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Consolidated Billing for Long-Term CareFrosini Rubertino, RN, BSN, C-NE, CONA/LTCConsolidated billing remains a constant challenge for compliance and billing long-term care professionals. Consolidated Billing for Long-Term Care helps skilled nursing facilities (SNF) figure out which billed services they are responsible for paying and which they are not.This book opens with helpful background information on the intersection of SNF services and billing. It then covers the five major categories of consolidated billing and all the service inclusions and exclusions that apply to each, with an entire chapter dedicated to dissecting the trickiest cases. Also detailed is how to determine which components of an invoice should be paid and how to develop airtight payment agreements with outside service partners. Finally, this book provides strategies for implementing and shaping industry-required compliance systems (i.e., compliance and ethics programs and QAPI) that promote successful consolidated billing.Included are case scenarios and figures to illustrate key concepts, tips on avoiding fraudulent practices and other common billing pitfalls, and guidance on obtaining appropriate reimbursement.This resource will help you to do the following:Apply expert insight and insider tips to your SNF consolidated billingUnderstand what is excluded and included under consolidated billingImprove workflow and financial viability with compliant consolidated billing practicesAvoid auditor scrutiny by correctly submitting claims to Medicare on the first tryTable of ContentsPart I: Background and Regulatory BreakdownChapter 1: The Basics of SNF Skilled CoverageMedicare General Program BenefitsSkilled Services DefinedSNFs and NFs DefinedReimbursable SNF ServicesSNF Payment Coverage RequirementsGeneral SNF Payment and Billing RequirementsBottom LineChapter 2: Introduction to SNF Consolidated Billing: The MechanicsA Checkered Billing PastConsolidated Billing DefinedSNF CB Coding RequirementsFirst Look: Sample CB Claim FormTermination of the Consolidated Billing RequirementBottom LineChapter 3: The Five Major Categories of Consolidated BillingExcluded Services DefinedMajor Categories of Consolidated BillingBottom LineChapter 4: Consolidated Billing IllustratedCB Reference Charts: The Who, What, and When of Consolidated BillingTest Your Knowledge: CB Fact vs. FictionBottom LineChapter 5: Navigating Special Billing CasesCategorical ExclusionsAmbulance ServicesPhysician and Nonphysician Practitioner ServicesUnique Billing ScenariosLeave of AbsenceChemotherapy AdministrationInfluenza and Pneumococcal Pneumonia VaccinationsBottom LinePart II: Compliance StrategyChapter 6: Forging Successful Payment Arrangements With Outside Service PartnersAgreements and Notifications DefinedRundown of the Payment Arrangement ProvisionSample CMS Agreement and Notification Letters DecodedBottom LineChapter 7: Best Practices for Ongoing Consolidated Billing ComplianceBilling Stage-Specific Compliance StrategiesSystemic Compliance ProgramsPutting It All Together: Consolidated Billing Case StudiesBottom LineAppendix: Key Acro

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This book is a data-driven, proactive approach to improving the quality of life, care, and services in nursing homes. It is useful for identifying opportunities for improvement; addressing gaps in systems or processes; developing and implementing an improvement or corrective plan; and continuously monitoring effectiveness of interventions.

Engineering --- Health Care Quality, Access, and Evaluation --- Residential Facilities --- Quality of Health Care --- Health Services Administration --- Health Facilities --- Health Care --- Technology, Industry, and Agriculture --- Health Care Facilities, Manpower, and Services --- Technology, Industry, Agriculture --- Quality Improvement --- Nursing Homes --- Quality Assurance, Health Care --- Health Care Quality Assessment --- Health Care Quality Assurance --- Healthcare Quality Assessment --- Healthcare Quality Assurance --- Quality Assessment, Healthcare --- Quality Assurance, Healthcare --- Quality Assessment, Health Care --- Assessment, Healthcare Quality --- Assessments, Healthcare Quality --- Assurance, Healthcare Quality --- Assurances, Healthcare Quality --- Healthcare Quality Assessments --- Healthcare Quality Assurances --- Quality Assessments, Healthcare --- Quality Assurances, Healthcare --- Homes, Nursing --- Home, Nursing --- Nursing Home --- Improvement, Quality --- Improvements, Quality --- Quality Improvements --- Healthcare Facilities, Manpower, and Services --- Community-Based Distribution --- Contraceptive Distribution --- Delivery of Healthcare --- Dental Care Delivery --- Distribution, Non-Clinical --- Distribution, Nonclinical --- Distributional Activities --- Healthcare --- Healthcare Delivery --- Healthcare Systems --- Non-Clinical Distribution --- Nonclinical Distribution --- Delivery of Dental Care --- Health Care Delivery --- Health Care Systems --- Activities, Distributional --- Activity, Distributional --- Care, Health --- Community Based Distribution --- Community-Based Distributions --- Contraceptive Distributions --- Deliveries, Healthcare --- Delivery, Dental Care --- Delivery, Health Care --- Delivery, Healthcare --- Distribution, Community-Based --- Distribution, Contraceptive --- Distribution, Non Clinical --- Distributional Activity --- Distributions, Community-Based --- Distributions, Contraceptive --- Distributions, Non-Clinical --- Distributions, Nonclinical --- Health Care System --- Healthcare Deliveries --- Healthcare System --- Non Clinical Distribution --- Non-Clinical Distributions --- Nonclinical Distributions --- System, Health Care --- System, Healthcare --- Systems, Health Care --- Systems, Healthcare --- Facilities, Health --- Facility, Health --- Health Facility --- Administration, Health Services --- Health Services --- Pharmacy Audit --- Quality of Care --- Quality of Healthcare --- Audit, Pharmacy --- Care Quality --- Health Care Quality --- Healthcare Quality --- Pharmacy Audits --- Facilities, Residential --- Facility, Residential --- Residential Facility --- Healthcare Quality, Access, and Evaluation --- Engineerings --- organization & administration --- Quality Assurance, Health Care. --- standards. --- Nursing homes --- Administration. --- Quality control.