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Wiki SNF billing/charges - podiatrist be reimbursed

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nprayer2

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I work for a Podiatrist's office. Our podiatrist did a surgery on a patient and when the patient came back to the office, for 29405-58-RT, Q4037. 73620-Rt, these charges were denied by Medicare for invalid pos because the pt was still a SNF at the time of service.

1. Can a podiatrist go to the SNF for the f/u after surgery?

2. How can our podiatrist be reimbursed for the above-mentioned charges?

IL Medicare was billed/denied.
 
Consolidated Billing

Medicare considers this part of consolidated billing and payment to the SNF, in order to be paid they expect you to bill the SNF. Good luck!
 
When you provide services in the office setting for a patient that is registered in a different setting, you use the POS of where the patient is registered. So do not use 11 even though the service was provided in the office, use 31 for SNF if gat is where the patient is registered.
 
First you would need to contact the SNF the pt has been admitted to & find out the primary dx. Have them fax you a facesheet. If that dx is different for what you are billing for then you need to do a first level appeal with Medicare stating so. If your dx is the same as the SNF then you would bill the SNF.

The only way your md can see the pt @ the SNF is if he/she has privileges & has been credentialed by the facility.
 
THe first thing you need to do is contact the SNF to verify that the resident was their resident and on a Med A stay at the time of services. You can also check the CWF to see the last billed period for SNF services but it may not say what SNF it was. Otherwise reach out to the resident or POA to speak with them.


If the patient is on a SNF med A stay and are within their 100 days in their available benefit period-you need to look up those CPT codes in the SNF consolidated billing helpfile to see if they are included or excluded from consolidated billing. The SNF is responsible with the exception of the five categories that are listed as exclusions to be responsible for the patients care for the duration of the stay. If the patient or family did not notify the SNF, or your office did not notify the SNF that they were going out to have a proceedure done during a Med A stay they may argue over the cost of the bill.

After you check the CPT codes in the consolidated billing help file and determine if the SNF is responsible- that then you will need to discuss with the SNF how to work out payment. Many SNFs will reimburse you at the Medicare physician fee schedule amount for services rendered if you can speak with a BOM there.

Good luck.
 
Under consolidated billing the technical component is billed to the SNF. Physician professional charges are billed to Medicare using the POS of where the patient is registered. If the patient is a register d SNF patient then regardless of where the service is rendered, the professional charges are billed to Medicare with the SNF POS and any technical charg s are billed to the SNF.
 
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!
 
hopepg said:
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!
Click to expand...

Exactly, the professional services are not billed directly to the the SNF. Howeve you do need to use the correct POS to be paid and that POS is the SNF POS.
 
If they are a medicare beneficiary in a covered stay then use POS 31, if they are in a non covered stay then you can use POS 32. You may have a beneficiary in a SNF continuing to receive care at a skilled level even if their benefits have exhausted and the need for skilled care has continued.

Yes, the SNF is responsible during a covered stay for the technical component and the provider (physician) may bill part b directly for their services. Some SNF's send their residents out with a letter or make arrangements with frequent provider offices to notify them in advance and negotiate payment for the technical component.
 
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