Billing When a Patient is in a SNF
Most DMEPOS products provided to patients in a Skilled Nursing Facility (SNF) are included in the bundled payment made to the facility.
Most DMEPOS products provided to patients in a Skilled Nursing Facility (SNF) are included in the bundled payment made to the facility. In other words, the SNF is responsible for paying for the items the patient needs. Medicare has established a few exceptions to this rule, which means the products identified on the exception list may be billed separately.
Recently, CGS Medicare, the Jurisdiction B and C MAC, has created a DMEPOS Consolidated Billing Tool to assist you in determining if an item is separately billable. You do need to know if the patient is covered under a Part A stay at the SNF. Follow this link, enter the HCPCS code of the item in question, and press "enter." Then you will get one of these responses:
- Not separately payable. The SNF is financially responsible for the item during the Part A stay
- Separately payable. You may bill the DME MAC for the item if the patient is outside of the Part A stay
You will also get information regarding billing during a home health episode or hospice enrollment.
When a device is delivered to a patient in a SNF, the supplier bills the appropriate DME MAC. You must still have all the necessary documentation and paperwork.
You may use the Consolidated Billing Tool regardless of which Jurisdiction your practice is located. You may learn more about Consolidated Billing here.