Determining whether a patient is in a Part A or Part B stay is your key to proper reimbursement. Most practices deal with a patient who is staying in a nursing facility at some point. When that time comes and your physician sees a nursing facility patient in your office, your challenge is collecting proper reimbursement for those services. The problem: Good news: 1. Understand Consolidated Billing and How It Affects Your Practice Before you can start billing for services your physician performs for nursing facility patients, you need to figure out what consolidated billing really is and why it matters to your billing process. How it works: Here's why it matters: "Obviously, Medicare doesn't want to pay for those services twice -- once to the nursing facility in that lump sum payment and second to the physician on an ala carte basis," Gilhooly says. "As a result, if the patient is currently in the nursing facility covered under a Medicare Part A stay, the physician can only bill Medicare for his/her professional services. Any technical or 'facility' services you need to perform during that office visit must be billed directly to the nursing facility, requesting reimbursement for billable supplies and/or technical component expenses your practice incurred during the encounter." Note: 2. Check the Patient's Status To properly bill and collect for nursing facility patient services is to actually contact the facility to confirm whether the patient is in a Part A or Part B stay. If he is not covered by Part A, you may bill your Part B carrier for all the services you provide. But if his nursing home stay is covered by Part A, you are about to enter the world of consolidated billing. "This really should start, not during billing, but with appointment scheduling," Gilhooly says. She advises practices to contact the nursing facility on the day of the appointment to confirm whether the patient is in a Part A or Part B stay. Warning: 3. Leave the Professional Portion to Medicare For services with both a technical and a professional component that your physician performs for a nursing facility patient in your office, you should report only the professional component -- such as the written interpretation of an x-ray -- to your Medicare carrier/MAC. And for many of the medications your physician might administer to a nursing home patient in a Part A stay, Medicare Part B will not reimburse you in the usual manner. Instead, you must submit a claim to, and seek payment from, the nursing facility itself for reimbursable expenses for medications, supplies, the technical components of diagnostic services, etc. as explained in step one. Example: You're unaware that the patient is an SNF resident in a Part A stay, so you report the office visit, the global x-ray code, the joint injection code, and the medication to the patient's Medicare Part B carrier. Since this patient is a nursing facility resident in a Medicare Part A stay, the carrier will deny part of your claim, likely using denial code 190 (Payment is included in the allowance for a Skilled Nursing Facility [SNF] qualified stay). "Since Medicare is paying to cover some of these under consolidated billing, Medicare will not pay again for the technical component of the x-ray or for the Depo-Medrol medication used in the injection," Gilhooly explains. For a Part A-covered patient in this scenario, you should report the office visit (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...), the injection (20610, Arthrocentesis, aspiration, and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]), and the professional component of the x-ray service using modifier 26 (Professional component) to your Part B carrier. You should seek reimbursement from the nursing home directly for the technical component of the x-ray service and for the Depo-Medrol supply (J1030 - Injection, methylprednisolone acetate, 40 mg).