decisionhealth Newsletters, Coder Pink Sheets - 2005 Issue 12 (December)
Written agreements with nursing homes: Do it now
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Article Overview
This article covers Medicare reimbursement concerns for urology practices treating patients associated with skilled nursing facilities, with emphasis on the need for written payment agreements, Part A and Part B distinctions, and consolidated billing. It is aimed at coders, billing staff, and physicians who need to understand how nursing home status can affect whether services and supplies are billed to Medicare directly or handled through the facility. The article also discusses general categories of services commonly implicated in this setting and highlights the importance of checking patient status before services are delivered.
Why This Topic Matters
SNF-related billing can shift payment responsibility away from the physician practice and create avoidable revenue loss if eligibility and billing pathways are not checked in advance. Understanding the general framework helps practices reduce denials and manage reimbursement expectations for services delivered to nursing home residents.
Article Sections
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SNF payment and reimbursement background
Introduces the payment issue faced by urology practices when treating nursing home residents and explains why written agreements are important.
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SNF eligibility and consolidated billing
Summarizes general eligibility concepts for skilled nursing facility status and describes the consolidated billing framework discussed by CMS and AUA.
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Practical billing issues for services and supplies
Describes how different categories of professional services, procedures, diagnostics, and drugs may be handled in the SNF setting.
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SNF checklist
Provides a short operational checklist for verifying patient location, coverage status, reimbursement allowance, and the presence of a written agreement.
What You Will Learn
- How SNF status can affect Medicare reimbursement for urology-related encounters
- Why written agreements with nursing homes are needed for payment coordination
- The general distinction between services handled under Part A and Part B in this context
- Which broad categories of services are commonly affected by consolidated billing
- What steps practices should take before providing services to a nursing home resident
Who Should Read This
- Urology practices
- Medical coders
- Billing staff
- Practice managers
- Physicians treating Medicare beneficiaries in SNFs
Codes Discussed
Modifiers Discussed
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