Consolidated Billing: Solid Contract With Nursing Facilities to Ensures You Get Paid Every Time

Think of having a healthcare attorney assist with the process.

In order to get payment for the some of the technical components of the services your physician offers in the office for patients in nursing facilities, you may need to have a set contract with the facility. Read this expert medical billing article to learn more.

Collecting payment from the nursing facility for the technical component services your physician carries out – for instance medications, lab work, x-rays (the technical portion, not the interpretation), the technical share of EKGs, billable supplies, DME allotted from office, etc.-- can be your next task. Setting up a contract with each nursing facility you work with can help you circumvent consolidated medical billing and collection headaches down the road -- here's how.

Make the Contract Specific and Detailed

You'll wish to make the contract specific and identify the services, by means of CPT and HCPCS codes, your physicians can deliver to the facility's patients along with the negotiated fees for those procedures and services.

To ensure accurate medical billing, the contract must evidently indicate the nature of the relationship, compensation for the services to be delivered, the length of the contractual obligation, along with confidentiality and further compliance requirements.
The contract must also list your medical Coding billing information and involve a disclaimer mentioning that you anticipate payment for services rendered irrespective of the nursing facility's reimbursement status with the Medicare carrier. Deliver an executed copy of the contract to the facility, and you must keep one for your records.

Medical Billing Tip: Don't Price Gouge Simply Because You Can

You must consider charging the nursing facility merely for the reimbursement you could assume as per the Medicare Physician Fee Schedule, experts recommend. Just for the reason that you're not held to a set fee schedule doesn't mean you could set prices higher than you'd charge for other patients.

While you are not bound by Medicare's set fees for the services you bill directly to the nursing facility, you'll likely find yourself struggling to get additional dollars from the facility over and above the fee schedule amount. The effort won't be worth the time and effort, chiefly if you deal with several nursing facilities -- besides you risk having the facility choose to stop using your practice.

Good practice: Try using a contract and talking first to resolve any persistent payment problems with a nursing facility. As a last resort, however, you can report your problems to the local or regional overseer of nursing homes and request an investigation into their medical billing operations.

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