Practice Management Alert

Not knowing which services are covered for SNF patients will cost you time and money

Question: We often have to treat patients in skilled nursing facilities and end up sacrificing part of our fees after completing a service. How can I ensure that I-m following consolidated billing guidelines and that I-m going to get paid for my claims?

Answer:

A patient's skilled nursing facility (SNF) status determines how you should be billing for your physician's services, and if you-re not following consolidated billing rules you-ll continue to sacrifice part of your fees.

The problem: Billing is complicated for patients in SNF care, but not all nursing facilities are SNFs, says Carol Pohlig, BSN, RN, CPC, ASC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia. An SNF may not even be an entire facility--some facilities have SNF beds and non-SNF beds.

-Even more difficult is what visits physicians can report for the SNF patients,- Pohlig adds.

First step: Call the facility to confirm that the patient is in SNF care. If he is not, you may bill your Part B carrier for all the services you provide. But if he is an SNF patient, you are about to enter the world of consolidated billing.

Because Medicare Part A typically covers SNF patients and consolidated billing rules apply, you can only report certain services to Medicare. 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.

Exceptions: Medicare has made things a little more complex by excluding physicians- services and the professional components of certain diagnostic services from the consolidated billing requirement. Medicare sees these as outside the SNF bundle, and says -they remain separately billable to Part B when furnished to an SNF resident by an outside supplier.- Leave the Professional Portion to Medicare CMS regulations state that for services with both a technical and a professional component, you should report only the professional component to Medicare, Pohlig says.

You should report the professional component to Medicare and then submit a claim to the SNF for the technical component. And for many of the medications your physician might administer, Medicare Part B will not reimburse you in the usual manner. Instead, you must submit a claim to, and seek payment from, the SNF itself.

Example: A urologist sees a patient with bladder cancer and administers a Bacille Calmette-Guerin (BCG) instillation. You-re unaware that the patient is an SNF resident, so you report 51720 (Bladder instillation of anticarcinogenic agent [including retention time]) for the drug instillation and J9031 (BCG live [intravesical], per instillation) for the drug itself to [...]