Medicare Guide for SNF Billing and Reimbursement, Third Edition

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Medicare Guide for SNF Billing and Reimbursement, Third Edition

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Medicare Guide for SNF Billing and Reimbursement, Third Edition

Long-term care billers play a vital role in ensuring proper reimbursement for their facility—but that role is not easy. Billers need to ensure they are not leaving money on the table these days. The Medicare Guide for SNF Billing and Reimbursement, Third Edition will help you tackle the newest and most complex billing issues.

This guide is updated to reflect the FY 2021 final payment rule, and of course, includes all Patient-Driven Payment Model changes from 2019. Offering tables, charts, and tools outlining both case-mix and non-case-mix components that will form SNFs’ rates, this book is the perfect referral resource to make sure you and your staff are filing clean claims.

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, including updates to PDPM clinical diagnosis mapping for 2021
  • Disaster-related billing, including COVID-19 waivers

This book will help billing staff:

  • Understand new changes under the FY 2021 payment rule
  • 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: September 2020

Page count: 252
Dimensions: 8.5 x 11 perfect bound
ISBN: 978-1-64535-061-3

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
With knowledge and experience spanning over 30 years, Rubertino is the founder and president of and is a nationally recognized industry leader, speaker, author, and educator. She received her executive management training from Weatherhead School of Management at Case Western Reserve University and Continuous Process Improvement training from the dynamic healthcare environment of Cleveland, Ohio. She is the author of Carmelina: Essential Nursing Systems for LTC, The QIS Mock Survey Guide, The Complete Guide to LTC Medicare Billing, QAPI: A Nursing Home’s Guide to Compliant Care, Consolidated Billing for LTC, and Dementia Care: A Handbook for LTC Staff. Through’s audits and training workshops, Rubertino brings her experience in risk manage­ment, regulatory compliance, and clinical systems management in the post-acute care industry, helping organizations achieve quality outcomes and compliance with regulatory expectations.

Jennifer Matoushek, MBA/HCM, CPC
Matoushek 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 post-acute 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 American Association of Professional Coders.