Skilled Nursing Facility Medicare Billing: Few Pointers on Consolidated Billing

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There’s a general lack of clarity in the healthcare industry on skilled nursing facility Medicare billing and ancillary services around it. The complexity comes from a lack of awareness of how a Skilled Nursing Facility (SNF) works. The confusion intensifies with not having proper information about the Medicare qualified coverage of the services it renders.

Different aspects of nursing home billing such as bundled services consolidated billing, Prospective Payment System (PPS), etc. need expert handling. Often even the in-house staffs of the SNFs are not competent enough to efficiently and accurately handle consolidated billing and other stuff. However, it will be an injustice to doubt their ability considering the workload they take owing to the fact that these SNFs are run by a very limited workforce, forcing the staffs to do a lot including patient care. Obviously, they cannot solely focus on the very important aspect of consolidate billing and neither get regular trainings to cope with the latest regulatory changes and updates.

In such a situation, a basic understanding of consolidated billing always gives you a good start if you want to know more or work around skilled nursing facility Medicare billing.

SNF Consolidated Billing – Things to Know

Let us explore the vital points that can help us understand consolidated billing better.

·         As a part of the Prospective Payment System for SNFs, Medicare introduced the consolidated billing requirement to negate duplicate billings raised for the services rendered to SNF patients by a number of providers. As per general consolidated billing, only an SNF can bill Medicare for the services provided to its residents.

·         A beneficiary staying in a Medicare Part A-approved SNF qualifies to be covered by Medicare for the services availed under consolidated billing.

·         Since a service qualified to be included in the SNF consolidated billing needs to be billed by the SNF itself, any service exclusion can be billed by the performing physician to Medicare separately. The categorical exclusions from consolidated billing are mainly due to the high-cost factor/specialization requirement that include:

·        Physicians’ professional services

·        Certain services for dialysis like ambulance transportation to obtain dialysis services

·        Other ambulance services like transportation to the SNF at the start and end of the stay or intensive or emergency outpatient hospital services in some cases

·        Erythropoietin for dialysis patients

·        Particular chemotherapy drugs

·        Particular chemotherapy administration services

·        Radioisotope services

·        Customized prosthetic devices

·         Medicare Part A covers an SNF resident’s entire package of care during the stay under consolidated billing. These are the general services that are covered by Medicare:

·        Medications

·        Meals

·        Equipment used in the facility

·        Semi-private/shared room

·        Nursing care

·        Therapies

·        Pathology services

·        Ambulance service

It has been observed that practices outsourcing their skilled nursing facility Medicare billing to professional medical billing services have fared much better with the expert handling resulting in improved cost-effectiveness, efficiency, accuracy, and follow-up strategies.