Long-Term Care

Benefits exhaust and no-pay bills: Obstacles to compliance

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

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Complying with the nuances of when and how to properly submit benefits exhaust and no-pay bills relies on more than simply knowing the rules. But failure to comply will attract unwanted attention by auditors.

The current process to submit no-pay bills was launched October 1, 2006 (Transmittal 930); however, CMS has made many changes to these guidelines over the years. It’s important to monitor all transmittal changes to this process as they are released.

Several elements must be in place for the no-pay billing process to be successful and compliant: knowledge of the rules, communication between the clinical and billing teams, and processes to ensure good flow of information between the two departments. To address some of the communication stumbling blocks, members of the billing and clinical teams should review the Medicare rules for generating a new benefit period and determining what constitutes skilled care.

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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