Medicare Compliance & Reimbursement

September ODF promises relief from confusion for nursing homes.

Don't look now, but the Centers for Medicare & Medicaid Services has fine-tuned yet again its message about "under arrangement" services provided in skilled nursing facilities to Part A stay residents.

The good news: The shift could save nursing homes costly legal fees.

"It was never our intent to mandate a specific contractual arrangement," said Sheila Lambowitz, speaking at the SNF/Long-Term Care Open Door Forum held Sept. 28. Lambowitz was addressing providers' persistent concerns about how to tie up loose ends with suppliers providing PPS covered services.

Seeming weary from months of discussion on the topic, Lambowitz went on to simplify matters even more, characterizing the needed "arrangement" between SNFs and Part A suppliers as simply "having an understanding." Confused about all the "guidance" on the topic? You're not alone. Look for an important revision to Transmittal 183 by the middle of the month, advised Lambowitz.

Other ODF highlights: Need a refresher on Part B therapy billing? Check out CMS's new Web site dedicated to provider education of Part B billing for therapy: www.cms.hhs.gov/medlearn/therapy/billing.asp. Battered by the season's storms? Providers who have survey concerns related to the recent storm evacuations and damage in the Southeast should contact Colleen Carpenter, regional specialist for CMS in Atlanta at 404-562-7242.

"A provider that's coming out of serious power outage isn't ready to have nine surveyors enter the building," notes LuMarie Polivka-West, the Florida Health Care Association representative who has coordinated storm-related communications between providers and CMS. Billing for blood glucose monitoring? CMS officials stuck to their guns when several callers asked about some providers' recent denied claims for blood glucose monitoring in SNFs. Some FIs, it seems, have recently begun denying claims that they previously covered, possibly in error.

The future on the matter doesn't look bright: "We're standing by our existing policy [of noncoverage]," stated Lambowitz. "We have no plans to change it."