Click here for more sample CPC practice exam questions with Full Rationale Answers

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes


As a part of President Trump’s Opening Up America Again effort, the Centers for Medicare & Medicaid Services (CMS) announced a new independent Commission that will conduct a comprehensive assessment of the nursing home response to the 2019 Novel Coronavirus (COVID-19) pandemic. The Commission will provide independent recommendations to the contractor to review and report to CMS to help inform immediate and future responses to COVID-19 in nursing homes. This unprecedented effort builds upon the agency’s fivepart plan unveiled last April to ensure safety and quality in America’s nursing homes, as well as recent CMS efforts to combat the spread of COVID-19 within these facilities. May 1 marks the beginning of Older Americans Month and, as we take this time to honor seniors, CMS remains committed to enacting policies that benefit our Nation’s seniors.

Home Health Plans of Care: NPs, CNSs and PAs Allowed to Certify

Section 3708 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (Pub. L. No. 116-136) amended sections 1814(a) and 1835(a) of the Social Security Act to allow Nurse Practitioners (NPs), certified Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) to certify beneficiaries for eligibility under the Medicare home health benefit and oversee their plan of care. This is a permanent change that will continue after the Public Health Emergency.

Effective for claims with dates of service on or after March 1, 2020, these non-physician practitioners may bill the following codes,

• G0179: Physician re-certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care

• G0180: Physician certification for Medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care

• G0181: Physician supervision of a patient receiving Medicare-covered services provided by a
participating home health agency (patient not present) requiring complex and multidisciplinary care
modalities involving regular physician development and/or revision of care plans

The descriptors of the three codes will be revised at a later date to include the non-physician practitioner specialties.

Ref: https://www.cms.gov/files/document/2020-05-07-mlnc.pdf


Coding Ahead

Enhancing Transparency About Nursing Home Abuse and Neglect

A movement toward increased transparency about abuse and neglect will further help to ensure nursing home quality and safety. Earlier this month the Centers for Medicare & Medicaid Services (CMS) announced a significant enhancement of the information available to nursing home residents, families, and caregivers on the Agency’s Nursing Home Compare website. Beginning Oct. 23, […]

The post Enhancing Transparency About Nursing Home Abuse and Neglect appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Home Sleep Study done in Skilled Nursing Facility. Need advice

Hi,

Has anyone ever encountered billing for a HST when the patient is in a SNF. We are a private group practice and not sure if we could bill this and be reimbursed. The insurance is Medicare.

Any advice would be greatly appreciated. We typically bill 95806 with POS 12.

Thank you,
Michelle

Medical Billing and Coding Forum

Nursing Home Shopping May Get Easier in April

With an aging population and increased reliance on nursing homes, it’s common to have concerns on whether the needs of our elderly loved ones will be met under the care of others. That’s where the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare website can help; it provides an easy way to search […]

The post Nursing Home Shopping May Get Easier in April appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Place of service for Nursing and assisted living facility

Current Procedural Terminology (CPT) Codes 99304 Through 99318

The CPT nursing facility services codes shall be used with POS 31 (skilled nursing facility or SNF) if the patient is in a Part A SNF stay. They shall be used with POS 32 (nursing facility) if the patient does not have Part A SNF benefits or if the patient is
in a NF or in a non-*‐covered SNF stay (e.g., there was no preceding three-*‐day hospital stay). The CPT NF code definition also includes POS 54 (intermediate care facility/mentally retarded) and POS 56 (psychiatric residential treatment center).

CPT Codes 99324 Through 99328 and 99334 Through 99337 :

Domiciliary, rest home (e.g., boarding home) or custodial care services are used to report Evaluation and Management (E/M) services to residents residing in a facility which provides room, board and other personal assistance services, generally on a long-*‐term basis. These CPT codes are used to report E/M services in facilities assigned POS codes 13 (assisted living facility), 14 (group home), 33 (custodial care facility), and 55 (residential substance abuse facility). Assisted living facilities may also be known as adult living facilities.

Narashiman.R COC CPC

Medical Billing and Coding Forum

Get to Know the Nuances of Skilled Nursing Facility Consolidated Billing

Adhere to the Medicare requirements and bundling rules for SNF coverage payment. If you don’t work in a skilled nursing facility (SNF), you may not understand how SNF consolidated billing (CB) affects you. The way you answer the following two questions may help you to see the connection: Have you ever had a Medicare patient […]

The post Get to Know the Nuances of Skilled Nursing Facility Consolidated Billing appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Ask the expert: Navigating the skilled nursing benefit for Medicare

Ask the expert

Navigating the skilled nursing benefit for Medicare

Learning objective

At the completion of this educational activity, the learner will be able to:

  • Identify strategies to help patients who don’t qualify for inpatient admission find postacute options

 

Assigning the correct patient status is important not only to ensure that the hospital gets accurate payment for a patient stay, but also to ensure that the patient receives access to the postacute benefits to which he or she is entitled. One of the more problematic topics in this arena is the three-day inpatient stay required by Medicare for a patient to qualify for a covered postacute stay in a SNF. One reader submitted the question below on this topic, and we asked Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, the manager of case management at Washington Adventist Hospital in Takoma Park, Maryland, to supply an answer.

 

Q: As a case manager, I already know that my patients placed in observation don’t qualify to use their Medicare SNF benefits after a hospital stay. However, family members often oppose a patient’s discharge date, citing safety concerns and demanding that the patient be admitted as an inpatient for three days so that he or she can be transferred to a SNF to use the patient’s Medicare SNF benefit to pay for nursing home care. What do I do when the patient’s family members resist the plan of discharging their loved one home?

 

A: Family members often become concerned about how their loved one will manage when there is a change in the patient’s ability to provide self-care. An injury or illness that results in a hospital stay?even a short one?can prompt a temporary or permanent loss of function. Patients and families may have some knowledge that insurance could pay for some rehabilitation services.

Beginning in August 2016, the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act requires all hospitals to explain to patients?both verbally and in writing?what it means when they are placed in observation. The NOTICE Act also compels the hospital to inform patients that they do not qualify to use their Medicare SNF benefits to recover from a hospital stay. This may result in more patients demanding that they be admitted for inpatient care.

Despite the current emphasis on population health, few patients have long-term care plans in place. This means that seniors are caught unprepared after a short stay in hospital observation care. They may not be able to return to a home that lacks a 24-hour caregiver or that has stairs they can no longer negotiate.

Patients and family members often believe that their insurance, Medicare, will pay the entire cost for care in a nursing home. They don’t fully understand the difference between skilled versus custodial care, or that if Medicare does provide coverage, it won’t pay the entire cost of care and will cover costs only for a short time.

Since explaining the above information to patients can be challenging, the smart case manager should get busy and assess what options are available to the patient. First, review the situation and determine that the patient truly does not meet inpatient criteria. When in doubt, refer the case to your physician advisor without delay.

The 2016 OPPS final rule, CMS-1633-F, effective January 1, 2016, allows the physician to document the need for inpatient care based on a set of "complex medical factors," which include:

  • Severity of signs and symptoms
  • Current medical needs
  • Risk of an adverse event occurring

 

Qualifying for inpatient care does not mean a patient must require hospitalization that extends for more than two midnights. If the patient truly does not meet inpatient criteria, next determine if he or she is a candidate for acute rehab. Acute rehab does not require a prior three-day or greater hospital stay. Does your patient have Medicare Part C? A managed Medicare plan does not require an inpatient stay of three days or more, although it does require an authorization for a SNF benefit.

Some secondary payers will cover a rehab stay in a SNF. Look at all of the patient’s insurance policies and call the payers. A Medigap policy will pay only if Medicare pays, which requires a three-day inpatient admission. Some patients, however, are covered by a spouse’s policy or have a policy from a previous job that is not a Medigap policy?these policies will potentially cover a SNF stay.

Ask if the patient has been in a nursing facility prior to the current hospital stay while using his or her Medicare SNF benefits. If the patient was in a SNF after a three-day qualifying hospital stay, and his or her discharge from the SNF was within 30 days of the expected date of admission for the new SNF stay, then chances are the patient’s stay will be covered under Medicare.

Case managers often don’t ask about private-pay funds. Patients may pay privately for care in a nursing home. Ask if the patient has a long-term care policy that will cover the cost. Alternatively, the patient’s family may assist with the funding. Some patients who own a home use a home equity line of credit to pay for the cost or apply for a reverse mortgage.

Applying for long-term care Medicaid is an option, but this can take a long time, and many nursing homes want a source of funding at the time the patient enters the facility.

A patient can also go home with family members who are able to help with care until the patient is able to make a more permanent plan. Family members who work can apply for family and medical leave while they are serving as caregivers.

Adult medical day care facilities also have all-day programs where patients can be cared for during the day while family members work. Patients can receive nursing education about their illness, undergo blood pressure and blood sugar checks, and receive physical and occupational therapy. Payment is provided through sliding-scale or private-pay funding, or by community Medicaid.

Finally, patients may benefit from skilled home health care services, covered by insurance or by private-duty aide care paid for with the patient’s (or family’s) funds.

If, after reviewing these options, none are acceptable to the patient or family, you may have to give the patient the Hospital-Issued Notice of Noncoverage, or HINN, which notifies the patient that you do not anticipate the hospital bill or subsequent rehab will be paid by Medicare. The notice may help the patient determine what course of action to take.

 

Editor’s note: Got a question? Email it to us and we’ll send it to one of our experts. Send questions to Kelly Bilodeau at [email protected].

HCPro.com – Case Management Monthly