Skilled Nursing Facility Consolidated Billing

Bundle SNF’s responsible for most care
One payment for all included services during a Part A covered inpatient stay<br>

SNF CB Benefits Why was this enacted?
Enhances overall care
SNFs oversee and coordinate
Less patient out-of-pocket
Eliminates duplicate billing<br>

SNF Stays Part A stay
Medicare is covering the inpatient stay
Room and board
Nursing care
Etc.
100 days during a benefit period Part B stay
Otherwise, covered Part B services
Medicare is not covering the inpatient stay
Does not meet the coverage criteria or benefits exhausted<br>

SNF’s Payment Responsibility Part A Stay
Medicare covered services
Clinical Social Worker services
Incident to services
Preventive and screening services Part B Stay
Physical therapy
Occupational therapy
Speech-language pathology<br>

Excluded Services Medicare excluded services
Medicare will not cover
Excluded in the law
Bill the patient
Medicare Benefit Policy Manual, Chapter 16 – General Exclusions From Coverage SNF CB excluded services
CMS determined by procedure code
Other considerations
Not part of the bundle
Billed by the provider performing the service
Bill Medicare directly<br>

Who to Bill<br>

Patient Medicare excluded services
Coverage criteria not met
Frequency limits
No 3-day qualifying stay
No medical necessity
Patient comfort
Patient assigned liability<br>

SNF – Part A Stay Service within the SNF’s scope of care
Established by law
CMS website files
Providers must determine before billing Medicare
Technical and professional component
Associated to another service<br>

SNF – Part B Stay Bill the SNF for outpatient rehabilitation therapy
Physical therapy (PT)
Occupation therapy (OT)
Speech language pathology (SLP)
Bill other services to Medicare directly
Must meet the Part B coverage guidelines<br>

Medicare Which services are SNF CB excluded?
Most physician services
Most emergency room services
Services outside the scope of the SNF
Medicare excluded services
Telehealth originating site facility fee<br>

CMS Files<br>

Steps to Locate the Files Select the following to locate the files
CMS website (www.cms.gov)
Medicare
Coding & Billing
Skilled Nursing Facility (SNF) Consolidated Billing<br>

Part A MAC Updates Part A stay facility charges
5 major categories
Updated annually
Page contains updates between the annual updates
Check the explanation for important information
Downloads on the page’s bottom<br>

Part B MAC Update 4 files
Files 1 – 3 billable to Medicare
File 4 billable to the SNF
Updated annually
Page contains updates between the annual updates
Downloads on the page’s bottom<br>

More Information CMS web resources
SNF Consolidated Billing
SNF CB Best Practices Guidelines
Skilled Nursing Facility PPS
Historical Questions & Answers on SNF Consolidated Billing
Skilled Nursing Facility Billing Reference
On-demand course SNF Consolidated Billing<br>

Questions and Answers<br>

How does the outside providers affect Medicare’s SNF reimbursement? SNFs submit claims monthly or at discharge.
Claims process in chronological order
One claim must adjudicate, before the next month is submitted
Late charges can delay or cause claims issues
Late charges may be needed to add your outside service<br>

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Disclaimers This material is a tool to assist the provider community. Medicare rules change often. Access CMS’ website for current coverage, regulations and rulings.
The basis for answers given today rely on facts given in the question. Medicare rules determine final coverage. 
Do not record the event as CMS does not allow this for profit making purposes.<br>

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