Major category V: Therapy services included in consolidated billing

May 02, 2019
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The Bottom Line

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.

AMBR Journal, Issue 1, available for download

Apr 12, 2019
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The Bottom Line

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.

Minor surgical procedures included in SNF consolidated billing

Feb 22, 2019
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The Bottom Line

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.

Map for determining included vs. excluded services under consolidated billing

Feb 08, 2019
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The Bottom Line

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.

Consolidated billing: Fact or fiction?

Dec 27, 2018
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The Bottom Line

Test your CB knowledge with the following fact or fiction scenarios:

Fiction

A SNF does not need to list all the CB-included services it renders on the consolidated bill’s claim form because the provider won’t be reimbursed for each specific service anyway.

Fact

Yes, the SNF does. Otherwise, the provider is out of compliance with Medicare’s rules for consolidated billing—a lapse that could result in the recoupment of any identified overpayments.

Case study: Consolidated billing, major category I

Dec 07, 2018
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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.

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