Skilled Nursing Facility Consolidated Billing

Consolidated billing includes physical, occupational, therapies, and speech-language pathology services received from any patient that resides in an SNF. Therefore the SNF must work with suppliers, physicians, and other practitioners.

You can also check A/R Cleanup & A/R SNF Solutions & Skilled Nursing Facilities Billing Solutions online.

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Physician Services

There are a limited number of services that are excluded from consolidated billing, including services of a physician assistant, nurse practitioner and clinical nurse specialist when they are not an employee of the SNF and when these clinicians are working in collaboration with a physician or under their direct supervision.

Physicians submit claims to Medicare Part B for services that are excluded from SNF consolidated billing. There are four files in the Part B update for SNF consolidated billing:

File 1: Part A Stay-Physician services

Codes listed are not subject to SNF consolidated billing and should be submitted to Medicare Part B or Durable Medical Equipment contractor, as appropriate.

File 2: Part A Stay-Professional components of services to be submitted with a 26 modifier

Codes listed are not subject to SNF consolidated billing and should be submitted to Medicare Part B for payment consideration.

File 3: Part A Stay-Ambulance

Codes are subject to SNF consolidated billing and will always be denied by Medicare Part B when submitted with a NN, ND, or DN modifier.

File 4: Part B Stay Only – Therapy services

These therapy codes are subject to SNF consolidating billing and will always be denied by Medicare Part B.

These services must be provided and billed under arrangement with the SNF.