Threat to Medicare pay

John O'Connor
John O'Connor

Believe it or not, there exists a tiny sliver of skilled care facilities that do not receive Medicare funds. And a few other operators have never encountered billing issues with Uncle Sam. Members of this exclusive club need not worry about a new measure that could significantly change Medicare's rules of participation.

As for just about every other skilled nursing facility, this might be a good time to break out the flop sweat. That is, unless the prospect of being culled from one of your most vital revenue streams is nothing to worry about.

For the government may soon be allowed to discontinue Medicare access for operators with recurring claims-submission issues, under a final rule from our friends at the Centers for Medicare & Medicaid Services. 

You get the feeling that what drove this rule is that some of the folks at CMS finally had their Howard Beale eruption. 

In other words, they decided they were fed up with the fraudsters, con artists and others unclear on the concept of how to accurately bill for services.

But here's the thing: Government rules can be both tedious and ambiguous. Yes, long-term care is a big-boy sport, and ignorance of what's required is hardly acceptable. Yet you sometimes have to wonder if the people writing the rules were actively setting out to make life miserable for operators. Just ask your MDS coordinator to name a few bizarre or contradictory rules off the top of her or his head. But don't make any plans for immediately afterward. The monologue that follows may be a real stem-winder.

So am I trying to defend sleazy operators who actively refuse to play by the rules? Hardly. Those rascals should have been thrown out a long time ago. But you don't need to be an industry apologist to note that billing submission rules can be unclear and sometimes contradictory.

Operators who make mistakes with billing rules need to be held accountable. But they should not be facing the equivalent of a Medicare death penalty. At least, not while so many of those rules might qualify as cruel and unusual punishment. 


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