Medical Billers and Coders

  Determining Medicare Drug Coverage While  billing for Skilled Nursing Facilities (SNF)  or for  hospital billing , billers always make the mistake of considering the wrong Medicare drug coverage. For example, Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are covered under Part D. In this article, we shared an excerpt from a CMS document, which will act as a basic tool to assist you in understanding Medicare drug coverage determinations under Part A, Part B and Part D of Medicare, and to clarify coverage for specific Part D products/drugs/categories.  We also shared billing scenarios, which will help you to determine which part of Medicare covers a drug in a particular situation, assuming all other requirements are met, e.g., a drug must still be medically necessary to be covered. This information is applicable to people in the Original Medicare Plan. People who have a Medicare Advantage HMO or PPO Plan with prescription drug covera

  Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect in 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services administered by contracted healthcare providers. As a result, most of the services provided to Medicare beneficiaries are to be bundled together and billed by SNFs under the Prospective Payment System (PPS) in one consolidated claim. The SNF concerned is then responsible to pay for contracted services out of the per diem rate that it earns for caring for a Medicare beneficiary. Eliminating Skilled Nursing Facilities (SNF) Medical Billing Complication While this imposition may have helped reduce potential fraud and abuse due to double billing by healthcare providers, SNFs have certainly had a hard time understanding: What services are covered under consolidated billing What is billable under Me

  The Trump Administration is taking aggressive actions and exercising regulatory flexibility to help healthcare providers contain the spread of the 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps through 1135 waivers as well as, where applicable, the authority granted under section 1812(f) of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19. As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. CMS is ending the specific emergency declaration blanket waivers for SNFs/NFs, inpatient hospices, ICF/IIDs, and ESRD facilities. CMS passed several temporary emergency declaration blanket waivers for SNFs which were intended to provide healthcare providers with extra flexibilities required to respond to the COVID-19 pandemic. Emergency Declaration Blanket Waivers for SNFs 3-Day Prior Hospitaliza

  During the Public Health Emergency (PHE), The Centers for Medicare & Medicaid Services (CMS) used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer healthcare providers the flexibility needed to respond to the pandemic. In certain cases, these flexibilities suspended requirements in order to address acute and extraordinary circumstances. Now, CMS is taking steps to continue to protect nursing home residents’ health and safety by announcing guidance that restores certain minimum standards for compliance with CMS requirements. We shared a recent update on the removal of temporary emergency waivers for nursing homes, inpatient hospices, ICF/IIDs, and ESRD facilities. Emergency Waivers for Nursing Home Restoring these standards will be accomplished by phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 PHE. These temporary emergency waivers were designed to provide facilities with the flexib