Wiki SNF Billing and Awareness

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We are dealing with Skilled Nursing Facility nightmares and would like any input you may have. We are a specialist office and see many Medicare patients. Unfortunately we do not have a system set up to know when a patient comes in if they are in fact a SNF patient. So, we end up billing to Medicare, then receive recoupment request, send monies back and then rebill the professional component back to Medicare.
I am learning more about SNF regulations and now know that each patient only has a certain amount of days per year that a physicians office can bill for testing services to the SNF.
I had thought to add a line on our patient info sheet asking if patient is or isn't SNF, that way our receptionists could stamp each fee ticket so that when the ticket gets to me the biller/coder, I know how to bill the services provided. That is a thought but we are still looking for a great way to identify these patients and get paid for both the professional and the technical side of things.
If anyone has run into this as well or has figured out a great way to identify these patients please share your experiences. Any advice is greatly appreciated!!! Gail Davis, CPC

 

[halebill]

Hello Gail,

I just happened to see this old post with no replies. I am in orthopedics and have been dealing with this SNF issue for years. I have developed a system which has greatly helped. Asking Medicare patients if they are enrolled in a SNF does help, but is not 100% effective. Sometimes, they don't even know that they are enrolled in the SNF. We also tried calling Medicare to verify that each patient was or was not in a SNF. This proved to be a waste of time because at the time of your call, their system may not have been updated, and the recoupment came anyway.

Here's what I do, and suggest for you:

1. Continue to ask Medicare patients if they are enrolled in a SNF under a part A stay. If so, send any charges, which are subject to consolidated billing, to the SNF on a HCFA 1500. Be sure you bill them at the Medicare rate, because that's all they'll pay.

2. Split every x-ray charge (or any other charge which would be subject to SNF colsolidated billing) into technical and professional components, whether you have SNF info on them or not. For example, x-ray of left shoulder, complete - instead of billing 73030-LT, bill 73030-26-LT and 73030-TC-LT. Medicare gladly processes them this way. When the recoupment comes later, they will only recoup the technical component. Then, all you need to do is obtain the SNF info for that patient and send the TC charge to them.

This doesn't eliminate the headache completely, but will greatly help.