Practice Management Alert

If Medicare has been sending you requests for refunds for services your physicians provided to skilled nursing facility patients, you're not alone. CMS now is on the hunt for reimbursement physicians shouldn't have received under a provision that hit the books last summer, and medical offices are now beginning to feel the fall-out. "I just received a couple of letters today from Medicare requesting refunds for services because our patients reside in skilled nursing facilities," reports Lucia Yang, billing specialist with Windsong Radiology Group in Williamsville, NY. These refund requests explain that the practice has received an overpayment because Medicare paid for the entire encounter with a SNF patient, when in fact it should have reimbursed only for the professional component. "They're asking for a refund on the technical component because the patients have Part Acoverage through their nursing facility," Yang reports. When Yang inquired about these letters, a Medicare representative explained that medical offices are supposed to bill the SNF for the technical component of the patient visit, and bill Medicare for the professional component, she tells Medical Office Billing & Collections Alert.     Sound confusing and complicated? It is. The whole mess started on July 1 of last year, when Medicare decided that services provided to patients in a SNF bed would be paid through a fiscal intermediary under Medicare Part A, explains Michael Ferragamo, MD, FAC-S in Garden City, NY. Translation for physician practices: You'll no longer receive payment from Medicare for any procedures or laboratory studies you perform in the office setting for patients sent to you from a skilled nursing facility bed. The program reimburses physicians only for E/M services provided to these patients. That means the only way a physician can receive payment for the technical component of services provided to SNF patients in her office is to bill the nursing facility directly, notes Ferragamo.

Here's how it should work: ASNF patient comes to the physician's office, and the physician performs E/M-type services (the professional component) and determines what else needs to be done on the technical side. At that point, the billing office at the practice contacts the billing office at the SNF to arrange for the SNF to pay the practice for these services. 

"They'd pay for everything not covered by Part B Medicare, which is most everything except for the E/M services," Ferragamo explains. Of course many facilities are less-than-thrilled with this arrangement. Weigh Your Options When Billing For SNF Patients If a SNF says it won't pay you for these services, you have a couple of options, Ferragamo continues. Option #1: The physician can see the patient if no procedure is necessary at the time, and bill for the professional component. Then [...]