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03/18/2010Reimbursement Update – Ambulatory Surgical Centers
By, Joy Newby, LPN, CPC, Newby Consulting, Inc.
Implementation of a New Skilled Nursing Facility Consolidated Billing Edit for Facility Services Billed by Ambulatory Surgical Centers
http://www.ngsmedicare.com/Content.aspx?CatID=2&DOCID=21661
Implementation Date: July 6, 2010
The Balanced Budget Act (BBA) of 1997 required the Centers for Medicare & Medicaid Services (CMS) to implement a Medicare SNF prospective payment system (PPS). Additionally, the BBA of 1997 required consolidated billing (CB) for SNFs. Under the CB provision, an outside supplier must bill and receive payment from the SNF rather than from Medicare for services provided to a beneficiary in a Part A SNF CB stay.
Effective for claims with dates of service on or after January 1, 2008, Medicare will deny claims from an ASC that is enrolled as a provider specialty type 49, where the service has a type of service of F, and the patient is in a Part A SNF CB stay. Also, where Medicare receives a SNF claim for a patient in a Part A SNF CB stay and has previously paid an ASC claim incorrectly due to SNF CB, Medicare will follow current processes to recoup any overpayment from the ASC.
Services excluded from the CB provision include ambulatory surgeries performed at an outpatient hospital. However, this exception does not apply to the facility service provided by a freestanding, (non-hospital), ASC. Physicians' professional services are also excluded from consolidated billing.
Additional Information
The official instruction (CR 6702) issued to your Medicare MAC and/or carrier is available at http://www.cms.hhs.gov/Transmittals/downloads/R1911CP.pdf on the CMS Web site. - Posted 02/18/2010
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