Oncology & Hematology Coding Alert

Question: When we provide radiation therapy to a patient in a SNF unit, should we bill the professional portion to Medicare?

Ohio Subscriber

Answer: Yes. You can report the professional service to your Part B contractor. The SNF is reimbursed under a PPS system, meaning it gets paid a flat amount per day for each patient there in a qualified stay.

The Balanced Budget Act of 1997 requires SNFs to consolidate their billing for Medicare Part A, and some Part B, residents.

Medicare excludes certain services from consolidated billing, meaning you may separately report them to Part B. These services include the professional portion of physician service codes that include professional and technical components. Caution: Include the SNF's Medicare provider number on the bill.

CMS also specifically excludes radiation therapy services from consolidated billing because these radiation services are exceptionally intensive and costly.

Remember: Your practice should have a contract with the SNF facility in which the facility agrees to pay you an agreed-upon amount for the technical radiation services from the reimbursement Medicare sends the SNF.

For more information from CMS on SNFs and consolidated billing, see www.cms.hhs.gov/SNFPPS/05_ConsolidatedBilling.asp.

The answers for You Be the Coder and Reader Questions were reviewed by Cindy C. Parman, CPC, CPC-H, RCC, co-owner of Coding Strategies Inc. in Powder Springs, Ga., and past-president of the American Academy of Professional Coders National Advisory Board.