02 — Capability · BC-1890.60
Post-Acute Reimbursement
Bill each post-acute setting under its own payment rules, so home health periods, skilled nursing stays, hospice benefit days and equipment rentals are paid correctly the first time. Claim transmission, remittance and denials common to every setting are the revenue cycle's.
- Post-Acute Billing
- PAC Reimbursement
- Home Health & Hospice Billing
In scope
- Home health notices of admission and payment period billing
- Skilled nursing consolidated billing, stay payment classification and benefit day tracking
- Hospice election and termination notices, benefit periods and cap tracking
- Equipment rental, capped-rental, oxygen and supply billing, and notices when coverage ends
Out of scope
- Claim edits, transmission and remittance posting (see BC-1840.30)
- Denials, appeals and payer audits (see BC-1840.40)
- The annual cost report and its settlement (see BC-1840.60.60)
- Advance notices before a service that may not be covered (see BC-1810.30.50)
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- BC-1890.60.10Home Health Period BillingFile the notice of admission within five calendar days of the start of care, group each 30-day period by admission source and timing, diagnosis and functional score, apply the low-utilization rule, hold the claim until visits and signed orders are complete, and bill each period, with pre-claim review where a demonstration requires it.
- BC-1890.60.20Skilled Nursing Stay BillingClassify each covered stay for payment from its assessment, track qualifying stay and benefit days, bill and pay for the outside services consolidated billing makes the facility's responsibility, and reconcile claim, assessment and record before sending.
- BC-1890.60.30Hospice Benefit BillingFile each notice of election and of termination or revocation within its deadline, bill each level of care and day in the right benefit period, and track the aggregate and inpatient caps so repayments are foreseen, and pass room and board through to nursing facilities for residents whose stay Medicaid pays through the hospice.
- BC-1890.60.40Equipment Rental BillingBill each rental month with the right month count, transfer title after the thirteenth month of a capped rental, stop oxygen rental payments after the thirty-sixth month while still furnishing the equipment for its useful lifetime, and bill purchases and supplies within frequency limits.
- BC-1890.60.50Coverage End NoticesDeliver the notice of non-coverage at least two days before covered skilled nursing, home health or hospice services end, so the patient can ask for a fast appeal, give the home health change of care notice when services are reduced or stopped, and record each delivery.