The Centers for Medicare and Medicaid Services (CMS) is reporting these events, updates and deadlines for providers and hospitals on payment issues concerning Medicare and Medicaid. Read the latest MLN Connects Weekly Provider eNews.
Provider Compliance
Inpatient Skilled Nursing Facility Denials
According to the 2015 Comprehensive Error Rate Testing (CERT) Report, the denial rate for Skilled Nursing Facilities (SNFs) increased from 6.9% in 2014 to 11% in 2015 due to missing or incomplete certification/recertification:
- Statement must contain need for skilled services that can only be provided in SNF/swing-bed on a daily basis for a condition patient was treated for in prior hospital stay
- Must include physician’s dated signature (printed name if signature is illegible)
In addition, recertifications should include:
- Expected length of stay
- Explanation if continued need for services is for a condition that arose after SNF admission
- Any plans for home care
Resources:
- CERT: SNF Certifications and Recertifications MLN Matters® Special Edition Article
- SNF Billing Reference Fact Sheet
- Medicare Fee-For-Service 2014 Improper Payments Report, page 19
- Medicare Fee-For-Service 2015 Improper Payments Report, page 18
Claims, Pricers & Codes
Chronic Care Management Payment Correction for RHCs and FQHCs
Effective January 1, 2016, Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) received payment for Chronic Care Management (CCM) services based on the Medicare Physician Fee Schedule national average non-facility payment rate. However, for claims with dates of service on or after January 1, 2017, RHCs and FQHCs have been receiving a locality adjusted payment rate for these services. Your Medicare Administrative Contractor will adjust any claim processed incorrectly. No provider action is required.
Upcoming Events
IMPACT Act: Standardized Patient Assessment Data Activities Call — March 29
Medicare Shared Savings Program ACO: Preparing to Apply for the 2018 Program Year Call — April 6