Billing correctly using MDS/RUGs system

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Ask the payment expert
Ask the payment expert
Q: With all the confusion of the new MDS/RUGs system, how can we assure that we are billing correctly?

A: With the new system changes, a triple-check process is essential for every facility. The triple-check process ensures that nursing, therapy and billing all review the UB-04 prior to it being submitted for payment.

The administrator needs to be very involved in this process. Remember, the administrator is legally responsible for the billing submitted.

Nursing should be matching the RUG level to the MDS and making sure the pertinent diagnoses are listed. The therapist should validate that the RUG level is supported by documentation. They should verify that the requirement of five days of therapy per week is met and also validate that the diagnoses for therapy is included.

Finally, the billing person should verify the number of days of coverage for each RUG level. The billing person should also make sure all consolidated billing charges are included.

As for having any bills rejected, first remember you need to have been billing the RUG-IV level since Oct. 1, 2010.

Also, CMS has published some new information that may be helpful. You should access the new PC Pricer for 2011 at http://www.cms.gov/PCPricer/04_SNF.asp. In addition, new Q codes for this year's influenza and pneumonia vaccine billing are located at http://www.cms.gov/transmittals/downloads/R815OTN.pdf.

Please send your payment-related questions to Patricia Boyer at ltcnews@mcknights.com. 

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