Medicare Compliance & Reimbursement

Payments for SNF patients may seem small, but don't write them off If you write off X-ray fees for SNF patients, you could be forfeiting thousands by not following up on the X-ray fee's technical component. The problem: Skilled nursing facilities (SNFs) must consolidate their billing for Medicare beneficiaries who are in a Part B non-covered SNF stay in which their Part A benefits are exhausted. When coding for these patients who present to private practices or clinics for X-rays, bill the physician's x-ray interpretation to Medicare with modifier 26 (Professional component) appended, but bill the technical component directly to the SNF. Some practices find this procedure so frustrating that they write off the X-rays' technical portion, which can run anywhere from $17 for 73020-TC (One-view shoulder X-ray) to $52 for 72114-TC (Complete lumbosacral spine X-ray). But if you see SNF patients frequently, these fees can add up, and writing them off is not a valid solution. These five steps can help you collect. 1. Determine the patient's SNF status: The ideal situation would be to determine the patient's SNF status when he calls to make the initial appointment. If the patient is in an SNF, the front office staff should get authorization to x-ray the patient and record the name of the SNF staffer who gave authorization. But even if the receptionist tries to identify each SNF patient during the initial phone call, you may still miss some. In those cases, "You kind of need to be a detective," says Angie Good, CPC, of the Orthopaedic Institute of Ohio. "Observe who brought the patient in -- are they wearing a badge from a nursing home? Some patients come with a packet of papers from the nursing home that need to be filled out. Ask, ask, ask!" Once you establish that the patient is in an SNF, you should flag his or her chart for future claims, says Jenny Harrison, of N'Orthopedics, PC, in Gaylord, MI. 2. Don't worry about lengthy SNF contracts. Although some orthopedic practices believe they have to write up complex contracts with the nursing home before they can capture payment for the x-rays' technical portions, this is not accurate. "A clarification from Medicare was issued in January 2005," Harrison says. "It states that an arrangement is validated not by written documentation, but rather compliance with requirements. We have three SNFs that we mainly deal with and have had no problems with them." 3. Don't waste time with big markups if you're dealing with multiple SNFs. Some orthopedic practices note that consolidated billing allows them to bill the SNF for a significantly higher amount than they would collect from Medicare. Their rationale is that because they are [...]