Medicare Compliance & Reimbursement

Take heed: Some plans may require frequent recertifications for skilled care. Failing to nail down the right information when admitting a patient who may be on a Medicare Advantage plan can put your facility at a major disadvantage payment-wise. Golden rule: Always "do an insurance verification before admission because problems can creep up with Medicare Advantage (MA) plans," warns Atlanta consultant Darlene Greenhill. "And if you don't take care of them in time, you might admit the person and find out you have all kinds of billing issues." Examples: "Sometimes a family member thinks the beneficiary has traditional Medicare," says Greenhill, "but later you find out that the beneficiary is really in a Medicare Advantage plan," she says. The opposite scenario has also been known to occur. Also: The admissions staff should look at the Common Working File (CWF) to see how many days the person has left in his [...]