SKILLED NURSING FACILITY BILLING

Looking for the best Skilled Nursing Facility(SNF) billing companies? Nurses are the backbone of the healthcare system as the entire medical industry is being managed with their help. BillingFreedom assists SNFs by providing high-quality and smooth medical billing, credentialing, front desk management, AR management, and RCM services. With the goal to maximize collections, BillingFreedom allows nursing staff to focus on patient care with peace of mind.

Skilled Nursing Facility Billing Guidelines

After the Balance Budget Act came into effect, reimbursement for care services received in a skilled nursing facility are subject to an increasing number of regulatory restrictions. In order to reduce potential fraud such as double billing by providers, SNFs currently bill medicare under the Prospective Payment System, just like the inpatient facilities get reimbursed for medically necessary care. This is referred to as skilled nursing consolidated billing. Let’s take a quick look at Skilled Nursing Facility consolidated billing.

SNF Consolidated Billing

In 1997, The US Congress mandated that payment for the majority of services provided during an 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 Skilled Nursing Facilities in a consolidated bill. In short, entities that provide services in an SNF stay cannot bill separately for these services.

However, only a limited number of care services are specifically excluded from consolidated billing, and separately payable.

For Medicare beneficiaries in a covered Part A:

1. Physician's professional services
2. Certain dialysis-related services
3. Certain ambulance services
4. Erythropoietin for certain dialysis patients
5. Certain chemotherapy drugs
6. Certain chemotherapy administration services
7. Radioisotope services
8. Customized prosthetic devices

For Medicare beneficiaries in a non-covered stay:

For non-covered stay, only therapy services are subject to consolidated billing. All other covered services provided by Skilled Nursing Facilities for these beneficiaries can be separately billed.

Submitting SNF claims as part of consolidated billing requires a thorough understanding of medical codes and what is covered by Medicare A and what’s not. We have listed skilled nursing facility billing codes below for your reference.

Skilled Nursing Facility Billing Codes

99304:Initial nursing facility care for the evaluation and management of a patient that requires the following three components:

1. A detailed or comprehensive history
2. A detailed or comprehensive examination
3. Medical decision making of low complexity

Typically, 25 minutes are spent.

99305: Initial nursing facility care for the evaluation and management of a patient that requires the following three components:

1. A comprehensive history
2. A comprehensive examination
3. Medical decision making of moderate complexity

Typically, 35 minutes are spent.

99306: Initial nursing facility care for the evaluation and management of a patient that requires the following three components:

1. A comprehensive history
2. A comprehensive examination
3. Medical decision making of high complexity

Typically, 45 minutes are spent.

99307: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

1. A problem focused interval history
2. A problem focused examination
3. Straightforward medical decision making

Typically, 10 minutes are spent.

99308: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

1. An expanded problem focused interval history
2. An expanded problem focused examination
3. Medical decision making of low complexity

Typically, 15 minutes are spent.

99309: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

1. A detailed interval history
2. A detailed examination
3. Medical decision making of moderate complexity

Typically, 25 minutes are spent.

99310: Subsequent nursing facility care for the evaluation and management of a patient that requires at least two of the following three components:

1. A comprehensive interval history
2. A comprehensive examination
3. Medical decision making of high complexity

Typically, 35 minutes are spent.

99315: Nursing facility discharge day management; Up to 30 minutes.

99316: Nursing facility discharge day management; Over 30 minutes.

99318: Evaluation and management (E/M) of a patient involving an annual nursing facility assessment visit on the required schedule, that requires the following three components:

1. A detailed interval history
2. A comprehensive examination
3. Medical decision making of low to moderate complexity

Typically, 30 minutes are spent.

You can read more about nursing facility medical billing codes at CMS.GOV.

Why BillingFreedom

Time is of the essence for healthcare professionals working in SNFs, to be bothered with medical billing and other back-office chores. SNF managers would need to spend precious work hours supervising billing departments, which can leave them pressed for time. Nursing facility managers can have peace of mind with our dependable SNF billing and revenue cycle management services. Moreover, BillingFreedom helps SNFs maximize their revenue, faster and more easily. Learn how, by giving us a call at (855) 415-3472.