E/M Coding Alert - 2004 Issue 7
Diagnostic Tests: Your Equipment, Their Payment - How to Get Paid for Tests in SNFs
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Article Overview
This article discusses reimbursement challenges for diagnostic testing performed in skilled nursing facilities, including how payment for the technical component may be handled by the facility and how professional interpretation claims can be affected by Medicare carrier processing. It is aimed at physicians, coders, and billing staff who work with diagnostic services in SNFs and need to understand the general payment and claims-submission issues involved. The article also references CMS guidance and the role of place-of-service reporting when services are split between different locations.
Why This Topic Matters
Diagnostic testing in SNFs can create payment and claims-processing conflicts that affect whether physicians and facilities are reimbursed as expected. Understanding the general policy issues helps practices reduce denials and coordinate billing correctly.
What You Will Learn
- How diagnostic test reimbursement can be divided between a skilled nursing facility and a physician practice
- Why professional interpretation claims for tests performed in SNFs may face payment issues
- How CMS guidance and place-of-service reporting relate to diagnostic test claims
- Why differing carrier practices can affect payment for split-location diagnostic services
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Practice administrators
- Healthcare consultants
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