Q:
How does Consolidated Billing apply to dialysis services during a Skilled Nursing Facility (SNF) stay, and what is covered versus not covered?
A:
The consolidated billing requirement assigns the SNF the responsibility for billing the entire package of care provided during a covered Part A stay, as well as for physical, occupational, and speech therapy services during a non-covered stay. However, certain services are excluded from consolidated billing and are therefore separately payable. For Medicare beneficiaries in a covered Part A stay, these separately payable services include:
- Certain dialysis-related services, including covered ambulance transportation to obtain dialysis.
- Specific ambulance services: those transporting the beneficiary to the SNF at admission, from the SNF at discharge (except in cases of transfer to another SNF), and roundtrip services required for offsite dialysis or certain intensive/emergency outpatient services.
- Erythropoietin for select dialysis patients; (References: SNF Consolidated Billing | CMS Items and Services Subject to ESRD PPS Consolidated Billing Effective 1-1-2020 – CR11506)
Written by:
Yetta Christian, RN, RAC-CT
Proactive LTC Consulting
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