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Medicare PPS and Part B Billing for Skilled Nursing Facilities
May 24, 2011 @ 8:30 am - 4:00 pm
Description: This two-day comprehensive course will provide you with an understanding of coverage and reimbursement under Medicare Part A in a skilled nursing facility including procedures for establishing reimbursement through the MDS 3.0, RUGs IV reimbursement levels, denial notices, demand billing, consolidated billing and medical determination of coverage. In addition, the process, procedures, and requirements for Medicare Part B outpatient therapy claims will be covered along with billing Medicare Part B for immunizations.
Participants will be able to:
- Understand the Medicare Part A coverage and reimbursement using RUGs IV for a skilled nursing facility stay;
- Describe proper documentation requirements for the MDS 3.0, and in obtaining and supporting appropriate RUGs IV levels of care for reimbursement;
- Understand the process, procedures and requirements for billing Medicare Part A claims and Medicare Part B outpatient therapy and immunization claims;
- Understand Medicare Part B outpatient therapy services documentation and billing requirements including annual therapy cap limitations and exclusions and Multiple Procedure payment Reduction (MPPR);
- Understand how and when to prepare Medicare Denial Notices, No Pay Claims, and Demand Bills as well as the beneficiary’s appeal process; and
- Describe the consolidated billing requirements for services provided by outside health professions to residents of a skilled nursing facility covered under Medicare Part A.