Wiki Medicare denial code MA101

[april j]

We are a pulmonology office, and saw a patient who resides in a SNF. We did an office visit and spirometry. Medicare denied the spirometry saying "a SNF is responsible for payment of outside providers who furnish these services/supplies to residents."
Does this mean that I am supposed to actually send a bill to the facility for the spirometry? I've never had this denial before, so I don't know the procedure.

Thanks for your help!

 

[halebill]

April,

That is exactly what it means. We get SNF patients in our orthopedic office all the time. If they are enrolled in the SNF under Medicare Part A, we have to split our x-ray charges and bill the professional component to Medicare, and the technical component to the SNF. This is thanks to "Consolidated Billing for Skilled Nursing Facilities", which is part of the Balanced Budget Act of 1997 passed by congress. Billing the SNF is usually quite easy; just send your charges to them on a HCFA 1500, and be sure they are at the Medicare rate, because that's all they will pay.

https://www.cms.gov/SNFPPS/05_ConsolidatedBilling.asp


Bill Hale, CPC