I know there are a lot of opinions on this scenario. I have read through a lot of them! What I felt most comfortable with for the provider I work for is sending a redetermination to Medicare to request payment. You may feel otherwise but thought I would share...
-Get the SNF face sheet for the patient's admission.
-Verify your diagnosis codes are for a different condition than what is listed on the SNF admission information.
-Pull from the CMS.gov website (I don't have the link, I only saved the document) go to Home >Medicare >Skilled Nursing Facility PPS>Consolidated Billing
In that area of CMS is mentions "THE LAST FOUR PAGES ATTACHED ARE DIRECTLY FROM THE CMS.GOV WEBSITE. IT LISTS THE EXCLUDED SERVICES CATEGORICALLY EXCLUDED FROM SNF CB INCLUDES “PHYSICIANS’ SERVICES FURNISHED TO SNF RESIDENTS."
-Pull your medical records, include the SNF face sheet & send a redetermination to Medicare.
-Let them know in your redetermination request that your doctor is performing/providing services to the patient that is unrelated to their SNF admission. Reference the SNF face sheet is attached to your request. Reference the information from CMS.gov that you find & include a print out of it with the information circled or something.
I have done this on a few of our patients & have received favorable decisions.
Good luck!