Wiki SNF deadbeats

Create Wiki
S

SKB1sh0p

Guest
Messages
2
Best answers
0
Realistically, what are your options when Medicare says that a SNF is the proper payer, you bill the Skilled Nursing Facility the Medicare allowed amount, and they never pay.

This particular facility will tell you the department I need to speak to is in a meeting, or the person I need to speak to is gone for the day, or they will take a message, etc...

Sheila
 
Your providers either need to discuss this with the SNF administrator or stop being available to see their patients. A friend of mine used to run multiple SNF's and he always took care of the providers because without providers, the SNF is out of luck.
 
After numerous attempts to get these type of claims paid from one SNF, I finally prevailed upon higher levels in provider service from MCR asking what might be done. In our case we were told to submit an appeal to MCR letting them know that the SNF was not responding to certified mail or phone requests and claim continued to remain unpaid. Furthermore I documented the attempts we had made to get the claim paid, and requested intervention on their part. The fact that we alerted them to non-payment might put the SNF in the cross-hairs of a MCR investigation? We know skilled nursing facilities do not want that! We are 45 days into the appeal.
 
We had to work with the SNFs to devise an arrangment for payment, if they wanted our providers to continue to see their patients. The SNF was clueless, by the way.
 
Pam, this may be what is happening in our case. But the lack of response to our calls and letters is just unacceptable. I think you are correct that a working arrangement needs to be initiated prior to patients being seen.....going off memory here, but doesn't the consolidated billing rules support this?
 
Suzanne, yes, we had to actually provide the consolidated billing rules to the SNF and show them that they are responsible for providing specific services under their CMS contract. They had no idea. Scary.
 
Just wanted folks to know that MCR did deny the appeal (expected), but we had included a complaint that the SNF was not responding. So, we're going higher up into the corporate chain of the SNF centers, and dragging PART A with us now that they are also aware of the issue. I'm just not ready to give up on this one, even though we're aware that further appeals to Part B will not be productive based on the consolidated billing rules.
 
You must log in or register to reply here.
Top