Nursing facilities across the U.S. have somehow endured a series of Medicare/Medicaid cuts thus far, but the latest move by CMS to reduce reimbursement for so-called Medicare “bad debt” – Medicare co-payments not made by beneficiaries or state Medicaid programs – may bring them on the threshold of a major operational crisis. The new legislation has effectively brought down reimbursement rate for bad debts to 65 percent from what used to be 100 percent of unpaid co-payments under dual-eligible beneficiaries, and 70 percent for other Medicare bad debts. With most of the nursing facilities encountering dual-eligibles (Medicare & Medicaid beneficiaries), and federal law allowing Medicaid programs to opt out of making co-payments in most cases, it may be difficult to sustain quality and operationally viable nursing services amidst shrinking Medicare and Medicaid reimbursement rates.
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Therefore, it is not unusual for nursing facilities adopting contingency plans to safeguard their operational viability. Amongst several options available to nursing facilities, the following seem to have been deemed strategically more sensible:
While these plans may be effective to a certain extent, they will certainly be limiting nursing facilities’ ability to sustain quality, motive staff, and look beyond myopic operational strategies. That is why, rather than protective plans, operators would do well to explore alternatives that can keep their facilities responsive to quality and growth demands. Medical Billing is the area which has answers to most of the operational issues. Therefore, operators should look at making their nursing facility medical billing as effective and efficient as possible. Significantly, operators will need to align their billing practices to Medicare/Medicaid’s policy on reimbursing bad debts from disowned co-payments or deductibles.
Medicalbillingandcoders.com remains the most comprehensive source for medical billing solutions, more so for Medicare and Medicaid billing. With a resource base of medical billing experts spread across the 50 states in the U.S., nursing facilities can look forward to instant, effective, and efficient nursing facilities medical billing that can help them sustain quality and grow with evolving demand for nursing facilities.