Long-Term Care

Master the rehab workaround

Billing Alert for Long-Term Care, July 1, 2009

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When a resident’s therapy services are decreased or discontinued, but there are still payment days left under the rehab resource utilization group (RUG), a SNF biller may have to do a rehab workaround to prevent the claim from rejecting.

The Medicare claims processing system includes edits that will reject claims if the therapy services do not meet the criteria for the rehab RUG being billed.

“A rehab workaround bypasses the Medicare edits by putting the therapy services on the claim with a charge of one penny,” says Lee A. Heinbaugh, president of The Heinbaugh Group, a long-term care consulting company in Lakewood, OH. “Basically, it tricks the system into thinking that the correct amounts of therapy disciplines are included so the claim will process correctly.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Billing Alert for Long-Term Care.

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