Optometry Coding & Billing Alert

Question: We consistently have trouble collecting for services our physicians provide to patients from skilled nursing facilities (SNF). Is there any way to overcome this challenge?

Connecticut Subscriber

Answer: Consolidated billing -- in which you bill the SNF directly for services, and the SNF in turn bills Medicare -- can make collecting payments from skilled nursing facilities challenging and downright frustrating. But by following a few expert tips, you may be able to ease that burden.

Tip 1: First, you should create a contract that your providers ask each SNF they work with to sign. The contract should provide the physician's billing information as well as a statement telling the SNF that your office expects prompt payment for services rendered.

Make sure the disclaimer specifies that your office should get payment regardless of the SNF's reimbursement status with Medicare or other carriers. Even if your practice rarely sees SNF patients, experts recommend having a contract ready. You never know when one of your patients will be admitted for an SNF stay, and unless the SNF has a doctor on staff for temporary transfer of care, your provider may be asked to go and care for the patient.

Tip 2: Bill SNFs only for the reimbursement you could expect according to the Medicare fee schedule. Leave off additional costs your physicians might incur, such as gas to travel to the SNF.

Tip 3: Refer to guidance from the CMS Web site at www.cms.hhs.gov or call your Medicare carrier to resolve questions about what services they include and exclude under consolidated billing.

If all else fails: When problems arise and talking with the SNF or referencing your contract doesn't work, report your problems to the local or regional overseer of nursing homes and SNFs and request an investigation into the facility's billing operations.

-- Answers to You Be the Expert and Reader Questions reviewed by David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas.