Practice Management Alert

Billing Every Charge Every Time Is Best

Question: If I know a payer is going to deny a certain charge, do I need to bill it at all? Since I am familiar with which payers reimburse for certain charges and which ones don't, is there any reason why I shouldn't be billing payer-specific to save time and effort?
   
- Ohio Subscriber Answer: "You should not treat anyone differently," says Donna Rachunas of Health Claim Services Inc., a billing service in Haddonfield, N.J.

"There should be a protocol that you follow," she says. Bill every charge and then administer the contract when you get the payment and/or denial. This leaves less room for human error, since you won't have to remember which things to bill, Rachunas says. Billing everything provides you with a clear record of what each of your carriers is doing for you.

It might seem as if you could save yourself a lot of effort by not billing certain charges, but that's probably not the case. Billing for everything saves you the mental energy of determining the exact status of your charges billed, Rachunas says. 

If the claim comes back noncovered, nonbillable, then you know to write it off. If it comes back noncovered but the patient is responsible, then you release the bill to the patient. Without the payer determining these things for you, you're forced to choose. That means the possibility of mistakes and losing revenue.

You also need to remember that carrier policies change all the time, Rachunas says. Payers might change what charges they cover, but unless you're billing them you'll never know.

The only exception to billing everything is with Medicare. You should not bill Medicare for anything that you know to be noncovered without first notifying the patient, Rachunas says.




Know What to Bill for Consolidated Billing

Question: Would you clarify the details of consolidated billing for SNF stays? For example, what qualifies a patient as an SNF resident and what services are excluded from the consolidated billing?

- Nebraska Subscriber Answer: A skilled nursing facility (SNF) resident "is defined as a beneficiary who is admitted to a Medicare-participating SNF, or to the nonparticipating portion of a nursing home that also includes a Medicare-participating SNF, regardless of whether Part A covers the stay," according to the Centers for Medicare and Medicaid Services. 

Consolidated billing (CB) requires an SNF to bill Medicare for the entire package of care that its residents receive. The SNF collects any deductibles or coinsurances from its beneficiaries, and outside providers of any service or supplies must bill the SNF for payment, not the beneficiary or the Medicare carrier.

Services included in CB:

- all care that Part A residents receive
- technical components of physician services for [...]