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Practice Management Alert

Beware:

SNF Patients Can Snuff Your Reimbursement: Here's what you need to do protect your bottom line.

Published on Sun Jun 01, 2003

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 the physician tells the facility what is necessary in terms of the technical component and suggests the facility perform the services there, if possible.

"In other words, the physician would say, 'I'd like you to get a urine analysis and a urine culture and send me the report, and I'd like you to give the patient 7.5mg of Lupron every month,'" Ferragamo offers as an example.

Option #2: If you're facing an emergency situation, in which the patient requires an immediate procedure, "you might want to send the patient to the hospital and take care of her in the emergency room," Ferragamo suggests. That's because the SNF billing conundrum is limited to the physician office setting. "Once a patient goes to the hospital, all those services are payable by Part B Medicare," Ferragamo points out.

Get On The Phone To Safeguard Payment

 When a SNF calls your office to schedule a visit for a patient, "you have to determine when you're going to see the patient and then you have to determine the patient's status, and you should also begin to make some negotiation with the facility that they'll be responsible for payment for some of those services," Ferragamo notes. 

Unfortunately, another sticky wicket when it comes to billing for SNF patients is that their status changes all the time, Ferragamo laments. That means just because a patient was not considered to be in a SNF bed at the time your office schedules her appointment doesn't mean she won't have SNF status when she actually comes in for that appointment.

 To avoid getting the short end of the reimbursement stick due to a patient's changing SNF status, medical offices should call the SNF the day before the appointment to confirm that the patient's status hasn't changed since the appointment was made, Ferragamo instructs.

 

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