Long-Term Care

No-pay bills and benefits exhaust: Back to basics

Billing Alert for Long-Term Care, July 1, 2010

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Benefits exhaust and no-pay bills are ways for CMS to maintain records on all inpatient services provided to Medicare beneficiaries. Essentially, their intent is to track Medicare benefit periods.

“Prior to facilities completing no-pay bills and benefits exhaust claims, Medicare had no way of knowing how many benefit days had been used, so they were paying some claims erroneously,” says Karen Connor, president of Connor LTC Consulting in Haverhill, MA. No-pay bills and benefits exhaust claims hold no reimbursement value for SNFs. As a result, despite their importance to CMS, they often go overlooked or even ignored by billing office staff because of the need for billers to address more financially pressing issues.

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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