http://www.auanet.org/content/practice-resources/coding-tips/qa.cfm#misc
Skilled Nursing Facility (SNF)
Q. How can I be sure that I will be reimbursed for services provided for the patients residing in a SNF and requested by the facility staff?
A. To address this, CMS recently clarified the requirements that must be met for a Medicare SNF to have a valid "arrangement" in effect with an outside supplier. This "arrangement" must constitute a written arrangement to reimburse the outside entity for Medicare-covered services subject to consolidated billing, i.e. services that are reimbursable only to the SNF as part of its global prospective payment system per diem or those Part B services that must be billed by the SNF.
CMS also plans to post more information on its web site, develop sample written arrangements and implement a computerized system that will allow Part B suppliers to check Part A eligibility prior to billing.
Services such as luteinizing hormone—reducing hormone (LH-RH) injections, the technical component of urodynamics testing, urinalysis, biofeedback, and laboratory work performed on patients residing in the SNF must be reimbursed through the SNF itself.
Medicare has also addressed the "arrangement" between the SNF and the supplier (physician) of services provided to SNF patients. Transmittal 183 (dated May 21) Medicare Claims Processing Manual Pub. 100-04 for Skilled Nursing Facility Consolidated Billing, published by CMS, outlines detailed background on SNF agreements, what is excluded from consolidated billing and what is necessary to secure proper reimbursement for services performed on SNF patients.
The main directive in this transmittal is that "The SNF and the supplier of services (anyone who provides services to a skilled nursing facility patient other than the SNF itself) must have their "arrangement" in writing." The arrangement should specify what services will be provided by the supplier, how the supplier is to be paid and the reimbursement amount for the services, as well as a means of resolution if there is a dispute over a particular service.
No agreement, no payment
If an agreement is not in writing between the supplier (physician) and the SNF, physician services will not be reimbursed if inappropriately billed to the Part B carrier. A letter requesting repayment to the Medicare program could also result. Most importantly, the inappropriate submission of these claims could result not only in payment denials but might also cause civil monetary penalties for improper billing.
The SNF also risks violating the terms of the Medicare provider agreement (which requires a SNF to have a valid arrangement in place whenever a resident receives services not subject to consolidated billing from any entity other than the SNF itself) and removal from the Medicare program.
It is vitally important to have a written agreement with a SNF when services are provided to SNF patients that are subject to consolidated billing. For more information on this subject visit the CMS web site at http://www.cms.hhs.gov/SNFPPS/LSNFF/list.asp and choose Transmittal R183CP.
Tips for treatment of SNF patients
•Have a written agreement with the SNF that outlines services provided, amount of reimbursement, billing procedures, and who to call to verify information, where to bill, what happens if incorrect information is provided to the supplier, and a means of resolution if there is a problem with services provided as a result of the incorrect information.
•When the SNF calls for an appointment, verify the status of the SNF patients. These patients are covered under Part A for the first 100 days of residence in a SNF. Get the name of the contact person and the verification of coverage. If this information proves to be incorrect, then the written agreement should have a clause to cover payment.
•Sometimes a family member may remove a patient from the SNF for a brief leave of absence and may try to arrange physician services without the knowledge of the SNF or does not relay that information to the office staff. It is necessary to check with this family member to ascertain whether the patient is a resident of the SNF. This is a more difficult situation for office staff.
•Make sure you know the status of the patient that comes into your office. When a patient is scheduled for an appointment, make sure a question is asked. "Is this patient a resident of a SNF?" If the answer is yes, unless you have a written agreement with the SNF, then the urologist shouldn't provide anything except professional services, i.e., office visits, minor office procedures, etc. Check CMS web site for a list of excluded services for SNF patients.
•Make sure physicians and staff understand the important of verifying this information.
Skilled Nursing Facility (SNF)
Q. How can I be sure that I will be reimbursed for services provided for the patients residing in a SNF and requested by the facility staff?
A. To address this, CMS recently clarified the requirements that must be met for a Medicare SNF to have a valid "arrangement" in effect with an outside supplier. This "arrangement" must constitute a written arrangement to reimburse the outside entity for Medicare-covered services subject to consolidated billing, i.e. services that are reimbursable only to the SNF as part of its global prospective payment system per diem or those Part B services that must be billed by the SNF.
CMS also plans to post more information on its web site, develop sample written arrangements and implement a computerized system that will allow Part B suppliers to check Part A eligibility prior to billing.
Services such as luteinizing hormone—reducing hormone (LH-RH) injections, the technical component of urodynamics testing, urinalysis, biofeedback, and laboratory work performed on patients residing in the SNF must be reimbursed through the SNF itself.
Medicare has also addressed the "arrangement" between the SNF and the supplier (physician) of services provided to SNF patients. Transmittal 183 (dated May 21) Medicare Claims Processing Manual Pub. 100-04 for Skilled Nursing Facility Consolidated Billing, published by CMS, outlines detailed background on SNF agreements, what is excluded from consolidated billing and what is necessary to secure proper reimbursement for services performed on SNF patients.
The main directive in this transmittal is that "The SNF and the supplier of services (anyone who provides services to a skilled nursing facility patient other than the SNF itself) must have their "arrangement" in writing." The arrangement should specify what services will be provided by the supplier, how the supplier is to be paid and the reimbursement amount for the services, as well as a means of resolution if there is a dispute over a particular service.
No agreement, no payment
If an agreement is not in writing between the supplier (physician) and the SNF, physician services will not be reimbursed if inappropriately billed to the Part B carrier. A letter requesting repayment to the Medicare program could also result. Most importantly, the inappropriate submission of these claims could result not only in payment denials but might also cause civil monetary penalties for improper billing.
The SNF also risks violating the terms of the Medicare provider agreement (which requires a SNF to have a valid arrangement in place whenever a resident receives services not subject to consolidated billing from any entity other than the SNF itself) and removal from the Medicare program.
It is vitally important to have a written agreement with a SNF when services are provided to SNF patients that are subject to consolidated billing. For more information on this subject visit the CMS web site at http://www.cms.hhs.gov/SNFPPS/LSNFF/list.asp and choose Transmittal R183CP.
Tips for treatment of SNF patients
•Have a written agreement with the SNF that outlines services provided, amount of reimbursement, billing procedures, and who to call to verify information, where to bill, what happens if incorrect information is provided to the supplier, and a means of resolution if there is a problem with services provided as a result of the incorrect information.
•When the SNF calls for an appointment, verify the status of the SNF patients. These patients are covered under Part A for the first 100 days of residence in a SNF. Get the name of the contact person and the verification of coverage. If this information proves to be incorrect, then the written agreement should have a clause to cover payment.
•Sometimes a family member may remove a patient from the SNF for a brief leave of absence and may try to arrange physician services without the knowledge of the SNF or does not relay that information to the office staff. It is necessary to check with this family member to ascertain whether the patient is a resident of the SNF. This is a more difficult situation for office staff.
•Make sure you know the status of the patient that comes into your office. When a patient is scheduled for an appointment, make sure a question is asked. "Is this patient a resident of a SNF?" If the answer is yes, unless you have a written agreement with the SNF, then the urologist shouldn't provide anything except professional services, i.e., office visits, minor office procedures, etc. Check CMS web site for a list of excluded services for SNF patients.
•Make sure physicians and staff understand the important of verifying this information.