Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement

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Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement

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Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement

Elizabeth Malzahn-McLaren

To reduce your facility’s risk of unwanted outcomes and ensure proper Medicare reimbursement for the type and number of skilled services provided, it’s essential to submit claims appropriately and in accordance with the Centers for Medicare & Medicaid Services’ (CMS) skilled services regulations. Don’t miss out on Medicare reimbursement or put your facility at risk for fraudulent penalty charges and monetary recoupment!

Long-Term Care Skilled Services: How to Document for Proper Medicare Reimbursement breaks down CMS’ skilled services requirements and explains how facilities can best manage the daily operations that affect skilled coverage and necessary documentation. This book provides information for all staff members who play a role in determining and documenting skilled services and includes:

  • Easy-to-understand explanations of complex CMS rules and regulations regarding skilled services
  • A topic-driven format enabling readers to research specific questions and conveniently and efficiently obtain complete and descriptive answers
  • Examples of documentation for skilled services
  • Guidance to help facilities receive the benefits and reimbursement they deserve
  • Downloadable forms


This book will help SNFs:

  • Identify common problems and challenges associated with skilled services and gain a better understanding of how to handle the major pain points
  • Properly assess skilled services under the MDS 3.0
  • Increase skilled census and improve their facility’s reputation with the support of the entire staff
  • Avoid under- and overpayments from Medicare with easy-to-understand explanations of complex rules and regulations
  • Provide necessary skilled services to each resident through a complete understanding of eligibility requirements
  • Accurately document skilled services using proven, time-saving solutions for proper Medicare reimbursement


Table of Contents

  • Breaking Down the Regulations
  • Technical Eligibility for Skilled Services in Long-Term Care
  • Meeting the Regulatory Guidelines for “Skilled” Services in a Skilled Nursing Facility
  • MDS 3.0—Assessments, Selection, and Sections 
  • Proper Communication During a Medicare Part A Stay
  • Other Important Things to Know
  • Medicare Managed Care


About the Author

Elizabeth Malzahn-McLaren, national director of healthcare for Covenant Retirement Communities, has extensive experience in skilled nursing operations, including third-party billing, revenue enhancement, and regulatory compliance.

As the skilled nursing and assisted living subject -matter expert for Covenant Retirement Communities, Malzahn-McLaren oversees the skilled nursing and assisted living operations at the senior services provider’s 13 campuses nationwide.

An authority on healthcare regulation and compliance, Malzahn-McLaren conducts training programs for Covenant Retirement Communities as well as for HCPro, and for national and state nonprofit
healthcare organizations.


Published: March 2015

Page count: 136
Dimensions: 8.5x11
ISBN: 978-1-55645-261-1