Optometry Coding & Billing Alert

Our contract will help ODs sniff out full payment from nursing facilities

Dealing with consolidated billing for skilled nursing facilities (SNFs) can be both frustrating and confusing. Developing a contract to use for your SNF visits can ensure your payment and give you legal leverage.
 
Consolidated billing denies your billing office direct control over the quality of billing and reimbursement.
 
Consequently, SNFs with poor billing behavior can come up short of money and try to deny you payment. This is unacceptable, says Joan Elfeld, CPC, president of Denver-based Medical Practice Support Services Inc. It's not fair or legal for a SNF to tell providers they'll only be paid when and if the SNF receives adequate payment. Most care provided to SNF patients is in direct response to a request from the SNF; therefore it is the SNF's legal obligation to pay the provider in full, Elfeld says.
 
Follow these expert suggestions to make consolidated billing as painless as possible:
 
1. Take a one-page contract with you on SNF visits. The contract should list your billing information and include a disclaimer stating that you expect payment for services rendered regardless of the SNF's reimbursement status with the Medicare carrier (see sample contract below).
 
2. Charge SNFs only for the reimbursement you could expect according to the Medicare Physician Fee Schedule, says Erin Shabareck, billing manager at the Florida Vision Institute in Stuart. You can't tack on fees to account for driving time or gas costs related to SNF visits, even if you think you deserve pay for this.
 
3. Try using a contract and talking first to resolve any persistent payment problems with an SNF. As a last resort, however, you can report your problems to the local or regional overseer of nursing homes and SNFs and request an investigation into their billing operations.
 
4. Consult the CMS Web site or call your Medicare carrier to resolve questions about what services are included and excluded under consolidated billing. Medicare may even be able to send a trainer to your office to advise you on consolidated billing issues.
 
Note: For more information on consolidated billing, visit www.cms.hhs.gov/providers/snfpps/cb/.