{"id":7857,"date":"2022-07-18T16:40:25","date_gmt":"2022-07-18T11:10:25","guid":{"rendered":"https:\/\/www.medisysdata.com\/blog\/?p=7857"},"modified":"2022-10-11T18:58:12","modified_gmt":"2022-10-11T13:28:12","slug":"understanding-snf-consolidated-billing-cb","status":"publish","type":"post","link":"https:\/\/www.medisysdata.com\/blog\/understanding-snf-consolidated-billing-cb\/","title":{"rendered":"Understanding SNF Consolidated Billing (CB)"},"content":{"rendered":"

Basics of SNF Consolidated Billing (CB)<\/h2>\n

In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered SNF stay be included in a bundled prospective payment made through the Part A Medicare Administrative Contractor (MAC) to the SNF. These bundled services had to be billed by the SNF to the Part A MAC in a consolidated bill. No longer would entities that provided these services to beneficiaries in a SNF stay be able to bill separately for those services. Medicare beneficiaries can either be in a Part A covered SNF stay which includes medical services as well as room and board, or they can be in a Part B non-covered SNF stay in which the Part A benefits are exhausted, but certain medical services are still covered though room and board is not.<\/p>\n

History of SNF Consolidated Billing<\/h2>\n

Prior to the Balanced Budget Act of 1997 (BBA), a SNF could elect to furnish services to a resident in a covered Part A stay, either directly, using its own resources; through the SNF’s transfer agreement hospital; or under arrangements with an independent therapist (for physical, occupational, and speech therapy services). However, the SNF also had the further option of \u201cunbundling\u201d a service altogether; that is, the SNF could permit an outside supplier to furnish the service directly to the resident, and the outside supplier would submit a bill to Medicare Part B, without any involvement of the SNF itself.\u00a0 This practice created several problems. Congress then enacted the Balanced Budget Act of 1997 (BBA), Public Law 105-33, Section 4432(b), and it contains a Consolidated Billing (CB) requirement for SNFs. Under the CB requirement, an SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services).<\/p>\n

Excluded Services from CB<\/h2>\n

There are a number of services that are excluded from SNF CB. These services are outside the PPS bundle, and they remain separately billable to Part B when furnished to an SNF resident by an outside supplier. However, bills for these excluded services, when furnished to SNF residents, must contain the SNF’s Medicare<\/a> provider number. Services that are categorically excluded from SNF CB are the following:<\/p>\n