Medicare Guide for SNF Billing and Reimbursement

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Medicare Guide for SNF Billing and Reimbursement

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Medicare Guide for SNF Billing and Reimbursement

Janet Potter, CPA, MAS
Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC

Long-term care billers play a vital role in ensuring proper reimbursement for their facility—but that role is anything but easy. With value-based purchasing transforming the long-term care billing landscape, billers need to bill appropriately to ensure they are not leaving money on the table. The Medicare Guide for SNF Billing and Reimbursement will help tackle even the most complex billing issues.

This guide is the go-to resource for billing staff to help them understand the Medicare billing process and obtain appropriate reimbursement for their facility. In addition to billing for services covered under Medicare Parts A and B, this book also addresses:

  • No-pay bills
  • Filling out the UB-04
  • SNF consolidated billing
  • Part B outpatient therapy services and billing 
  • Billing for medical supplies
  • Billing for diagnostic tests, lab services, and radiology
  • Billing for screening and prevention
  • Tips to avoid common billing errors and ensure a solid billing system


This book will help billing staff:

  • Correctly bill for Medicare Part A and Part B claims to obtain accurate reimbursement
  • Understand how to comply with claims submissions and avoid common billing errors
  • Navigate difficult reimbursement scenarios
  • Effectively communicate with other departments to manage reimbursement and proper documentation


Table of Contents

Chapter 1: SNF Billing Overview
Chapter 2: Part A SNF Billing
Chapter 3: SNF Consolidated Billing
Chapter 4: Part B SNF Billing
Chapter 5: Part B Outpatient Therapy Services and Billing
Chapter 6: Billing for Medical Supplies
Chapter 7: Billing for Diagnostic Tests, Lab Services, and Radiology
Chapter 8: Billing for Screening and Prevention
Chapter 9: Ensuring a Solid SNF Billing System 


About the Authors:

Janet Potter, CPA, MAS, is a senior manager in the healthcare advisory group at Marcum LLP. Potter joined Marcum through the firm’s 2015 merger with Frost, Ruttenberg, & Rothblatt PC (FR&R Healthcare Consulting, Inc.). She delves into numerous aspects of the healthcare industry, including Medicare and Medicaid billing, compliance issues, and changing regulations for skilled nursing facilities.

Potter writes and prepares articles, speaker presentations, and seminar materials, as well as monitoring industry websites for regulatory and compliance changes. She is a frequent speaker on various topics affecting long-term care. Potter is a member of the Advisory Board for HCPro's Billers' Association for Long-Term Care and frequently contributes to PPS Alert for Long-Term Care and other HCPro publications.

Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC, is a regulatory specialist with more than 25 years of experience in the healthcare industry. She is the author of HCPro’s The QIS Mock Survey Guide, The Medicare Billing Manual for Long-Term Care, The Complete Guide to Long-Term Care Medicare Billing, QAPI: A Nursing Home’s Guide to Implementation and Management, Dementia Care: A Handbook for Long-Term Care, and Caring for the Dementia Resident: Ensuring Regulatory Compliant Care; she also authored TrainingInMotion.org’s Carmelina: Essential Nursing Systems for Long-Term Care. As the founder of TrainingInMotion.org and instructor for HCPro’s Medicare Boot Camp®—Long-Term Care Version, she is a nationally recognized trainer and speaker, advising long-term care organizations in regulatory compliance and how to maintain excellence in their respective roles.

Published: 08/22/2017

Page count: 200
Dimensions: 8.5 X 11
ISBN: 978-1-68308-130-2