Practice Management Alert

If an SNF resident is still covered under Part A, the services you provide are subject to consolidated billing under the Prospective Payment System (PPS). This means Medicare pays the SNF for all of the services it provides and you have to contract with the SNF to get paid.

You can't bill Medicare directly for technical components of diagnostic procedures provided for SNF patients, even if done in the physician's office. You must bill Part A through the SNF under PPS. In order to be paid, your practice must bill the SNF and have a prearranged agreement that the SNF will pay the physician.

Once the patient exhausts his Part A benefits (having been at the SNF for more than 100 days following the hospital visit) or if he fails to meet CMS- Part A level-of-care requirements, the patient is in a Part B stay as a nursing facility patient and services aren't subject to consolidated billing. You should be able to bill Medicare directly for all components of diagnostic testing, as long as you have a physician order and medical necessity.