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Thread: medicare denial help!

  1. #1

    Unhappy medicare denial help!

    AAPC: Back to School
    Any help is appreciated.
    Medicare is taking back money on a claim for a patient that is in a skilled nursing facility, but the patient came to our office for an office visit and a x-ray. Medicare is stating I have to bill the skilled nursing facility and not medicare. Has anyone hear of this?
    Please help!!

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Is it the radiological payment they are recouping?

    Many physician services include both a professional and a technical component, and the technical component is subject to CB. The technical component of physician services must be billed to and reimbursed by the SNF.

    The TC is billed to the SNF and the PC is billed to Medicare. The SNF will send you the payment for the TC. Word of caution...I recommend implementing some type of agreement with the SNF. Many times, lack of an agreement can result in overdue payments.


    Last edited by RebeccaWoodward*; 03-07-2011 at 12:51 PM.

  3. #3


    They are taking the money back on the Office visit 99213 and the xray 73565.

    Thanks for those links, it is still alittle confusing to me though. Do I just send a claim form to the skilled nursing facility?

  4. #4
    Join Date
    Apr 2007
    North Carolina


    That's strange. I would have thought that they would have only recouped the xray. Theoretically, the correct way to bill would be:

    To Medicare
    99213 (i.e.)

    To SNF

    Noridian has a nice link that explains a little better:

    There are additional specifically excluded services that are separately billable to the Part B Medicare carrier and include the services of physicians and certain other types of medical practitioners (e.g. physician office visits).

    The professional component, or the physician?s interpretation of a diagnostic test, is considered a physician service and is separately billable to the Medicare carrier. The technical component, or the diagnostic test itself, is considered a diagnostic test and is subject to consolidated billing


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