Medicare Guide for SNF Billing and Reimbursement, Second Edition

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Medicare Guide for SNF Billing and Reimbursement, Second Edition

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Medicare Guide for SNF Billing and Reimbursement, Second Edition

Long-term care billers play a vital role in ensuring proper reimbursement for their facility—but that role is not easy. With the new Prospective Payment System (PPS) transforming the long-term care billing landscape, billers need to ensure they are not leaving money on the table. The Medicare Guide for SNF Billing and Reimbursement, Second Edition will help tackle the newest and most complex billing issues.

This guide’s second edition highlights the largest change in payment methodology since 1998. On October 1, 2019, the Patient-Driven Payment Model (PDPM) methodology will completely replace the previous RUG-IV system for reimbursement and rate calculations. Offering tables, charts, and tools outlining both case-mix and non-case-mix components that will form SNFs’ PPS rates, this book is the perfect referral resource to make sure you and your staff are filing clean claims under PDPM.

In addition to billing for services covered under Medicare Parts A/B and PDPM, this book 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
  • ICD-10 coding

This book will help billing staff:

  • Understand the PDPM rate calculation methodology
  • Identify opportunities to maximize reimbursement and accurately project revenue
  • Correctly bill for Medicare Part A and Part B claims
  • 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

Published: May 7, 2019

Page count: ~254
ISBN: 978-1-68308-882-0

Table of Contents

Chapter 1: SNF Billing Overview

Chapter 2: Part A SNF Billing

Chapter 3: PDPM Methodology

Chapter 4: SNF Consolidated Billing

Chapter 5: Part B SNF Billing

Chapter 6: Part B Outpatient Therapy Services and Billing

Chapter 7: Billing for DMEPOS

Chapter 8: Billing for Diagnostic Tests, Lab Services, and Radiology

Chapter 9: Billing for Screening and Preventive Services

Chapter 10: Ensuring a Solid SNF Billing System

Chapter 11: Best Practices for Ongoing Consolidated Billing Compliance

About the Authors

Frosini Rubertino, RN, BSN, C-NE, RAC-CT, CDONA/LTC, is the founder and president of and is a nationally recognized industry leader, speaker, author, and educator. With knowledge and experience spanning over 25 years, she received her executive management training from Weatherhead School of Management at Case Western Reserve University and her Continuous Process Improvement training from the dynamic healthcare environment of Cleveland, Ohio. She is the author of Carmelina: Essential Nursing Systems for Long-Term Care, The QIS Mock Survey Guide, The Complete Guide to Long-Term Care Medicare Billing, QAPI: A Nursing Home's Guide to Compliant Care, Consolidated Billing for Long-Term Care, and Dementia Care: A Handbook for Long-Term Care Nursing Staff. Through’s audits and training workshops, Rubertino brings her experience in risk management, regulatory compliance, and clinical systems management in the postacute care industry, helping organizations achieve quality outcomes and compliance with regulatory expectations.

Jennifer Matoushek, MBA/HCM, CPC, is a senior consultant at LW Consulting, Inc., with more than 10 years of healthcare industry experience. She works with clients in acute, primary care, and postacute settings. Her expertise includes preparation of Medicare and Medicaid cost reports, market analysis, benchmarking analysis, inpatient rehabilitation due diligence billing audits, SNF medical billing and claims reimbursement, monthly exclusion checks, database design and creation, and anesthesia/E&M billing audits. She also has experience in billing and collections for outpatient physical therapy. Matoushek holds a bachelor’s degree in science in business administration, a master’s degree with a concentration in healthcare management, and a Certified Professional Coder designation from the AAPC.