# Consolidated Billing



## bethb (Sep 11, 2013)

Good morning.

I am having trouble understanding Medicare's consolidated billing rules.  I do understand that if a patient is in a Skilled Nursing Facility and certain services are rendered and billed to Part B Medicare, those services will deny for SNF consolidated billing.  However, we are receiving rejections for laboratory/pathology services (CPT 88305) and the patients involved were NOT under any admission, Part A or Part B, to a skilled nursing facility.  

I contacted our Medicare contractor (Novitas) and was told that the service (CPT 88305) is denying because the patient had an outpatient facility service, which was billed to Medicare Part A.  I cannot find any information on this and Novitas was not forthcoming with much else, other than the patient had services as an outpatient on the same date of service with our physician.

Does anyone have any information or any guidance as to where I can find the rules for this, as Novitas stated, Part A consolidated billing?  

For the patients I received the CO-B20 (payment adjusted because procedure/service was partially or fully furnished by another provider), I verified with the patients that they were not in a SNF at the time of service, not admitted into Home Health or Hospice on the date of service; but all of them had separate testing or services (ordered by physicians other than ours) done on the same date of service at the hospital.

Thank you in advance!

Beth


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## bethdeak (Sep 11, 2013)

Can you check the common working file to determine that the patient was not entered as being on a home health or hospice stay at the time of service?

SNF's bill on a monthly basis for a date range for their patients on Med A stays.  I'd suggest speaking with the patient to determine if they can help you figure out what service they had on the same date.

Here's a link to the consolidated billing manual.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c06.pdf


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## bethb (Sep 11, 2013)

Thank you so much!  I appreciate your reply..  You gave me really places to start with figuring this out.  We are going to contact the patient.


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