Medical Billers and Coders

  Medical billing for Skilled Nursing Facilities has undergone metamorphic changes ever since the Balanced Budget Act of 1997 came into effect in 1998. One of the significant requirements under the new legislation is that Skilled Nursing Facilities are not permitted to unbundle services administered by contracted healthcare providers. As a result, most of the services provided to Medicare beneficiaries are to be bundled together and billed by SNFs under the Prospective Payment System (PPS) in one consolidated claim. The SNF concerned is then responsible to pay for contracted services out of the per diem rate that it earns for caring for a Medicare beneficiary. Eliminating Skilled Nursing Facilities (SNF) Medical Billing Complication While this imposition may have helped reduce potential fraud and abuse due to double billing by healthcare providers, SNFs have certainly had a hard time understanding: What services are covered under consolidated billing What is billable unde...

  SNF Advanced Beneficiary Notice of Non-coverage Medicare requires SNFs to issue the SNF Advanced Beneficiary Notice of Non-coverage to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is not medically reasonable and necessary; or considered custodial. The SNFABN provides information to the beneficiary so that s/he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNFABN when applicable for SNF Prospective Payment System services (Medicare Part A). SNFs will continue to use the ABN Form CMS-R-131 when applicable for Medicare Part B items and services. Form Filling Instructions for SNF Advanced Beneficiary Notice The SNFABN has 5 sections for completion i.e., header, body, option boxes, additional information, and signature & date.  Failure to use this...