Consolidating billing snf

Prior to 1998, when the Balanced Budget Act of 1997 went into effect, SNFs were allowed to unbundle services that were provided by contracted healthcare entities.Since 1998, most services provided to a Medicare beneficiary are required to be bundled together and billed by the SNF under the PPS in one consolidated healthcare claim.To be an SNF provider, you must have a financial agreement with the SNF.If there is not an agreement made with the SNF, the physician risks not being compensated because, unless the services is considered to be an excluded service, the charge cannot be submitted directly to Medicare.

They use diagnostic codes from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and the Healthcare Common Procedural Coding System (HCPCS) with includes Current Procedural Terminology (CPT) and HCPCS Level II codes.

Also, the SNF is not responsible for payment to the treating provider if it’s unaware of the treating physician’s orders for that service.

So how does a practice know if a patient is residing in a SNF at the time of the office visit?

The consolidated billing requirements instituted after 1998 have expanded since its implementation, while other services have been excluded.

Under Medicare Part A, SNFs receive a set per diem rate for each patient.

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