MDS Alert

It should ... This advice will protect your SNF's bottom line and compliance record.

A SNF can and should negotiate a rate with physicians and ancillary providers for services under consolidated billing, says Cindy Dunne, president of ECS Billing & Consulting Inc. in Dublin, OH. SNFs commonly negotiate contracts and rates with ancillary providers rendering services onsite at the facility, Dunne notes. But a SNF may not have a contract with a physician office for certain services provided to Part A residents, such as lab work, she observes. The idea, however, is to contract with the necessary providers in the facility's area and negotiate the best rate, Dunne stresses.

Also: Consultant Jane Belt, RN, MS, recommends a SNF's contract with a provider for consolidated billing include a time limit on how long that provider can wait to send the SNF a bill. That way, there's no question about that issue when the SNF gets a bill months and months after the service(s) when it's hard to even recall the circumstances, says Belt, managing consultant for Plante & Moran in Columbus, OH.

Good question: What if a resident receives an unexpected service at a physician's office and the SNF doesn't have an agreement with that physician for the technical component of services billable to the facility? The facility should offer the Medicare fee schedule rate rather than pay the physician's charge, Dunne counsels. "Most physicians and ancillary providers will accept that rate." If the SNF doesn't have a contract with a provider, always send a letter with the resident asking the provider to contact the SNF prior to providing any services, Dunne advises.

Compliance heads-up: "The conventional wisdom is that while a SNF can negotiate a better rate with a provider under Part A consolidated billing, it can't do so in exchange for giving that provider Part B or other business," cautions attorney Ari Markenson in White Plains, NY.