2024 Medicare Deductibles, Co-Insurance and KX Modifier Thresholds

Effective January 1, 2024, the Medicare Part A co-insurance increased to $204/day for Skilled Nursing days 21-100; the Medicare Part B deductible decreased to $240; and the KX modifier threshold increased to $2,330 for OT and $2,330 for PT/SLP combined. Medicare is continuing with the Medical Review threshold for therapy provided over the KX modifier threshold. The Medical Review threshold amount is $3,000 for OT and $3,000 for PT/SLP combined and will continue until CY 2028. Click here for more information about the new 2024 rates. Use this link to read more about the threshold amounts.

Independence Blue Cross Requirement to Bill with Taxonomy Codes Starting January 1, 2024

Effective January 1, 2024, Independence Blue Cross (IBC) is requiring the use of taxonomy codes when billing to ensure proper claims processing and payment. This allows for accurate application of specialty drive policies and in alignment with provider’s agreement(s) with IBC. Claims that fail to be submitted with the provider’s NPI and correct correlating taxonomy code will result in a denial, requiring correction prior to considering payment of the claim. Specific claim submission instructions for both Professional and Institutional Claims can be found here.      

Pennsylvania Department of Human Services Publishes Final Medicaid Rate Files for July 2023, October 2023 and January 2024 Quarters

The PA Department of Human Services (DHS) published the Medicaid final rate files for quarters beginning July and October 2023 and January 2024. They can be found at the Nursing Facility Rates on the DHS website. Any providers with questions or needing assistance updating rates may contact Gina Alifano or Lacy Albright. 

PCC Corner

PCC Census Setup and Best Practices:

Census is a daily activity in PCC that needs to be validated by the business office staff. The clinical team updates census using the QADT functionality which flows to the Incomplete Census Dashboard.  The Incomplete Census Dashboard should be reviewed daily and all census events validated. The entries can be validated using the blue hyperlink or by clicking the resident name and editing the census line in the Census/Rates tab.

It is important that census entries for hospital leaves and therapeutic leaves are aligned. For example, if a resident is going out to the hospital, the Action should be Transfer Out to the Hospital and when the resident returns, the Action should be Transfer In from the Hospital. If a resident is going out for a family visit, overnight with family, etc.), the Action should be Leave of Absence, and when the resident returns to the facility, the Action should be Return from Leave. The status code, based on the organizational configuration, would indicate how the Action is being billed/reimbursed.

In PCC census entries, there are two options that can be selected.  

• 1. Use Payer Setup file created by this Census Entry (Create New Payer Setup file) or
• 2. Use Last Known Payer Setup file

The best practice is to select Use Payer Setup file created by this Census Entry (Create New Payer Setup file) for all census entries except for room changes. Room changes should have the Use Last Known Payer Setup file selected.

Selecting the appropriate radio button based on the census action being taken, will ensure that payer trees pull forward correctly and patient liability amounts will remain attached to payer trees.

For Part A admissions/readmissions, the radio button for Start of Medicare Stay or New Benefit period should be selected as applicable. If a resident used any benefit days outside of your organization, those days should be entered into the days used previously box. When you begin a benefit period in PCC, the system will remember the days used by the resident, even if the resident is going out and coming back into the facility. So, transfers in and Readmissions utilizing the same benefit period should have the Start of Medicare Stay or New Benefit period set to No.  

Any providers with PCC questions may contact Paula Hynum. 

Questions about these updates? Need support to meet requirements?

Contact Stefanie Knaub, RKL Senior Living Services Partner, at 717.590.8648.