April 05, 2016
Janet Potter, advisory services senior manager, was quoted by McKnight's in article about Medicare compliance standards for skilled nursing facilities.
By Elizabeth Leis Newman
Skilled nursing providers should be prepared for managed care to drill down on Medicare Part A residents, creating the potential for major financial problems, a long-term care expert warned on Tuesday.
Janet Potter, CPA, MAS, a senior manager of advisory services at Marcum Accountants in Deerfield, IL, discussed when a Skilled Nursing Facility Advance Beneficiary Notice is needed. It does not need to be sent, for example, if the extended care service or item is not a Medicare benefit, but it should be issued if the services are not reasonable. It can be expensive to fail to send that notice, she warned.
"When you don't need to issue a particular form, you can issue a courtesy letter," she recommended. This letter would say Medicare will not cover the stay due to the patient exhausting his or her benefits because he or she does not have Medicare, or if there's an issue around a qualifying stay. Providers can use CMS-R-131 as a Part B form for when those services are discontinued.