Last Modified: 4/23/2020
Location: FL, PR, USVI
Business: Part B
Q: My claim was denied because the patient was in a skilled nursing facility (SNF) and consolidated billing applies. What is included in consolidated billing?
A: One of the provisions of the Balanced Budget Act (BBA) of 1997 (Section 4432b) requires consolidated billing for skilled nursing facilities (SNFs). The consolidated billing requirement confers on the skilled nursing facility (SNF) the billing responsibility for the entire package of care that residents receive during a covered Part A SNF stay, and physical, occupational, and speech therapy services received during a non-covered stay.
A limited number of services are specifically excluded from consolidated billing and therefore separately payable under Part B. These exceptions, as well as additional information concerning SNF consolidated billing, can be found on the CMS website at the CMS SNF consolidated billing webpage: https://www.cms.gov/Medicare/Billing/SNFConsolidatedBilling/index
Publication 100-04 Medicare Claims Processing Manual, Chapter 6, Section 10.1
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