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Consolidating billing snf

Because the Balanced Budget Act of 1997 requires SNFs to "consolidate" their billing for Medicare Part A-stay residents, all but a few services are excluded from the prospective payment system (PPS).Physicians who bill Medicare for services that are part of the all-inclusive PPS rate could be setting themselves up for payment recoupments and potential fraud and abuse investigations.When billing for skilled nursing facility (SNF) patients who present to your oncology practice for chemotherapy and associated services, you may be tempted to thank your lucky stars for the many oncology services that are excluded from consolidated billing but don't get smug yet.The Balanced Budget Act of 1997 requires SNFs to consolidate their billing for Medicare Part Aresidents, thus turning reimbursement into even more of a monster when it comes to nursing-home patients.Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Final Rule Federal Register / Vol. 219 / Wednesday, November 15, 2017 / Rules and Regulations Page 52975 Vol. 219 November 15, 2017 Part II Department of Health and Human Services ----------------------------------------------------------------------- Centers for Medicare & Medicaid Services ----------------------------------------------------------------------- 42 CFR Parts 405, 410, 414, et al.

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Because the Balanced Budget Act of 1997 requires SNFs to "consolidate" their billing for Medicare Part A-stay residents, all but a few services are excluded from the prospective payment system (PPS).

Physicians who bill Medicare for services that are part of the all-inclusive PPS rate could be setting themselves up for payment recoupments and potential fraud and abuse investigations.

When billing for skilled nursing facility (SNF) patients who present to your oncology practice for chemotherapy and associated services, you may be tempted to thank your lucky stars for the many oncology services that are excluded from consolidated billing but don't get smug yet.

The Balanced Budget Act of 1997 requires SNFs to consolidate their billing for Medicare Part Aresidents, thus turning reimbursement into even more of a monster when it comes to nursing-home patients.

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program; Final Rule Federal Register / Vol. 219 / Wednesday, November 15, 2017 / Rules and Regulations Page 52976 ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405, 410, 414, 424, and 425 [CMS-1676-F] RIN 0938-AT02 Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ----------------------------------------------------------------------- SUMMARY: This major final rule addresses changes to the Medicare physician fee schedule (PFS) and other Medicare Part B payment policies such as changes to the Medicare Shared Savings Program, to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services, as well as changes in the statute.

In addition, this final rule includes policies necessary to begin offering the expanded Medicare Diabetes Prevention Program model.

The ICD-9 code for the visit is obstructive bronchitis, acute exacerbation (491.21).

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Chemo and J Codes Excepted From SNF Billing The list of codes that are excluded from consolidated-billing requirements includes the common chemotherapy administration codes (the 96400 series) and a fat selection of J codes.

When patients are transferred from a hospital to an SNF, the SNF may be reluctant to accept those patients because the costly chemotherapy burden will fall on the nursing home's shoulders.

While an SNF can't refuse a patient solely on account of cost, they have been known to use low staffing to justify turning patients away, says Rusti Bauman, RN, BSN, MS, a nurse consultant with FR&R Healthcare Consulting in Deerfield, Ill.

The first step in consolidated billing is to develop a "tickler system" or other mechanism to identify Part A SNF-stay patients seen in the office.

"Many SNFs send a form or notice to the physician's office with the Part A-stay patient instructing the physician's office to bill the SNF for services subject to consolidated billing," says Rusti Bauman, RN, a nursing and reimbursement consultant with FD&R Healthcare Consulting in Deerfield, Ill.

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