Wiki Consolidated Billing - Explain it to me like I'm five

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AprilSueMadison

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I've read a ton on consolidated billing, but I'm still having trouble grasping it. We regularly get pathology denied due to this.

So...a patient is in a skilled nursing facility...is that the only thing that causes consolidated billing rules to kick in? Are there other reasons such as therapy?

"Under the consolidated billing requirement, the SNF, or nursing home, bills Medicare for the entire package of care that residents receive during a covered Medicare Part A nursing home stay. The SNF also bills Medicare for physical, occupational, and speech therapy services received during a noncovered stay."

So, if we are asking patients, the only thing we should be checking for is skilled nursing right? We shouldn't be asking if they are in assisted living because that isn't the same thing here. I'm trying to understand it better so I can explain it to others better.

We can also bill the professional component of a pathology service, correct? So we would bill out 88305-26. How would the SNF be informed to bill out the technical component, 88305-TC?

I know this is a lot, but thank you for anyone who can help.
 
Consolidated billing

We have the same problem. Medicare gave me the phone number to the facility the patient was reported to be at on our date of service and it was the CEO of the hospitals private number! I'm not giving up. Either they need to correct the information they reported to Medicare or I'm going to bill them for the patient services.
 
Good luck with that! I can't believe the difficulty we've had in talking to a live rep who can actually help. Everything goes straight to voice mail. Certified letters have not been responded to and the same thing goes with the corporate offices. I'm heading to Part A tomorrow and seeing what can be done to prod these non-compliant institutions that will not even offer the courtesy of a call-back or response to letters to action.
 
For those of you still interested in this post decided to grab a friend and make a little "field" trip to two nursing homes in the area, and I just happened to know a few staff members there. I asked if the billing manager would mind sharing a few tips with me concerning the issue with getting nursing homes to play when it was their responsibility to do so. Both verified that what had been initiated on the part of our provider and billing in followup was correct and that the only recourse at this point would be to contact CMS and lodge a complaint. Their yearly evaluation score can be affected by negative feedback is my understanding, so creditable institutions would not appreciate this happening. So, tomorrow I warn, and next week will follow thru with a complaint of non-compliance. Still may not get paid, but the doctor will not be the only one suffering a loss.
 
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