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Consolidated Billing for SNF---help!

  1. Question Consolidated Billing for SNF---help!
    Medical Coding Books
    I work in a Neurology office. When we perform certain diagnostic tests on a patient who resides in a skilled nursing facility, Medicare takes the money back stating it is subject to consolidated billing. We then try and recoup the payment directly from the facility. My question is should we receive payment in full (what Medicare originally paid us) from the skilled nursing facility or just the technical component payment? If that is the case, how could I be paid for the professional component?

  2. #2
    Swainsboro/Statesboro, GA
    Default CMS Website link

    Below is the link to the CMS website for SNF. Hopefully you can find some answers there!

    Good luck!
    Freda Brinson, CPC, COC, CEMC
    AAPC Swainsboro/Statesboro Chapter
    2017/2018 Secretary/Treasurer
    2016 Education Officer
    2014/2015 President
    Past President - 2012, 2008; Past Vice President - 2013, Past Education Officer - 2009 of Savannah, GA Chapter
    Past Member AAPCCA Board of Directors (2009-2012)

  3. #3
    Hartford, CT
    The professional component can be billed to Medicare with a 26 modifier. The SNF is responsible for paying the technical component. They usually pay the medicare allowed amount for the technical component. We try to verify the patient's SNF status prior to their appointment so that we can bill appropriately at that time.

  4. Default
    Thank you both so much!

  5. Default
    How do you verify patient's SNF status. We have had many problems with this issue. I think we will check status as well, but want to know how to do it. I am a little bit clueless.

  6. #6
    Hartford, CT
    We just call the SNF (most patients come with paper work that needs to be completed) and ask if they are presently there under a Part A covered stay. Sometimes you get shuttled to a couple of different people before you find the one who has the answer, but eventual someone does know.

    Doreen, CPC

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