Wiki Medicare/Medicaid and SNF billing

[deborahcook4040]

I have a patient who is a fully qualified dual eligible (has Medicare Part A&B and FULL Medicaid, not just coins and deductibles), who is inpatient at a Skilled Nursing Facility and coming to our orthopedic practices for follow up on a hip fracture. The SNF does not take x-rays before they send him. When we take x-rays on a Medicare patient who is in a SNF, we are supposed to bill the SNF. The SNF says that the patient is not using his Medicare benefits to pay for the SNF, and that means they aren't responsible for the x-rays. He's using his MediCAID benefits, and we should bill Medicaid. Medicare says to bill another payor, and we're not yet credentialed with Medicaid, so we can't bill them at this time. Does anyone know what supposed to happen here? Any help would be appreciated. I THINK chapter 6 of the Medicare provider manual says that someone is supposed to bill Medicare part B, but i can't figure out who. Or even if that's accurate.

 

[LWoodson]

Reply

I think you may want to obtain an understanding of SNF billing for Medicare. Just because the patient has bother Medicare and Medicaid does not mean that Medicare will automatically pay for the SNF services. Patient must meet requirements set forth by Medicare (see Chapter 8) in order for SNF to bill Medicare. If patient does not meet these qualifications the SNF can bill Medicaid. If your facility is not credentialed for Medicaid at this time you should still be able to bill Medicaid once you become a participating facility. You should discuss this with your provider representative with Medicaid. I hope this helps.