Practice Management Alert

Dealing with consolidated billing for skilled nursing facilities (SNFs) can be both frustrating and confusing if you don't have the right approach. Developing a contract to use for your SNF visits can ensure your payment and give you legal ground to stand on if problems arise.

Consolidated billing - in which you bill the SNF directly for services, and the SNF in turn bills Medicare - denies your practice's 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 reimbursement. Most care provided to SNF patients is in direct response to a request from the SNF, therefore it is the SNF's moral and legal obligation to pay the provider in full, Elfeld says.

Follow these expert suggestions to make consolidated billing as painless as possible:

1. Develop a one-page contract for your providers to take with them on SNF visits. The contract should list the physician's 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).

"You should always have a contract," Elfeld says. While a contract may not always eliminate problems, it "gives you the legal boundaries to deal" with payment issues, she says.

What if your practice doesn't deal often or ever with SNFs? You should still have a contract just in case. 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 will be obligated to go and care for the patient.

2. Charge SNFs only for the reimbursement you could expect according to the Medicare fee schedule. 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 Centers for Medicare & Medicaid Services 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.

Use This Sample Contract for SNF Visits:

Your billing office should provide the doctor with two copies of this contract to bring with him or her on every SNF   visit - one to keep for billing records and one for the SNF. Be sure an SNF administrator signs the contract.

Date:

I am Dr. ___________. Occasionally I may be providing services to patients in your skilled nursing facility. My protocol is [insert brief clinical protocol written by doctor here]. I will then bill your facility for the services provided at your request. Payment will be expected regardless of your facility's reimbursement status with Medicare.

Payment should be cut and sent to the address below within X number of days from receiving my bill.

Provider tax ID number:

Please send payment to:
Billing Office Address
City, State, ZIP code

Signed:

Dr. _____________________            SNF administrator: _______________________

- Provided by Joan Elfeld, CPC, president of Denver-based Medical Practice Support Services Inc.