decisionhealth Newsletters, Part B News - 2018 Issue 5 (May)
SNF patient in your office? Bill MAC for E/M, SNF for technical services
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Article Overview
This article discusses how Medicare billing works when a beneficiary covered under SNF Part A receives services in a physician’s office. It focuses on the distinction between physician and diagnostic service billing, the role of SNF consolidated billing, and guidance referenced from CMS manuals and SNF billing resources. The piece is relevant for physician practices, billing staff, coders, and facilities that handle Medicare claims involving SNF residents.
Why This Topic Matters
SNF consolidated billing can change which entity is responsible for submitting Medicare claims, so understanding the billing pathway helps practices route claims correctly and avoid denials or improper billing.
Article Sections
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Question about office services for an SNF resident
Introduces a scenario involving a Medicare beneficiary enrolled in SNF Part A receiving multiple services in a physician office. The section frames the billing issue addressed by the article.
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Billing approach when the physician has no SNF arrangement
Discusses the general billing path when services are provided outside an arrangement with the SNF. The section references Medicare administrative contractor billing considerations.
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Medicare manual guidance on SNF consolidated billing
Summarizes CMS manual material cited in the article about services that remain separately billable and services that are part of SNF consolidated billing. It places the discussion in the context of Medicare Claims Processing Manual Chapter 6.
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Professional services versus diagnostic and technical components
Explains the broad distinction between physician services and diagnostic service components under consolidated billing. The section addresses how related service components are treated at a high level.
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Laboratory and pharmacy billing considerations
Covers the billing responsibility for laboratory processing and prescription-related services in the SNF context. The section notes how these nonphysician services are handled under the guidance discussed.
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Resources
Lists CMS resources and related guidance documents referenced by the article for further review.
What You Will Learn
- How SNF consolidated billing affects services furnished to a resident outside the facility
- Which broad categories of services are discussed as separately billable versus bundled under SNF payment rules
- How professional and technical components are treated in the context of diagnostic services
- What CMS reference materials are cited for SNF billing guidance
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Compliance staff
- Health information management professionals
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