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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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      >



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    • 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 2 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 3 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 4 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 5 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 6 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 7 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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