Wiki Patient in a SNF, who to bill?

[kbordner2]

I work for an independent Neurology practice and we are getting denials by a Pt's Medicare Advantage plan stating 'payment included in the allowance for SNF qualified stay'. We saw the Patient in our office, not at the SNF. Would it be appropriate to bill the Insurance plan with the SNF pos code or would we bill the SNF directly?

 

[Pam Warren]

While under a SNF plan of care, the patient is not to leave the SNF....they're considered an inpatient and based on the rules of consolidated billing, is expected to provide all medical care at their expense to the patient.
You should bill the SNF directly, since your doc was not at the SNF.... that would be a false claim.

 

[kbordner2]

We were not aware the Pt was at a SNF at the time we saw the patient.
There were conflicting opinions as to how this claim should be resubmitted. Thank you for confirming what I knew was the appropriate course of action, but when people start debating and make you start to question what you know is correct, you need that validation, lol (we did resubmit to the SNF directly).

 

[tmcgraw@oracleheartva.com]

While under a SNF plan of care, the patient is not to leave the SNF....they're considered an inpatient and based on the rules of consolidated billing, is expected to provide all medical care at their expense to the patient.
You should bill the SNF directly, since your doc was not at the SNF.... that would be a false claim.

We have the same situation, my question is then if we bill the SNF is the POS still 11 since we saw the patient in our office?