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Welcome to RSM’s Senior Living Health Care Connection

INSIGHT ARTICLE  | 

Thanks for your interest in RSM’s Senior Living Health Care Connection, your periodic update on news and insights related to the senior living and long-term care industry. Here’s what’s happening.

Part B changes

  • Remember to change the Part B fee schedules in your software system to ensure proper payment for services provided in 2015 starting January 1.
  • The therapy cap values have changed:
    • Physical therapy and speech language pathology cap - $1,940
    • Occupational therapy cap - $1,940
  • The exceptions process (KX modifier) has been extended through March 31, 2015. We should find out if there will be further changes to the fee schedules and the exceptions prior to that March 31 deadline.
  • The therapy thresholds remain at $3,700 for physical therapy and speech therapy and another $3,700 for occupation therapy. Any therapy services that go over the threshold are subject to a manual medical review.
  • The therapy functional reporting requirements (G-codes) remain in effect for all Part B therapy services.

Part A coinsurance for 2015

  • Days 1–20: zero dollars for each benefit period
  • Days 21–100: $157.50 coinsurance per day of each benefit period
  • Days 101 and beyond: all costs

Reimbursable Medicare bad debts

The payment of reimbursable bad debts claimed on Medicare cost reports will be 65 percent of the bad debts for traditional Medicare eligibles and 76 percent for full dual eligibles for any cost report with fiscal year begin dates of October 1, 2013, through September 30, 2014. For Medicare cost reports with a fiscal year begin date of October 1, 2014, or later, the payment will be 65 percent of the reimbursable bad debts reported for both the traditional Medicare eligibles and the full dual eligibles.

New senior living health care team member

Joan McCarthy recently joined RSM as a health care consultant. She is also the operations and reimbursement specialist at ProviNet. Joan specializes in the clinical areas of health care, with an emphasis on reimbursement and operations. She has more than 25 years of experience in the industry and assists skilled nursing facilities and other health care entities in compliance with federal and state regulations and provides clinical, financial and operational consulting. Her focus includes analysis of operational and clinical systems to ensure efficient and accurate management of services. She also has knowledge in billing for Medicare and Medicaid services and provides consulting services in the form of facility staff training, chart reviews, systems management, outcomes analysis and implementation of electronic medical records for multiple clients using various software systems.

For more information about our services and how we can help you address your business challenges, contact Joan McCarthy at joan.mccarthy@rsmus.com or 312.634.3479.

How can we help you?

To discuss how our team can help your business, contact us by phone 800.274.3978 or


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