Dreyfuss Williams` lawyers are uniquely positioned to facilitate communication between qualified care facilities (NFS), hospitals and Medicare to ensure that all payment obligations are met. Consolidated billing rules may prevent direct payment of Medicare if benefits overlap between a qualified care facility and the hospital. In other cases, hospital services may be excluded from the consolidated billing rules and are payable separately. Dreyfuss Williams` lawyers will assess your claim and will pursue the corresponding portion for payment. Medicare has developed a prospective payment system specific to NFAs. As part of the implementation of this payment system, Medicare has adopted rules commonly known as consolidated NWS accounts. The consolidated billing requirement has been defined in the legislation and is intended to eliminate double billings for services provided by several service providers to patients with NFS. According to the consolidated tally, the SNF is generally the only company to charge Medicare for services provided to its residents. An NSF should also be in contact with the external provider before providing services to determine which CPT and/or HCPCS codes the external provider charges for the services or procedures performed. After coverage, the SNF can browse these codes in the SNF`s annual consolidated HCPCS billing update file to determine if it is responsible for the services or processes. The NFS can also determine whether it is limited by the type of service or provider. If a beneficiary is in an SNF stay authorized by Medicare Part A, the services are considered consolidated. In other words, services provided to a beneficiary whose stay in a retirement home is covered by Medicare would be covered by a consolidated settlement.
When a service is identified under the consolidated NFS count, it must be billed by the SNF itself. If a service is excluded from consolidated billing, this means that Medicare service can be billed by the doctor who provided the service. Excluded benefits are considered to be billed separately by doctors or other providers. More information about consolidated NF billing can be found by phone from the local airline Medicare or from the financial intermediary. The CMS also offers an abundance of online information about www.cms.hhs.gov/SNFPPS/05_ConsolidatedBilling.asp. AsCO refund agents can help you answer questions about oncology billing, coding and practice management. Call (703) 299-1054 or call gro.ocsa@ecitcarp by email. When a resident is transported off-site for services or medications that have been excluded from consolidated billing, the physician or provider may directly charge Medicare for these excluded services.