Blackhorse
Guru
We billed 62370 and J0475 to Medicare, POS 11. Medicare denied J0475 because PT was in the Nursing Facility. The Nursing Facility brought her to our office. Why J0475 can not be paid?
Thank you for your info but PT was brought to our office by the Nursing Facility, the pump refill was not done in the Nursing Facility, it was done in POS 11. We should get paid for the procedure and the medication.Most drugs, supplies, and other technical services provided to a patient in a Medicare Part A covered skilled nursing facility stay are included in the payment rates that Medicare makes to that facility. If the patient receives these items from an outside provider during one of these stays, it is the responsibility of the nursing facility to reimburse that provider. So you will need to send an invoice to the nursing facility asking them to reimburse you directly for that drug.
Yes, I understand that you provided the drug and that you should get paid for it. What I am saying is that you will not get paid by Medicare, you will only get paid if you bill the nursing facility - those are the Medicare rules when a patient is in a facility, even if they travel outside to get care at a physician's office. This is called SNF Consolidated Billing - you can find more information about it here: SNFConsolidatedBillingThank you for your info but PT was brought to our office by the Nursing Facility, the pump refill was not done in the Nursing Facility, it was done in POS 11. We should get paid for the procedure and the medication.
Yes, after you bill it to them and they pay you, they can add it to their bill to Medicare to report that it was a cost that they incurred to treat the patient during the SNF stay.You mean even if the Nursing Facility didn't bill Medicare for 62370 & J0475, we can still bill Nursing Facility?
Ok, I get your points. If the PT is in the Nursing Facility, it doesn't matter where the PT goes, Medicare will only pays based on inpatient status. Thank you so much for your patience with me. I really appreciate it.Yes, after you bill it to them and they pay you, they can add it to their bill to Medicare to report that it was a cost that they incurred to treat the patient during the SNF stay.