Wiki Medicare global adjustment denial code

[leannvmc@yahoo.com]

Over the last several months, our billing department has received denials for global adjustment for labs and radiology performed same day claimed under outpatient hospital. The vast majority of these are Nursing home claims that share the facility with the hospital. They have asked for assistance in correcting these. Has anyone else noticed this trend, and could help shed some light on this for us.
Thank you in advance.

 

[ellzeycoding]

It sounds like this is happening because of the SNF consolidated billing rule. If a patient is in a SNF and you provide certain services (on-site) or even in the office, CMS will not pay for the technical component of these services. Only the professional component. You have to bill for the facility (good-luck) for the TC.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/ConsolidatedBilling.html