Better late than never: Get SNFs to sign an agreement to pay you for drugs, labs, biofeedback

Why This Topic Matters

Practices that treat SNF residents can face payment recoupments if claims are submitted incorrectly. Understanding the scope of consolidated billing and having the proper written arrangement can help reduce denials, repayment issues, and confusion with SNF reimbursement responsibilities.

Article Sections

1. Medicare consolidated billing for SNF residents

   Introduces the billing issue for patients in skilled nursing facilities during a Medicare Part A stay and explains that some services are included under consolidated billing. The section frames why practices need to distinguish between services billed to Medicare and services handled through the SNF.

2. Recoupment concerns and older claims

   Discusses how past claims may be affected and why practices may receive repayment requests. It also describes the practical challenges of addressing services furnished over prior years.

3. Services excluded from consolidated billing

   Reviews broad categories of services that may be billed directly versus those tied to the SNF payment structure. The section emphasizes the need to separate professional and diagnostic services from other items covered under the SNF arrangement.

4. Written agreements and contract practices with SNFs

   Explains why practices seek written agreements or contracts with nursing facilities and how those arrangements support reimbursement. It also notes that facilities may vary in their understanding of the billing requirements.

5. Notification procedures and payment handling

   Covers suggestions for identifying when a patient is within the relevant SNF stay period and how practices should handle payment responsibilities. The section discusses the importance of coordinating with the SNF before services are furnished.