annawade13
Networker
Hi all, I need help determining who is responsible for these claims, as both the SNF and Medicare point the finger at each other.
My optometrist comes to the SNF, performs an eye exam and does a diagnostic test (92250 retinal photography). The exam and professional component are paid by Medicare but they won't pay the TC of the test because they say it falls under consolidated billing and is the SNF's responsibility to pay. We sent a bill to the SNF and they said it's not their responsibility to pay because the patient is not there under their Part A benefits. I have two questions:
1. Does it matter whether a patient is residing under Part A or Part B SNF benefits?
2. If so, is there any way to determine (without the help of the unhelpful SNF) whether a pt is currently in a part A bed for a given date of service? If we can't, we have no way of knowing who it is we need to lean on to get payment. I looked at my MAC's web access but it just says "SNF 60 remaining."
We have called Medicare and talked to our supervisors and to the SNFs and have been told "write if off," "bill the pt," "bill MC," and "Bill the SNF" at various times.
I did look up 92250 on Medicare's 2015 list of "codes not subject to SNF consolidated billing." 92250 is not on that list, so I assume that means it IS subject to CB, which would make it the SNF's responsibility. Right?
Any and all help is appreciated!
Anna Wade, CPC, CPOC
My optometrist comes to the SNF, performs an eye exam and does a diagnostic test (92250 retinal photography). The exam and professional component are paid by Medicare but they won't pay the TC of the test because they say it falls under consolidated billing and is the SNF's responsibility to pay. We sent a bill to the SNF and they said it's not their responsibility to pay because the patient is not there under their Part A benefits. I have two questions:
1. Does it matter whether a patient is residing under Part A or Part B SNF benefits?
2. If so, is there any way to determine (without the help of the unhelpful SNF) whether a pt is currently in a part A bed for a given date of service? If we can't, we have no way of knowing who it is we need to lean on to get payment. I looked at my MAC's web access but it just says "SNF 60 remaining."
We have called Medicare and talked to our supervisors and to the SNFs and have been told "write if off," "bill the pt," "bill MC," and "Bill the SNF" at various times.
I did look up 92250 on Medicare's 2015 list of "codes not subject to SNF consolidated billing." 92250 is not on that list, so I assume that means it IS subject to CB, which would make it the SNF's responsibility. Right?
Any and all help is appreciated!
Anna Wade, CPC, CPOC