decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Nursing Facility Visits / Types of services included excluded from consolidated billing
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Article Overview
This article explains Medicare skilled nursing facility consolidated billing at a high level, focusing on which services are generally bundled into SNF payment and which services are carved out for separate billing. It is relevant to SNFs, hospitals, physicians, therapists, ambulance suppliers, and other providers that need to determine where billing responsibility lies during covered and non-covered stays. The article also notes effective dates and points readers to CMS resources listing separately payable services.
Why This Topic Matters
Consolidated billing affects who bills Medicare and who must seek payment from the SNF, so it has direct operational and compliance implications for facilities and outside providers. Understanding the broad included and excluded service categories helps avoid billing errors and supports correct claim routing.
Article Sections
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Included
Summarizes the general scope of services bundled into SNF payment during covered and certain non-covered stays. It frames the billing responsibility that applies to the SNF and outside providers.
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Excluded
Outlines broad categories of services and provider types that are excluded from consolidated billing and may be billed separately. It also identifies several facility- and setting-based exceptions and references related effective dates.
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Effective for services provided on or after April 1, 2000
Describes a later update that excludes a subset of HCPCS codes in several general service categories for residents in a covered stay. It references CMS guidance for determining separately payable services.
What You Will Learn
- How Medicare consolidated billing applies to skilled nursing facility stays
- Which broad service categories are generally included in SNF payment
- Which general categories of services and provider types are excluded from consolidated billing
- How effective dates affect consolidated billing exclusions
- Where CMS directs providers to find lists of separately payable services
Who Should Read This
- Skilled nursing facilities
- Hospitals and critical access hospitals
- Physicians and physician practices
- Therapists and rehabilitation providers
- Ambulance suppliers
- Medicare billing and coding staff
- Compliance teams
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