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4202RE: [MedicalBillers] Re: Physician Billing and Skilled Nursing Facilties

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  • Lin
    Dec 30, 2008
      Yes you are right, I stand corrected. Here is an article, it addresses
      Urologist but Jist is the same. SORRY!



      What is Consolidated Billing?

      SNF's are subject to consolidated billing. This means all services (e.g.,
      room, board, nursing services, etc.) provided in a SNF are reimbursed at a
      flat per day rate. Some of the services performed by urologists are subject
      to consolidated billing. Thus, reimbursement for covered services must be
      paid to the urologist directly by the SNF, and excluded services must be
      submitted and reimbursed through the Part B Medicare carrier. The urological
      services subject to and excluded from consolidated billing are explained
      below.

      CMS issued Program Transmittal 1796 (May 16, 2003) updating the Medicare
      Carriers Manual Part 3 - Claims Process and clarifying that outside
      providers and suppliers cannot submit a separate claim to Medicare for
      services rendered during a SNF covered stay except for "physician
      professional services." The policy states that unless the services and/or
      supplies are specifically excluded under consolidated billing, the outside
      provider must obtain payment from the SNF rather than from Medicare.

      There have been many new transmittals from Medicare since 2003. There are
      new changes to applicable covered HCPCS/CPT codes and CMS has developed a
      special section on Skilled Nursing Facilities. To view this special section,
      go to: http://www.cms.hhs.gov/center/snf.asp
      <Javascript:PopUp('http://www.cms.hhs.gov/center/snf.asp')> . To view
      transmittals applicable to SNF, go to the box on the left of the page and
      click Transmittals.

      In the situation where a urologist performed services on a SNF patient in
      the office or in the SNF and the service is not excluded from consolidated
      billing, the urologist must make arrangements for payment from the SNF. In
      this instance Medicare will deal exclusively with the SNF. The law is silent
      regarding the specifics of a SNF's payment to the outside supplier and there
      are no Medicare requirements. According to the Carriers Manual Claims Review
      and Adjudication Procedures Section 4210.6:

      "The issue of the outside provider or supplier's payment by the SNF is a
      private, contractual matter that must be resolved through direct
      negotiations between the parties. However, services under consolidated
      billing arrangements must be performed by Medicare certified providers that
      are licensed to provide the service involved. In addition, payment may not
      be made if the provider or supplier is subject to OIG sanctions that would
      prohibit Medicare payment for the service if the provider or supplier were
      billing independently."

      It is important that a legally binding, written contract between the
      provider and the SNF is negotiated and executed before services to a SNF
      patient are supplied either in the office or in the SNF. The assistance of
      an attorney may be required for such a contract.

      For more information on services furnished under an arrangement with an
      outside entity, review MLNMattersArticles
      <Javascript:PopUp('http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM324
      8.pdf')> . This article outlines ways providers can protect themselves from
      denials.



      Linda Walker

      Practice Managers Resource & Networking Community
      <http://www.billerswebsite.com> http://www.billerswebsite.com
      A division of K&L Media, LLC
      <http://www.klmediallc.com> http://www.klmediallc.com

      Website Design & Management for the Medical Services Industry







      From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
      On Behalf Of margo_apsbilling
      Sent: Tuesday, December 30, 2008 10:23 PM
      To: MedicalBillers@yahoogroups.com
      Subject: [MedicalBillers] Re: Physician Billing and Skilled Nursing
      Facilties




      The problem is that if a patient is in SNF then all charges are paid
      by the SNF under consolidated billing. Medicare Part B wont pay
      claims if the place of service is an SNF>

      --- In MedicalBillers@yahoogroups.com
      <mailto:MedicalBillers%40yahoogroups.com> , "Lin" <italiandoll1967@...>
      wrote:
      >
      > Facility charges are sent to Part A, Part B is professional charges.
      If you
      > are billing for the podiatrist you are going to bill Part B.
      >
      >
      >
      >
      >
      > Linda Walker
      >
      > Practice Managers Resource & Networking Community
      > <http://www.billerswebsite.com> http://www.billerswebsite.com
      > A division of K&L Media, LLC
      > <http://www.klmediallc.com> http://www.klmediallc.com
      >
      > Website Design & Management for the Medical Services Industry
      >
      >
      >
      >
      >
      >
      >
      > From: MedicalBillers@yahoogroups.com
      <mailto:MedicalBillers%40yahoogroups.com>
      [mailto:MedicalBillers@yahoogroups.com
      <mailto:MedicalBillers%40yahoogroups.com> ]
      > On Behalf Of margo_apsbilling
      > Sent: Tuesday, December 30, 2008 9:03 PM
      > To: MedicalBillers@yahoogroups.com
      <mailto:MedicalBillers%40yahoogroups.com>
      > Subject: [MedicalBillers] Physician Billing and Skilled Nursing
      Facilties
      >
      >
      >
      > Help... I have a podiatrist who sees patients in what I have found out
      > is an SNF. Since they file Part A, I cant file part b charges. Is
      > there any way to get around it? Are all charges included in
      > consolidated billing or are there any exceptions?
      >
      >
      >
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      > The message was checked by ESET Smart Security.
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      >
      > [Non-text portions of this message have been removed]
      >



      __________ Information from ESET Smart Security, version of virus signature
      database 3724 (20081230) __________

      The message was checked by ESET Smart Security.

      http://www.eset.com



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