The Medicare Billing Manual for Long-Term Care

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The Medicare Billing Manual for Long-Term Care

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The Medicare Billing Manual for Long-Term Care

Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC

Conquer no-pay bills, exhaust billing, and ensure proper reimbursement under RUG-IV

The Medicare Billing Manual for Long-Term Care provides easy-to-understand guidance to help long-term care facilities correctly file Medicare Part A and Part B claims. It breaks down the often misunderstood consolidated billing process, clarifies the appropriate use of beneficiary notices, and offers practical solutions for billing under RUG-IV.

The Medicare Billing Manual for Long-Term Care will help you:

  • Understand and comply with the billing changes under RUG-IV
  • Correctly file monthly, no-pay, and benefits exhaust claims
  • Complete the UB-04 accurately
  • Apply expert insight and insider tips to your SNF consolidated billing
  • Understand which ancillary services are covered under Part B
  • Increase cash flow and financial viability with Part B billing
  • Avoid auditor scrutiny by correctly submitting claims to Medicare on the first try

Table of Contents

Chapter 1: Overview and History of the Medicare Program

Chapter 2: Part A SNF Billing

Chapter 3: Billing for Ancillary Revenue

Chapter 4: Part B Outpatient Therapy Services and Billing

Chapter 5: Billing for DMEPOS

Chapter 6: Billing for Diagnostic Tests, Lab Services, and Radiology

Chapter 7: Billing for Screening and Prevention

Chapter 8: Ensuring a Solid SNF Billing System

Appendix A: Acronyms

Appendix B: Forms


When you purchase this book, you will also receive on-line access to a number of valuable tools, which you can download straight to your desktop, then customize to fit your specific needs. Among the tools available include:

  • RUG-IV classification chart (shows the breakdown of RUG-IV classification)
  • RUG spider chart
  • RUG grouper criteria chart
  • ADL calculation chart
  • UB-04 top sections that reveal code changes

About the Author

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, Caring for the Dementia Resident: Ensuring Regulatory Compliant Care, and’s Carmelina: Essential Nursing Systems for Long-Term Care. As the founder of 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: March 2013