bethb
Guru
Good morning.
I am having trouble understanding Medicare's consolidated billing rules. I do understand that if a patient is in a Skilled Nursing Facility and certain services are rendered and billed to Part B Medicare, those services will deny for SNF consolidated billing. However, we are receiving rejections for laboratory/pathology services (CPT 88305) and the patients involved were NOT under any admission, Part A or Part B, to a skilled nursing facility.
I contacted our Medicare contractor (Novitas) and was told that the service (CPT 88305) is denying because the patient had an outpatient facility service, which was billed to Medicare Part A. I cannot find any information on this and Novitas was not forthcoming with much else, other than the patient had services as an outpatient on the same date of service with our physician.
Does anyone have any information or any guidance as to where I can find the rules for this, as Novitas stated, Part A consolidated billing?
For the patients I received the CO-B20 (payment adjusted because procedure/service was partially or fully furnished by another provider), I verified with the patients that they were not in a SNF at the time of service, not admitted into Home Health or Hospice on the date of service; but all of them had separate testing or services (ordered by physicians other than ours) done on the same date of service at the hospital.
Thank you in advance!
Beth
I am having trouble understanding Medicare's consolidated billing rules. I do understand that if a patient is in a Skilled Nursing Facility and certain services are rendered and billed to Part B Medicare, those services will deny for SNF consolidated billing. However, we are receiving rejections for laboratory/pathology services (CPT 88305) and the patients involved were NOT under any admission, Part A or Part B, to a skilled nursing facility.
I contacted our Medicare contractor (Novitas) and was told that the service (CPT 88305) is denying because the patient had an outpatient facility service, which was billed to Medicare Part A. I cannot find any information on this and Novitas was not forthcoming with much else, other than the patient had services as an outpatient on the same date of service with our physician.
Does anyone have any information or any guidance as to where I can find the rules for this, as Novitas stated, Part A consolidated billing?
For the patients I received the CO-B20 (payment adjusted because procedure/service was partially or fully furnished by another provider), I verified with the patients that they were not in a SNF at the time of service, not admitted into Home Health or Hospice on the date of service; but all of them had separate testing or services (ordered by physicians other than ours) done on the same date of service at the hospital.
Thank you in advance!
Beth