Therapy services under major category V are included in the SNF daily rate and accounted for on the consolidated bill for beneficiaries who are in the midst of a Part A stay. However, once a beneficiary who also has a Part B plan exhausts his or her Part A benefits, the SNF must begin billing therapy services to Part B.
Review these Consolidated Billing Case Studies that illustrate common circumstances that can affect a SNF’s billing practices for beneficiaries who receive services from outside entities during a Part A stay.
Download the first issue of AMBR Journal! In this issue we discuss how to focus on new incentives under PDPM without scrapping therapy; how to get your compliance and ethics program into shape before November 1; ICD-10 training for your staff; a breakdown of consolidated billing, category I; and what billers can do to properly handle long-term care insurance policies.
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I.I. Additional surgery HCPCS exclusions: All of the HCPCS listed on the Update File for consolidated billing Category 1 are exclusions, except for minor surgical procedures. Minor surgeries listed on the file are included in SNF consolidated billing and are the responsibility of the SNF. These procedures are considered minor because they may be safely performed either in the physician’s office or in the SNF. Some examples of included minor surgical procedures include toenail debridement, application of certain types of casts, and blood transfusion.
Navigating the myriad rules, policies, and special cases that shape SNF CB—including distinguishing between services that are included in consolidated billing and those that must be billed for separately—can be daunting, but learning to do so is critical. CMS’ charts published in their revised SNF PPS booklet can help billers easily determine whether institutional or professional services are included or excluded from CB. Download these mapping tools for determining institutional services and professional services under CB.
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.