Before the Balanced Budget Act of 1997, skilled nursing facilities (SNFs) could provide services to residents in a Part A-covered stay in three ways: using their own staff, through a partner hospital, or by hiring an independent therapist. Now, with the new consolidated billing rule, the SNF must handle all the billing for the services a resident receives during a Part A-covered stay, including therapy services (physical, occupational, and speech) even during non-covered stays. This means the SNF handles all billing for the complete care package provided to the resident. 

The SNF could also choose to "unbundle" a service, allowing an outside provider to deliver the service directly to the resident. In this case, the outside provider would bill Medicare Part B directly, without the SNF being involved.  

The risk of duplicate billing to both Medicare Parts A and B if the SNF and outside supplier both submitted bills. 

Caused more out-of-pocket payments for the patients as they had to cover the cost of Part B deductible and copays in case of outside supplier billing 

It also caused poor coordination in resident care as it often involved several outside suppliers. Additionally, it cased substantial disruption in patient care and serious concerns were raised on the whole integrity of the program. 

Congress approved the Balance Budget Act in 1997 where they included skilled nursing billing in consolidated billing requirement. Based on this rule, your skilled nursing facility needs to submit the Medicare billing claims for the services provided to the patients. Of course, there are few services that are excluded from the consolidated billing. 

The whole purpose of consolidated billing is to mitigate the potential for duplicate billing for a same service covered under Part A for skilled nursing facility billing and Part B covering an outside supplier. 

It also improved your facility’s capabilities to perform all the existing responsibilities while allowing you to oversee the whole amount of care that your patients receive. 

In the Balanced Budget Act of 1997, Congress said that most services provided to beneficiaries during a Medicare-covered SNF stay must be included in a single payment made to the SNF through the Part A Medicare Administrative Contractor (MAC). This means you have to bill all those services together in a consolidated bill to the Part A MAC. Providers can no longer bill separately for these services. Medicare beneficiaries can be in either a Part A covered SNF stay, which covers both medical services and room and board, or a Part B non-covered SNF stay, where Part A benefits are used up, but some medical services are still covered, though room and board are not. 

With consolidated billing, you, as the SNF, are now responsible for billing for all the care residents get during a covered Part A SNF stay, plus any physical, occupational, and speech therapy services they get during a non-covered stay. 

There are some specific services that are not included in consolidated billing and you need to bill them separately. These exceptional services included in a covered part A stay are- 

Specific services related to dialysis. They also include ambulatory transportation for your patients due to dialysis  

Certain ambulance services are covered, like those that take the beneficiary to the SNF at the start, those that transport them from the SNF at the end of their stay (except when transferring to another SNF), and round-trip ambulance services during the stay for things like dialysis or some intensive or emergency outpatient hospital services. 

For you, this includes: 

• Erythropoietin if you're a dialysis patient.
• Some chemotherapy drugs.
• Certain chemotherapy administration services.
• Radioisotope services.
• Customized prosthetic devices. 

For billing non-covered Medicare stay, you just need to only include therapies in consolidated billing. 

You can bill and get paid separately for all other covered SNF services from the Medicare contractor. 

You now need to use a Prospective Payment System (PPS) for Medicare, just like inpatient facilities do for patient care. Working with a Skilled Nursing Facility Billing Company like Sunknowledge can make handling these rules a lot easier. 

Sunknowledge has helped nursing centers across all 50 US states, both rural and urban, to boost their revenues by lowering reimbursement rejection rates and focusing more on nursing services. Their billers and coders posses sound knowledge and expertise on SNF billing so that they can ensure a perfectly streamlined revenue cycle management process for your nursing facility. As a renowned SNF billing solutions company, Sunknowledge handles everything from checking patient eligibility for reimbursement to accurately sorting items covered by Medicare A and B.