This
session takes a deep dive into CMS's Consolidated Billing Policy. I
will break down the 5 Major Categories Of Excluded Services, teach
attendees how to identify excluded services beyond the 5 major
categories, give tips and tricks for screening claims for Consolidated
Billing as well as explain how Medical Necessity applies to types of
transportation, choosing a correct site of service and explaining how
different sites of service and levels of medical necessity may affect
what/how much the SNF is responsible for. Then, we will cover how to
successfully communicate to providers so they too can achieve successful
billing.
What
makes my session different is that I explain Consolidated Billing in a
way that business office staff, leadership and back-office services can
all understand and relate to. It's not just about memorizing CMS policy,
it's about learning how to apply policy to real-life situations and
understanding how to execute it. Attendees will leave my session ready
to take on their Consolidated Billing with a much greater level of
understanding and confidence.
What You Will Learn
- Understand the 5 Major Categories of Excluded Services, how to
identify them and how to communicate these exclusions to providers and
residents.
- Learn what the difference is between non-covered and excluded
services, when Consolidated Billing is paused or interrupted and how to
correctly reflect in billing.
- Identify common provider claim errors and how to remedy them when
identified, as well as put policy and procedure in place to avoid them
in the future.
- Understand the difference between all of the CMS Fee Schedules,
where to find them and know which is appropriate for each site of
service/type of bill.
- Review and understand how to meet the requirements outlined in CMS's Best Practice Guidelines.
- Where/how to reach out to CMS when your provider or your MAC is not able to resolve your issue.