Billing for Patients in a Skilled Nursing Facility (SNF)
Consolidated billing was established by the Centers for Medicare & Medicare Services (CMS) in 1998 to help eliminate duplicate billings for services rendered to SNF residents by multiple providers. With consolidated billing, an SNF receives a basic per diem rate per level of care for each resident. CMS excludes some categories of services from consolidated billing because they are costly or require specialization.
For Medicare beneficiaries in a covered Part A Skilled Nursing Facility (SNF), providers can seek reimbursement for excluded services directly through Medicare Part B. One excluded service is a medical examination performed in a provider’s office. A provider that sees the resident of a SNF in the office for an examination would bill the examination directly to Medicare; however, a provider must obtain reimbursement for services included in SNF consolidated billing from the SNF itself. Ophthalmological services included in the SNF consolidated billing are the technical component (-TC) of any test, post-cataract glasses and injectable drugs.
Follow these steps to avoid denials of claims for SNF residents:
Confirm where patients are residing if it’s outside the home. The typical stay in a SNF is 20 days.
Train your front desk to be mindful of patients who arrive at the office via transportation services. This can be an indication that the patient came from a facility.
Train your workup/pre-screen technicians to ask the patient if he/she is currently residing in a skilled nursing facility.
A nursing home is not a Skilled Nursing Facility. Your staff may have to ask additional questions if the patient is uncertain in which kind of a facility they are currently residing.
Contact the facility before providing care and confirm that it will pay for these non-covered services.
Skilled nursing facilities are not required to reimburse the provider, so request all authorizations for payment be sent in writing to your office to keep on file in the patient’s chart.
If you will be administering a high-cost drug to a patient in a SNF, consider using a sample from the manufacturer.
Obtaining payment from a SNF can be challenging. Make sure your practice is doing everything it can to ensure you are paid for the services you provide to your patients.