Case study: Consolidated billing, major category I

Dec 07, 2018
The Bottom Line

Background: To illustrate the different billing requirements that apply to professional and technical components of a service, consider Malcolm, a beneficiary who visits the physician office in the midst of a Part A SNF stay to receive a chest x-ray. The physician performs the x-ray, then interprets the results. The administration of the x-ray constitutes the technical component, whereas the interpretation of the results represents the professional component of the total x-ray service.

Action: Because the professional component of the x-ray is excluded from consolidated billing, the physician must bill Part B directly to receive reimbursement for the interpretation of Malcolm’s x-ray. However, because the physician also rendered the technical component— which is included in SNF CB—the facility must reimburse the x-ray provider for this portion of the service from the PPS RUG rate according to the specific terms spelled out in the entities’ payment arrangement.

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