SNF consolidated billing from office perspective (x-post Billing/Reimbursement)

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I need help regarding final claim submission to Medicare for professional services to a patient admitted to SNF.

I have searched as much as I can and I cannot find any definitive information regarding correct billing. Our original claims were submitted with POS 11 and at first they were paid. Then a few months later Medicare recouped the payment stating the patient was enrolled in SNF. So, I need answers with supporting guidelines from any payer (preferably Noridian or CMS) please.

typical scenario: patient is enrolled in SNF (as inpatient) and comes to our office to see the physician (typically a specialist, i.e. cardio, general surgery, vascular, etc.). We bill Medicare with POS 11 (office, because that is where the patient was seen).

We're stuck on the POS because about a year ago another coder in the office researched this issue and created a policy to change the POS to 31 (SNF because that is where they are currently admitted). The E/M is also changed to a corresponding inpatient code. I feel very uncomfortable billing these out, I can't justify billing an incorrect POS. This new policy does allow claims to be paid but I still don't think it is appropriate billing. Please help us sort this out.
 

nkorab

Networker
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Our office experienced the same thing. I found out that you do need to bill under the POS for SNF and use the appropriate CPT codes in order to get paid by Medicare.
I called the SNF to confirm this. If a procedure is done in your office, you need to the bill the SNF.

Hope this helps.
Nancy
 
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235
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Hi Nancy,

that is pretty much the same conclusion we're coming to as well, even though professional services are supposedly excluded from consolidated billing. Noridian (our MAC) told us they will never ever pay a physician claim in office for a patient enrolled in SNF.

Next step, get the SNFs to respond to phone calls/emails, setup contracts, and submit claim directly to them.
 
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