NEWS & REFERENCE - CONSOLIDATED BILLING

In April, 1998, HCFA released a Program Memorandum concerning SNFs not on PPS prior to January 1, 1999:

"A transition period from July 1, 1998 through December 31, 1998 is available for those SNF's that will not have the systems and billing capability to submit claims to the intermediary for all the services that their residents receive....Intermediaries are to use this transition period to educate their providers...There will be no extensions beyond January 1, 1999."

Consolidated Billing for Medicare

Consolidated Billing, a part of the Balanced Budget Act of 1997, calls for billing of all non-physician Medicare Part B items and services delivered to Skilled Nursing Facility residents to be under the facility's provider number, regardless of who provides the service. The facility would then be responsible for paying outside providers.

With the announcement of a transition period, many facilities will not have to do Consolidated Billing before the change to Medicare PPS on January 1, 1999. At that time, they must bill for all services their residents receive. The impact on your facility depends on how many suppliers bill separately for your clients.

Facilities that begin using Medicare PPS before January 1, 1999 (their cost reporting period begins on or after July 1, 1998) will begin Consolidated Billing when they begin PPS. An exception is for services provided under Part B to residents not covered by Part A. In those cases, current billing practices would be used during the transition period.

Consolidated Billing covers Physical Therapy and Occupational Therapy services, plus items such as prosthetics, orthotics, oxygen, dressings, splints, casts, TPN, and PEN, as well as lab and radiology from independent suppliers.

HCFA will be providing fee schedules and a uniform coding system to identify items and services on the appropriate billing forms.

Consolidated Billing Details

• As of January 1, 1999, facilities cannot unbundle services from Part A and have them provided by outside suppliers under Part B. Consolidated Billing requires that these services be billed by the facility.

• Part B ancillary services must be billed under the facility's Medicare provider number.

• Excluded: services provided by physicians, physician extenders, certain advanced practice nurses, and psychologists.

• Facilities will send bills for Part B services to their Medicare Fiscal Intermediaries (not the Durable Medical Equipment Regional Carriers).

• Facilities will submit monthly on Form HCFA-1450 (UB-92) all Medicare claims for all the Part A and Part B services that their residents receive, except for excluded services.

• Facilities will be responsible for having the necessary certifications to provide the services, for example, certificate of medical necessity for PEN. The facility can elect to obtain the documentation from an outside supplier.

Click here to download the complete HCFA Program Memorandum (1.3 meg pdf).