Wiki Snf billing

[TRYOUNG]

We have received requests from medicare for refund of payments made to snf in the hospital setting. Am i correct that the dr can not bill medicare part b for these services but must bill the snf directly?

 

[clg23]

snf billing

yes you will have to bill SNF directly for some charges. Medicare will pay us for the office visit but not the test and then you have to break up the test between the tc and pc to bill. To do this correctly go up on Medicare's website and type in skilled nursing facility to get the instructions on how to bill. also sign up on Medicare's website so you can get notification on online classes such as your topic today. Medicare is very helpful.

hope this helps.

 

[mitchellde]

here is an excerpt from the CMS fact sheet on consolidated billing for SNF
What services are covered under consolidated billing?

Consolidated billing covers the entire package of care that a resident would receive during a covered Medicare Part A stay. However, some categories of services have been excluded from consolidated billing because they are costly or require specialization. The following categories of services have been excluded from consolidated billing:

•Physician's professional services;


•Certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services;


•Certain ambulance services, including transporting the beneficiary to the SNF initially, transporting from the SNF at the end of the stay (other than when involving transfer to another SNF), and transporting round-trip during the stay temporarily offsite to receive dialysis or certain types of intensive or emergency outpatient hospital services;


•Erythropoietin for certain dialysis patients;


•Certain chemotherapy drugs;


•Certain chemotherapy administration services;


•Radioisotope services; and


•Customized prosthetic devices


as you can see physician professional services , which includes the physician visit , is not included under consolidated billing which means you do not bill the SNF. if you performed a visit in the physician office setting while the patient is a SNF patient the you must use the POS of 31 for SNF and not 11 but use regular office visit level codes. IF you performed a visit in the SNF setting then use the SNF 31 POS and the appropriate visit levels for inpatient SNF . Medicare will pay physician services if they are submitted correctly

 

[Jessim929]

I just want to make sure I'm crystal clear on this, because I've got conflicting information.

Based on the above, if a patient is in a rehab post-stroke and comes to his urologist's office, it's a regular office visit with place of service 31, and NOT a hospital visit code with place of service 11? No GW modifier either?

 

[hstoner]

We saw patient in our office and we later found out that they were in a Part A stay at SNF. CMS states to use Place of Service where the patient is registered (SNF). We did this but now are getting denials stating E/M not typically performed at SNF. Any suggestions on how to get this paid?

 

[tmcgraw@oracleheartva.com]

here is an excerpt from the CMS fact sheet on consolidated billing for SNF
What services are covered under consolidated billing?

Consolidated billing covers the entire package of care that a resident would receive during a covered Medicare Part A stay. However, some categories of services have been excluded from consolidated billing because they are costly or require specialization. The following categories of services have been excluded from consolidated billing:

•Physician's professional services;


•Certain dialysis-related services, including covered ambulance transportation to obtain the dialysis services;


•Certain ambulance services, including transporting the beneficiary to the SNF initially, transporting from the SNF at the end of the stay (other than when involving transfer to another SNF), and transporting round-trip during the stay temporarily offsite to receive dialysis or certain types of intensive or emergency outpatient hospital services;


•Erythropoietin for certain dialysis patients;


•Certain chemotherapy drugs;


•Certain chemotherapy administration services;


•Radioisotope services; and


•Customized prosthetic devices


as you can see physician professional services , which includes the physician visit , is not included under consolidated billing which means you do not bill the SNF. if you performed a visit in the physician office setting while the patient is a SNF patient the you must use the POS of 31 for SNF and not 11 but use regular office visit level codes. IF you performed a visit in the SNF setting then use the SNF 31 POS and the appropriate visit levels for inpatient SNF . Medicare will pay physician services if they are submitted correctly

With this example, if the patient is seen in the cardiologist's office while at SNF, we use position 31 and still bill Medicare correctly?