The Complete Guide to Long-Term Care Medicare Billing
Frosini Rubertino, RN, CRNA C, C-NE, CDONA /LTC, CPRA
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Product Description:
Conquer no-pay bills, exhaust billing, and ensure proper reimbursement under RUG-IV
The Complete Guide to Long-Term Care Medicare Billing provides easy-to-understand guidance to help long-term care facilities correctly file Medicare Part A and Part B claims. It breaks down the often misunderstood consolidated billing process, clarifies the appropriate use of beneficiary notices, and offers practical solutions for billing under RUG-IV.
The Complete Guide to Long-Term Care Medicare Billing will help you:
- Understand and comply with the billing changes under RUG-IV
- Correctly file no-pay bills and benefits exhaust claims
- Complete the UB-04 accurately
- Apply expert insight and insider tips to your SNF consolidated billing
- Correctly complete and file Medicare Part A and Part B claims
Table of Contents
- Section I: Medicare Part A SNF services
- Overview of Medicare Part A
- Eligibility and enrollment
- Eligibility verification
- Enrollment
- Cost
- Technical criteria
- Coverage
- Benefit periods
- Beneficiary notices
- Physician certification and recertification
- Billing
- CMS 1450 (UB-04)
- Types of bills
- Timely filing guidelines
- Consolidated billing
- Major Categories
- Communication for accurate billing
- Reimbursement
- RUG IV
- MDS 3.0
- Section II: Medicare Part B SNF services
- Overview of Medicare Part B
- Eligibility and enrollment
- Eligibility verification
- Enrollment
- Cost
- Technical criteria
- Coverage
- Benefit periods
- Beneficiary notices
- Physician certification and recertification
- Billing Part B
- CMS 1500
- Timely filing requirements
- Part B Major Categories of billable services
- Reimbursement
- Section III: Ensuring a solid SNF billing system
- Communication
- Internal compliance systems
- Triple check
- Billing system challenges
Tools
When you purchase this book, you will also receive on-line access to a number of valuable tools, which you can download straight to your desktop, then customize to fit your specific needs. Among the tools available include:.
- RUG-IV classification chart (shows the breakdown of RUG-IV classification)
- RUG spider chart
- RUG grouper criteria chart
- ADL calculation chart
- UB-04 top sections that reveal code changes
About the Author
Frosini Rubertino, RN, CRNAC, C-NE, CDONA/LTC, is a registered nurse with more than 30 years of experience in the healthcare industry. A former member of the Arkansas Health Association's Education Committee, she specializes in risk management, Medicare and regulatory compliance, clinical systems, and education in long-term care.
Product Types : Departments :
SOURCE CODE: ESC
ISBN: 978-1-60146-730-0
PUBLISHED: 08/26/2010
