Notes from the desk of our CEO Kris Mastrangelo

 

• To provide an essential foundation for the SNF PPS, by bundling into a single facility package all of the services that the PPS payment is intended to capture;
• Spare beneficiaries who are in covered Part A stays from incurring out-of-pocket financial liability for Part B deductibles and coinsurance;
• Eliminate potential for duplicative billings for the same service to the Part A fiscal intermediary (FI) by the SNF and to the Part B carrier by an outside supplier; and
• Enhance the SNF's capacity to meet its existing responsibility to oversee and coordinate each resident's overall package of care.

There are a number of services that are excluded from SNF CB.  These services are outside the PPS bundle, and they remain separately billable to Part B when furnished to an SNF resident by an outside supplier. 
 
Many facilities contact Harmony to obtain clarity on which services are included in the SNF cost and which services can be billed by an outside provider for reimbursement under Medicare Part B service.
 
One particular area of confusion centers around physician services. Where physician services provided to SNF residents are not subject to Consolidated Billing, the facility must be aware of both billed components of physician visits.  Per CMS, "many physician services include both a professional and a technical component, and the technical component is subject to Consolidated Billing.  The technical component of physician services must be billed to and reimbursed by the SNF."
 
CMS provides guidance regarding Consolidated Billing on their website at http://www.cms.hhs.gov/SNFPPS/05_ConsolidatedBilling.asp
 
Harmony recommends that facilities educate themselves regarding the Medicare Fee schedules for services subject to Consolidated Billing provided to SNF residents. Many physicians and ancillary providers will accept the Medicare Fee schedule or will negotiate with the SNF prior to provision of the service.  Facilities have the ability to negotiate contracts and rates with outside providers to contain costs and manage the Medicare Part A expenses.

 
For additional information on this topic contact Harmony Healthcare or visit our web site at www.harmony-healthcare.com

  
MEDICARE MADNESS is coming.......

HARMONY UNIVERSITY