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Course Overview

HCPro's Skilled Nursing Facility Billing Boot Camp covers the latest Medicare billing rules and regulations so that you can help your facility bill appropriately for services and prevent payment denials.

Skilled Nursing Facility Billing Boot Camp provides hands-on, how-to education focusing on billing for Medicare Part A and B, the ins and outs of PDPM, consolidated billing, and accurately completing the UB-04. Plus, guidance on understanding the SNF coverage criteria and a breakdown of the different beneficiary notices.

Attendees will be able to return to their facility with the tools they need to understand the latest billing and reimbursement regulations, plus how to navigate the many billing processes to ensure their SNF is receiving appropriate reimbursement for services provided.

Learning Objectives

• Locate key Medicare sources of authority so that you can find answers to your Medicare questions
• Identify the eligibility criteria for a SNF Part A admission
• List the technical criteria for a SNF Part A admission
• Determine best practices for SNF Part A admissions
• Understand the required coding for Part B therapy claims
• Understand how to resolve discrepancies between documentation and claims
• Accurately complete the UB-04
• Describe the scenarios for the appropriate use of beneficiary notices
• Identify potential items and services subject to consolidated billing
• Understand the political landscape and evolving payment reform
• Understand how payment is assigned under PDPM
• Understand the different types of medical reviewers and claims audits
• Learn how to conduct an efficient and effective triple check

Course Outline/Agenda

DAY 1

Module 1: Intro to SNF Medicare

Medicare A, B, C, and D

Medicare administrative agencies

Spell of illness/benefit periods

SNF eligibility criteria

Verification of benefits

Module 2: Medicare Coverage

Coverage basics

Physician certification and recertification

Documentation requirement basics

Beneficiary notices

Module 3: Part A Billing

SNF PPS - Patient Driven Payment Model (DPDPM) overview

The impact of quality on reimbursement (SNFQRP and SNFVBP)

Completing the UB-04 for Part A

The relationship between the claim and documentation

Linking the MDS to reimbursement

Module 4: Special Part A Billing Scenarios

No pay claims

Benefits exhaust claims

LOA claims

Medicare C agreements, preadmission screening, and billing

Medicare as a secondary payor

DAY 2

Module 5: Part B Billing

Completing the UB-04 for Part B

Therapy caps

Multiple Procedure Payment Reduction (MPPR)

Applying modifiers

Ancillary billing

Module 6: Consolidated Billing

Five major categories of consolidated billing

Medicare allowable amounts

Drug exclusions

Tools and resources

Module 7: Tying It All Together

Admissions packet checklist

PEPPER reports

Medical review and appeals

Compliance & ethics program

Triple check

*Please Note: Agenda is subject to change.

Speaker

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