A question that I get asked repeatedly, that I haven’t taken the time to address in a long time, came up on a webinar that I was doing for orthopedic executives and coders. What happens when a provider sees a patient and then later finds out that they were a resident of a Skilled Nursing Facility (SNF)?
Let’s say that you get that telephone call, or you get a bill back from a SNF, and they state that your patient was based in their SNF when they were seen by your provider, and therefore, certain parts of your services won’t be reimbursed by Medicare Part B, and you’re stuck holding the bag. Well, here is a link that you can share with the SNF that explains their responsibility for reimbursing your practice for the technical component of those services. Way back in 1997, there was a balanced budget act (that we are all very familiar with) that created The Consolidated Billing Act. The Consolidated Billing Act made SNFs bill pretty much like inpatient services so that the SNF presents one bill to the resident while they are under the SNF stay. Once they submit that one bill for the patient stay under the Consolidated Billing Act, those services would then be billed, except for services that aren’t covered, like any other stay or any other service for a patient. There are a number of other services that just aren’t covered under the SNF covered benefits or the consolidated billing services, and those services could be separately billed to Medicare Part B services, and part of those services are those provided by a physician who is covered under Part B services. There is a section of this that states specifically that many physician services include both professional and technical components, and the technical component is subject to consolidated billing. The technical component of physician services must be billed to and reimbursed by the SNF.
So, you can forward this link or print this off, send it to the skilled nursing facility, and say, “Excuse me, per CMS guidelines, it is your responsibility to reimburse us for the service that we rendered to your resident that you’ve been reimbursed for through consolidated billing.” You should also have an agreement with the different SNFs that you service and let them know ahead of time that you’re always happy to see their patients. However, if you’re going to help service their patients, they need to know that you expect prompt payment for the services that are rendered for their skilled nursing patients that your provider sees.
Should you need any help with these or any other services, remember that we’re always here to answer your questions.
On another note, I have some exciting news to share with you! The agenda for the 15th Annual NAMAS Auditing & Compliance Conference will be released REALLY SOON. Be sure to keep an eye on your inbox for this! If you don’t get NAMAS updates, subscribe NOW so you don’t miss any important updates, audit tips, blogs -and more!
Your next steps:
- Contact NAMAS to discuss your organization’s coding and documentation practices.
- Read more blog posts to stay updated on the 2023 Revisions to the 2021 E&M Guidelines.
- Watch the YouTube video on this topic, and be sure to subscribe!
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