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FBDE SNF x-ray using Medicaid benefits

  1. Default FBDE SNF x-ray using Medicaid benefits
    Medical Coding Books
    I have a patient who is a fully qualified dual eligible (has Medicare Part A&B and FULL Medicaid, not just coins and deductibles), who is inpatient at a Skilled Nursing Facility and coming to our orthopedic practices for follow up on a hip fracture. The SNF does not take x-rays before they send him. When we take x-rays on a Medicare patient who is in a SNF, we are supposed to bill the SNF. The SNF says that the patient is not using his Medicare benefits to pay for the SNF, and that means they aren't responsible for the x-rays. He's using his MediCAID benefits, and we should bill Medicaid. Medicare says to bill another payor, and we're not yet credentialed with Medicaid, so we can't bill them at this time. Does anyone know what supposed to happen here? Any help would be appreciated.

  2. #2
    We also see quite a few SNF patients in our Ortho practice. We were instructed by Medicare to bill by components. Medicare pays the professional component and the SNF is responsible for the technical. For example, we bill 73654-26 to Medicare and 73654-TC to the SNF. If the SNF refuses to pay this way, I would contact your MAC to see if there are any extenuating circumstances that apply. We have had great results since we started billing this way.

    Pam Vanderbilt, CPC
    Pinnacle Orthopaedics & Sports Medicine Specialists
    Pam Vanderbilt, CPC, CPMA, CPPM, CPC-I, CEMC, CEMA

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