics: Denial Management

Modifying the Assessment Reference Date (ARD) After Transmission

Posted by Kris Mastrangelo on Wed, Jun 12, 2013

Providers have long struggled with items that may not be modified on the MDS 3.0 assessment.  Occasionally, a typographical or data entry error will cause an assessment to be submitted with the ARD entered incorrectly in section A2300.  Providers only option was to inactivate the assessment with the error and complete a new assessment when the error was discovered with the current date as the ARD.  If the resident was no longer covered under Medicare Part A when the error was discovered the facility would be unable to replace the inactivated assessment. 

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Topics: Denial Management

Updates to MDS 3.0; Section G May 2013 - A Few Recommendations

Posted by Kris Mastrangelo on Sat, Jun 08, 2013

Skilled Nursing Facility providers have been concerned about potential changes to Section G that would change common interpretation of coding instructions in Section G.  The example cited is as follows:  

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Topics: CMS, Denial Management, Medical Record Review

CMS Proposed Final Rule FY2014 - Medicare Payment Rates

Posted by Elisa Bovee on Wed, Jun 05, 2013

On May 1,2013 the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule [CMS-1446-P] outlining the proposed Fiscal Year 2014 Medicare payment rates for skilled nursing facilities (SNFs).  The proposed rule outlines an estimated increase in SNF payments of 1.4%.  This estimated increase is attributable to the 2.3% market basket increase, which is then reduced by the 0.5% point forecast error correction, and further reduced by the 0.4% point multifactor productivity adjustment required by law.

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Topics: CMS, Denial Management, Medical Record Review

5 Tips to Defend Against Allegations of Improper Claim Submission

Posted by Kris Mastrangelo on Wed, May 08, 2013

Over the last 12 months, there have been an inordinate amount of state and federal investigations conducted by ZPIC, OIG, DOJ along with many other governmental entities.  The etiology of these reviews vary in origin, UB-04 edits, diagnoses patterns, ICD-9 Coding, yet a considerable percentage is spurred by whistleblowers.

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Topics: CMS, Denial Management, Medical Record Review

SNF Denial Management

Posted by Peter Mastrangelo on Fri, Jul 27, 2012

Surely you have heard that there are “denials” now in the skilled care world, but do you know what this means?  There are more and more auditing agencies popping up everyday, from ACO to ZPIC, and the acronyms can make your head spin.  Has your facility helped to keep your rehab team informed on what types of audits are present in the current climate?  Or have you been doing your own research to stay afloat?  What kind of tools do you feel you need to better understand the world of “denials”?

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Topics: SNF, Therapy, Denial Management, ACOs

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