The Medi-Bill Systems Program was unveiled in 1986 to redirect existing Medicare Part B reimbursement to those who are most entitled to receive them, the long term care providers. Historically, these payments have been made to various third parties who do not share fully in the direct and indirect costs associated with your operations. Based on recent congressional action in Washington, Medicare payments will likely become an increasingly strategic source of revenue for your centers. The MBS program positions your operations to capture this revenue.

The mechanics of our program are simple and do not create any significant administrative burdens for the center's staff. Your Medicare claims are generated on the basis of easy to use usage reports and/or actual physician orders which you submit to us.

Currently our program manages DMERC claims for over 300 facilities from South Dakota to Texas. MBS is able to process claims for Regions B, C and D.

In addition to its DMERC claims management, MBS also processes the Medicare Part A and B claims to five Fiscal Intermediaries for Skilled Nursing Facilities in South Dakota, Nebraska, Iowa, Kansas, Missouri, Texas, Tennessee and Kentucky.

MEDI-BILL SYSTEMS SERVICES

In addition to processing and submitting Medicare Part A and B claims to the Fiscal Intermediary, Medi-Bill Systems provides a variety of support and other services including:

I. Medicare orientation for facility staff which covers:

• Medicare Regulations
• MDS training
• RUG III system overview
• PPS and reimbursement issues
• "Hands on" case studies
• Q&A session

II. On-going phone support for billing questions or regulatory interpretation

III. MDS completion questions

IV. Nurse consultant visits and phone support

V. Periodical on-site chart audits

VI. Medicare and MDS accuracy reviews

VII. Follow-up on non-payment of Medicare claims

COMPLIANCE

Medi-Bill Systems is committed to comply with all federal and state standards, with an emphasis on preventing fraud and abuse. We are proud of our record of high quality data submission, as evidenced by its accuracy, reliability, timeliness and validity.

As part of its commitment to compliance, Medi-Bill Systems has policies in place that address the education and training requirements for billing personnel; the risk areas for fraud, waste and abuse; the integrity of Medi-Bill Systems’ information system; the methodology for resolving ambiguities in the client’s paperwork; and the procedure to ensure duplicate bills are not submitted.

FACILITY SUPPORT

Medi-Bill Systems’ monitors the billing properties of all its clients on a quarterly basis. If a trends deviation is identified in our office, the responsible regional account manager is notified and they make contact with the facility. This approach allows Medi-Bill systems to stay actively involved, even though someone from the facility has not actually contacted us, for whatever reason.

All facilities receive a monthly unsigned CMN listing. This keeps the data in front of the responsible person in the center. We follow up with a monthly phone call in regards to the listing and offer any assistance with CMN completion.

These procedures, along with the monthly reporting, allow the system to stay dynamic, and thus, an effective and successful one.

STANDARD REPORTING LISTING

The reports below are included in the monthly management summary reporting package.

• Active Resident Listing
  Monthly reporting identifying all beneficiaries MBS has active in the system.
• Insurance Filed Summary
  Monthly report illustrating the claims filed for each beneficiary and the dollar amount of the claim.
• Net Income Report
  Monthly report illustrating the net income produced by the claim payment, factoring the billing fee and an estimated cost of goods.
• Financial Log
  Monthly log tracking claims submission, payment, and co-payment amounts.
• Unsigned CMN Listing
  Monthly listing of active beneficiaries for which MBS has not received the signed CMN.
• 20% Insurance Co-pay
  Monthly reporting applying the payment and indicating 20% co-payment amount due and from what payer, for each beneficiary.

MEDICARE PART A SNF CONSULTATION

Medi-Bill Systems Part A services will help you increase revenue by:

• Guiding your facility through the Medicare Part A certification process.
• Establishing a “Medicare Team” at your facility to manage key Part A operational issues.
• Electronically submitting your edited Part A claims.
• Billing all co-insurance amounts to the supplemental insurance.
• Sending Medicare financial logs to SNF.
• Providing comprehensive, consultative support, addressing proper admission criteria and length of stay concerns.

MEDICARE PART B DMERC CLAIMS ADMINISTRATION

Medi-Bill Systems will help you increase revenue by:

• Processing Part B claims for all supplies and devices covered under the Medicare prosthetic and orthotic benefit.
• Providing access to competitive contracts in place with key manufacturers of the supplies we bill to Medicare on your behalf.
• Creating a reporting system that causes little, if any administrative burden for you.
• An electronic filing system that minimizes the turn around time on your claim payments, thereby eliminating cash flow concerns.
• Furnishing comprehensive consultative support, as you need it, to resolve all matters related to your Part B program.