Wiki SNF and Part B billing for Professional services

[mvetanen]

I am returning to the billing world after three years in other areas of the medical world. The other day I spoke with Medicare RE: Our office performed a DVT rule out for a SNF patient. Initially, Medicare paid and then took it back. Then the bill was submitted to the SNF, but the denied it as it's a professional service and as far as we know we do not have a contract with this SNF. So I contacted Medicare to ask how may I bill this out? I was directed to 2018 Part B MAC Update as was also told to place a 26 modifier on 93971. We did get paid, but I was told by another biller that this was very wrong I should have never done this as the SNF needs to pay. I could use any additional guidance on this as the other biller is not willing to help me understand what I did that was so wrong when Medicare told me to do this. I know SNF is Part A and our services are Part B and with out a contract agreement, the SNF is not required to pay (I worked in contracts for two years). Any help would be appreciated!

 

[thomas7331]

If your provider performed the global service for 93971 using their own equipment, then putting the modifier 26 to get the reimbursement from Medicare for the professional component is not wrong, but you have only been reimbursed for a portion of the service. Medicare Part B does cover professional services for patients in a covered SNF stay, but the technical component is the responsibility of the facility. You are not required to have a contract with the SNF or with Medicare Part A to be eligible to be paid for this. Although the SNF is reimbursed by Part A, their facility payment from Medicare covers any technical services that the patient requires during that stay, which would include the technical component of this test. If that was provided, you may invoice the SNF for it and expect payment, the same as would any supplier that had provided materials or services to that facility. You should bill the technical component with modifier TC to the SNF and there should be no reason that they would not reimburse you - they may have refused to pay your original service because in billing globally with no modifier, the professional component was included in the charge, and that portoin would not be the SNF's responsibility.