Practice Management Alert

Question: My physician is the medical director for a skilled nursing facility and receives a stipend from the SNF for that service. Can he still bill for services he provides to the SNF's patients?

Nebraska Subscriber

Answer: Since you're dealing with directorship of the skilled nursing facility (SNF), which is a facility, you first need to look at Stark regulations. Fortunately, in this case, you shouldn't have to worry about potential Stark violations when you bill for the physician's service in the SNF where he is the medical director.

Why: Medical directorships usually involve a set of advisory and oversight responsibilities that aren't directly tied to the care and treatment of a single patient, but rather the entity as a whole as an administrator. Your physician can admit his own patients to the SNF and can see them in the SNF setting without interfering with his medical director responsibilities.

Caveat: In cases in which the patient needs to be admitted to the SNF but doesn't have a physician to manage his SNF care and your physician, as the medical director, is assigned to be the patient's SNF attending physician, halt your billing. Consult an attorney before billing to be sure there aren't any Stark issues in that sort of arrangement.

In fact, because Stark laws are so complicated and your physician stands to lose a lot if you violate the laws, consulting a Stark attorney is probably a good idea anyway.

Pay attention: Once you've determined that you can bill for the services, keep in mind that a patient's SNF status determines how you should bill for your physician's services. Because Medicare Part A typically covers SNF patients and consolidated billing rules apply, you can report only certain services to Medicare Part B. Whether the physician visits the SNF or the SNF patient visits your office, if the patient is in a covered Part A stay, the SNF rules apply and the facility is liable for the payment for the technical component of all diagnostic testing. You can bill physician services, such as E/M services, to Medicare Part B.

Stay tuned: Watch for an article about consolidated billing in an upcoming issue of Medical Office Billing & Collections Alert.