Wiki Office Visit & Skilled Nursing Facility

[hara.steph@gmail.com]

I am looking for insight - I work for a healthcare system which includes many different primary care and specialty services in the office setting. Some of our offices see patients who happen to be in a skilled nursing facility. The patients are being brought from the SNF to the provider's office for evaluation and management. Our providers do not go to the SNF, are not employed by the SNF, and do not get paid by the SNF.

Majority of these patients have Medicare Part B, which we bill for our services. Medicare denies our charges because the patient is in a SNF. In similar scenarios for Hospice patients we would append either the GV or GW modifier to indicate we are not employed or paid by Hospice so Medicare would reimburse the charges. Those modifiers, though, are just for Hospice and don't work for the SNF patients. I haven't been able to find a SNF modifier.

We've tried appealing this with Medicare but have been unsuccessful in getting our charges reimbursed. Does anyone have any advice on how this scenario should be handled; is there a modifier to append?

Thanks in advance for any guidance!

 

[mitchellde]

Your POS must be the facility POS not 11 for office.

 

[VoitChromy]

I know this question was asked almost a year ago but wondering if you ever learned how to bill for these. We are continuing to have the same issues. I see the response that you should bill with the facility POS but I have always been told that you can only bill that if the provider actually goes to the facility.

Any help would be greatly appreciated.

Thanks

 

[mitchellde]

Medicare has a section in the MCM on this and issued a couple of transmittals on it. The POS is where the patient is registered as a patient. If they are a patient in the SNF then they are registered as patient there and they cannot be a registered patient in two places at once so when they are brought to your office they are still a SNF patient. So you must use the POS of where the patient is registered as a patient and accept the reduced reimbursement.

 

[vasc2024]

Hi, what happens if the provider sees patient via telehealth video? Do we use POS 2 with modifier 95 if the patient is in a SNF?