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tci Medicare Compliance & Reimbursement - 2007 Issue 42

SNFs: Don't Bill Until You Have Submitted MDS

CMS announces a change in its stance on default ratesIf you forget to do a minimum data set, you can simply bill Medicare at the default rate for the days covered by the assessment, right?Not according to recent transmittals issued by the Centers for Medicare & Medicaid Services. Transmittals 196 and 1252 state that the facility must submit an MDS that's accepted into the state repository before billing the Medicare program, observes Ronald Orth, president of Clinical Reimbursement Solutions LLC in Milwaukee. "More specifically, Transmittal 196 says there are only two situations where you can bill the default...

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