Defining whether a patient is in a Part A or Part B stay is vital to proper reimbursement.
A lot of practices deal with a patient who is staying in a nursing facility at certain point. When that time comes and your physician sees a nursing facility patient in your office, your task is collecting appropriate reimbursement for those services. Read this expert medical billing article for more.
The challenge: A patient's nursing facility NF status -- whether the patient is in a Part A-covered stay or a Part B-covered stay -- defines how you are supposed to carry out medical billing for your physician's services, and in case you're not following consolidated billing rules you'll continue to lose part of your fees.
Good news: If you follow these steps, you'll ensure proper medical billing and payment every time.
1. Know Consolidated Billing and How It Affects Your Practice
Prior to you can start billing for services your physician carries out for nursing facility patients, you are required to figure out what consolidated billing really is and how does it affect your medical billing process.
How it works: Medicare's 'consolidated billing' is essentially a payment methodology that reimburses nursing facilities in a lump sum payment for entire facility services the patient may require in the course of a Part A nursing facility stay. Besides paying for the bed and using services the patient receives, the payment moreover covers other 'facility-type' services the patient may require to receive. The lump sum payment rate remains the same whether the patient gets these additional services or not.
Here's why it matters: As Medicare Part A normally covers nursing facility patients as well as consolidated billing rules apply, you can only report definite services to Medicare. When patient visits your office, in case the patient is in a covered Part A stay, the facility is accountable for the payment for the technical component services.
2. Check the Patient's Status
In order to ensure accurate medical billing and collect for nursing facility patient services is to in fact contact the facility to confirm whether the patient is in a Part A or Part B stay. In case he is not covered by Part A, you might bill your Part B carrier for the entire services you offer.
However in case his nursing home stay is covered by Part A, you are about to enter the world of consolidated billing. This really should start, not during medical billing, however with appointment scheduling.
3. Leave the Professional Part to Medicare
For services including both a technical and a professional component that your physician carries out for a nursing facility patient in your office, you must report only the professional component – for instance the written interpretation of an x-ray -- to your Medicare carrier/MAC.
Medical Billing Update: For a lot of the medications your physician may administer to a nursing home patient in a Part A stay, Medicare Part B will not reimburse you in the normal manner.
A lot of practices deal with a patient who is staying in a nursing facility at certain point. When that time comes and your physician sees a nursing facility patient in your office, your task is collecting appropriate reimbursement for those services. Read this expert medical billing article for more.
The challenge: A patient's nursing facility NF status -- whether the patient is in a Part A-covered stay or a Part B-covered stay -- defines how you are supposed to carry out medical billing for your physician's services, and in case you're not following consolidated billing rules you'll continue to lose part of your fees.
Good news: If you follow these steps, you'll ensure proper medical billing and payment every time.
1. Know Consolidated Billing and How It Affects Your Practice
Prior to you can start billing for services your physician carries out for nursing facility patients, you are required to figure out what consolidated billing really is and how does it affect your medical billing process.
How it works: Medicare's 'consolidated billing' is essentially a payment methodology that reimburses nursing facilities in a lump sum payment for entire facility services the patient may require in the course of a Part A nursing facility stay. Besides paying for the bed and using services the patient receives, the payment moreover covers other 'facility-type' services the patient may require to receive. The lump sum payment rate remains the same whether the patient gets these additional services or not.
Here's why it matters: As Medicare Part A normally covers nursing facility patients as well as consolidated billing rules apply, you can only report definite services to Medicare. When patient visits your office, in case the patient is in a covered Part A stay, the facility is accountable for the payment for the technical component services.
2. Check the Patient's Status
In order to ensure accurate medical billing and collect for nursing facility patient services is to in fact contact the facility to confirm whether the patient is in a Part A or Part B stay. In case he is not covered by Part A, you might bill your Part B carrier for the entire services you offer.
However in case his nursing home stay is covered by Part A, you are about to enter the world of consolidated billing. This really should start, not during medical billing, however with appointment scheduling.
3. Leave the Professional Part to Medicare
For services including both a technical and a professional component that your physician carries out for a nursing facility patient in your office, you must report only the professional component – for instance the written interpretation of an x-ray -- to your Medicare carrier/MAC.
Medical Billing Update: For a lot of the medications your physician may administer to a nursing home patient in a Part A stay, Medicare Part B will not reimburse you in the normal manner.
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