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

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  • Lin
    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
    Message 1 of 15 , 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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      >
      > [Non-text portions of this message have been removed]
      >



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    • debbie brosnan
      This is what I will say.  It just depends on where you live and what kind of work you are looking for.  Some practices such as an individual physician may
      Message 2 of 15 , Dec 31, 2008
        This is what I will say.  It just depends on where you live and what kind of work you are looking for.  Some practices such as an individual physician may not require you to be CPC certified.  However if you are looking for a large practice then a certification will be brownie points in the application process.  You do realize that your certification will be as an apprentice until you have enough hours under your belt.  In the hospital setting what are you looking for coding or billing?  If your working for the facility portion these are two very distint departments dependent on each other but very different.  If your working for the physician side of the hospital billing, such as for dr who are employed solely by the hospital then being both a biller and CPC is a plus. 
         
        I teach medical billing and manage a 285 physician based billing department in a 900 bed hospital.  Your future credentials is what I look for in applicants. 
         
        I wish the best of luck and keep us informed of where you land. 
         
        Deb

        --- On Wed, 12/31/08, Joktan Edison <ejoktan@...> wrote:

        From: Joktan Edison <ejoktan@...>
        Subject: Re: [MedicalBillers] Jobs...and the CPC exam...PLEASE REPLY!
        To: MedicalBillers@yahoogroups.com
        Date: Wednesday, December 31, 2008, 3:58 PM






        Happy Holidays!!!!
        I would advise you to graduate 1st and then take the CPC exam, If you have hands on exp or back ground knowledge it would be good enough to take the CPC Exam.

        " My Presence shall go with thee, and I will give thee Rest " - Exodus 33:14
        Contact Details:
        Joktan R Edison
        Cell: 1 (201) 310 6491 
        efax:1-509-695- 9578 www.edisonandleesol utions.com  

        --- On Wed, 12/31/08, meegan_sweeney <Speeddiva8@gmail. com> wrote:

        > From: meegan_sweeney <Speeddiva8@gmail. com>
        > Subject: [MedicalBillers] Jobs...and the CPC exam...PLEASE REPLY!
        > To: MedicalBillers@ yahoogroups. com
        > Date: Wednesday, December 31, 2008, 11:19 AM
        > Hi everyone,
        >
        > I haven't received a reply, so I thought I would try
        > again.
        >
        > I'm training to be a biller/coder and before I
        > graduate, I will take
        > the CPC exam. Other than some large practices and
        > hospitals, do any
        > other facilities require this certification?
        >
        > What is the job market like? Can anyone tell me about
        > their
        > experiences starting out?
        >
        > Thank you in advance...
        >
        > Meegan















        [Non-text portions of this message have been removed]
      • meegan_sweeney
        Thanks for the replies. I m going to get an externship during my schooling, to get some on the job experience. I know people that are taking the test before
        Message 3 of 15 , Jan 1, 2009
          Thanks for the replies. I'm going to get an externship during my
          schooling, to get some on the job experience. I know people that are
          taking the test before they walk at graduation, with the experience
          under their belt.

          Yes, I know that after a year of this experience (school counts,) that
          I will have a CPC-A, if I pass the certification exam.

          I've heard that different departments at hospitals, do different
          things. I'm currently at a medical collection agency, doing accounts
          receivable. I have a good knowledge of insurance terms and
          forms...and medical terminology.

          I'm in Connecticut, so the area hospitals and other facilities are
          always hiring...or it seems that way, when I look in the classifieds
          in the newspapers.

          Hopefully everything will work out in my favor.

          Thanks,

          Meegan
        • debbie brosnan
          Good Luck and study hard for the exam.  Its pretty tough test.  The best advice I can give you in prepairing to sit the test.  Is practice time trails. 
          Message 4 of 15 , Jan 2, 2009
            Good Luck and study hard for the exam.  Its pretty tough test.  The best advice I can give you in prepairing to sit the test.  Is practice time trails.  Have someone time you practice tests.  Most people fail simply bacause they run out of time. 
             
            Are you taking it through AAPC?

            --- On Thu, 1/1/09, meegan_sweeney <Speeddiva8@...> wrote:

            From: meegan_sweeney <Speeddiva8@...>
            Subject: [MedicalBillers] Re: Jobs...and the CPC exam...PLEASE REPLY!
            To: MedicalBillers@yahoogroups.com
            Date: Thursday, January 1, 2009, 1:37 PM






            Thanks for the replies. I'm going to get an externship during my
            schooling, to get some on the job experience. I know people that are
            taking the test before they walk at graduation, with the experience
            under their belt.

            Yes, I know that after a year of this experience (school counts,) that
            I will have a CPC-A, if I pass the certification exam.

            I've heard that different departments at hospitals, do different
            things. I'm currently at a medical collection agency, doing accounts
            receivable. I have a good knowledge of insurance terms and
            forms...and medical terminology.

            I'm in Connecticut, so the area hospitals and other facilities are
            always hiring...or it seems that way, when I look in the classifieds
            in the newspapers.

            Hopefully everything will work out in my favor.

            Thanks,

            Meegan















            [Non-text portions of this message have been removed]
          • meegan_sweeney
            Debbie-- Yes, I m going to be taking it through the AAPC. I think they hold it at Yale-NH Hospital or some other facility. Maybe a school? I don t know.
            Message 5 of 15 , Jan 2, 2009
              Debbie--

              Yes, I'm going to be taking it through the AAPC. I think they hold it
              at Yale-NH Hospital or some other facility. Maybe a school? I don't
              know. I've only been to the organization's website once or twice.

              But the test is months and months from now, in 2010. I'll just have
              to make sure I'm good at CPT. I've been told that a majority of the
              test is CPT, not ICD-9, right? I think I have ICD-9 down, though.
              Pregnancy? UGH. I hate that section of ICD-9! Those 5th digits!

              Meegan
            • debbie brosnan
              The test is a combination of both books and the HCPC s book.  There are three sections.   Section one.  is on law and terminology. Section two is all
              Message 6 of 15 , Jan 3, 2009
                The test is a combination of both books and the HCPC's book.  There are three sections.
                 
                Section one.  is on law and terminology.
                Section two is all surgery
                Section three is on  Lab, Xray, and Medicine. 
                 
                If I had to take it again I would do sections one and three first then two.  two is the largest and the most time consuming.  You have to pass all three sections to pass the test.  If you are not taking it until 2010.  You have plenty of time to prepare.  I studied for 9 months before sitting the test, and I have been coding for over 20 years.  If you dont pass it the first time dont get discouraged.  Lots of people dont make through the first time. 
                 
                Just remember to not rush but understand time is not your friend.  If you can find someone to give you sample op reports to practice with and then check your answers it would be the best way to prepare. 
                 
                Anyhow, gotta get to work.  Have a great day in Conn.  Do you have alot of snow.  Here in Michigan we did have two feet but now its just a good dusting. 
                 
                Deb


                --- On Fri, 1/2/09, meegan_sweeney <Speeddiva8@...> wrote:

                From: meegan_sweeney <Speeddiva8@...>
                Subject: [MedicalBillers] Re: Jobs...and the CPC exam...PLEASE REPLY!
                To: MedicalBillers@yahoogroups.com
                Date: Friday, January 2, 2009, 1:50 PM






                Debbie--

                Yes, I'm going to be taking it through the AAPC. I think they hold it
                at Yale-NH Hospital or some other facility. Maybe a school? I don't
                know. I've only been to the organization' s website once or twice.

                But the test is months and months from now, in 2010. I'll just have
                to make sure I'm good at CPT. I've been told that a majority of the
                test is CPT, not ICD-9, right? I think I have ICD-9 down, though.
                Pregnancy? UGH. I hate that section of ICD-9! Those 5th digits!

                Meegan















                [Non-text portions of this message have been removed]
              • Lin
                Happy New Year. I am just catching up from the holiday s. Just a side note because you mentioned working in hospitals which is your best bet in this economy..
                Message 7 of 15 , Jan 3, 2009
                  Happy New Year. I am just catching up from the holiday's.



                  Just a side note because you mentioned working in hospitals which is your
                  best bet in this economy.. but you will probably want to look into Hospital
                  / Facility coding (DRG) through AHIMA. Working in a hospital vs. an
                  individual or group practice is VERY different!

                  In today's economy I would think your physician practices will be cutting
                  back costs, hospital's and facilities are your best bet and like you
                  mentioned, most of them are always hiring. The down side is they often have
                  a high staff turn-over rate, and start you at the bottom.



                  Lin



                  From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
                  On Behalf Of meegan_sweeney
                  Sent: Friday, January 02, 2009 1:51 PM
                  To: MedicalBillers@yahoogroups.com
                  Subject: [MedicalBillers] Re: Jobs...and the CPC exam...PLEASE REPLY!



                  Debbie--

                  Yes, I'm going to be taking it through the AAPC. I think they hold it
                  at Yale-NH Hospital or some other facility. Maybe a school? I don't
                  know. I've only been to the organization's website once or twice.

                  But the test is months and months from now, in 2010. I'll just have
                  to make sure I'm good at CPT. I've been told that a majority of the
                  test is CPT, not ICD-9, right? I think I have ICD-9 down, though.
                  Pregnancy? UGH. I hate that section of ICD-9! Those 5th digits!

                  Meegan



                  __________ Information from ESET Smart Security, version of virus signature
                  database 3732 (20090102) __________

                  The message was checked by ESET Smart Security.

                  http://www.eset.com



                  [Non-text portions of this message have been removed]
                • margo_apsbilling
                  Tanya- I had another question regarding this SNF stuff. Once a patient no longer is receiving SNF benefits can we bill part B? Thanks for your help. ... pay
                  Message 8 of 15 , Jan 24, 2009
                    Tanya-
                    I had another question regarding this SNF stuff. Once a patient no
                    longer is receiving SNF benefits can we bill part B? Thanks for your
                    help.


                    --- In MedicalBillers@yahoogroups.com, "margo_apsbilling" <margo@...>
                    wrote:
                    >
                    > Thats very bad news!! I think I am going to cry. The doctor is going
                    > to FLIP!! Thank you for your answer though.
                    >
                    > --- In MedicalBillers@yahoogroups.com, "Tanya Peck" <tanya@> wrote:
                    > >
                    > > I used to work for a podiatrist and had this exact situation. In this
                    > > case, in the past for me, I had found that there was NO way to get
                    > > payment since the podiatrist IS Part B, but that the SNF should
                    pay the
                    > > podiatrist his fee OR have the family pay the fee since he has no
                    Part
                    > > B.
                    > >
                    > > That's what we did, anyways. We had "relationships" set up with
                    the SNF
                    > > that if they called us in to perform procedures on the patient, they
                    > > would pay us out of their daily allowance/payment that they got for
                    > > Part A. Or, if it was the patient that wanted services, we considered
                    > > them cash paying patients since they technically have no insurance
                    that
                    > > can be billed.
                    > >
                    > > T
                    > >
                    > >
                    > > --- In MedicalBillers@yahoogroups.com, "margo_apsbilling" <margo@>
                    > > wrote:
                    > > >
                    > > > 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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