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Know CB requirements when referring to PA care
Discharge planners and others might find the rules confusing with regards to consolidated billing (CB) under the Balanced Budget Act (BBA) of 1997. This may be particularly true when patients are discharged to skilled nursing facilities (SNFs) and home health services.
The Centers for Medicare and Medicaid Services (CMS) has provided descriptions and clarifications about how CB works for these post-acute services at these web sites:
Here is a summary of what CMS says:
Changes were made to original CB legislation: The original CB legislation in the BBA was modified over the years. Now the provision regarding SNFs applies only to services that a skilled nursing facility resident receives during a covered Medicare Part A stay. The only exceptions include physical, occupational, and speech-language therapy, which remain subject to CB regardless of whether the resident receiving the services is in a covered Part A stay.
Excluded services are billed separately to Part B: Services excluded from SNF CB are billed separately to Medicare Part B, but the bills still must contain the SNF's Medicare provider number. The services that are excluded include these:
Physicians' services that include furnished to SNF residents, although the technical component of physician services is subject to CB and must be billed to and reimbursed by the SNF;
Physician assistants, nurse practitioners, and clinical nurse specialists working in collaboration with a physician or under a physician's supervision;
Certified nurse-midwives, qualified psychologists, and certified registered nurse anesthetists;
Part B coverage of home dialysis supplies and equipment, self-care home dialysis support services, and institutional dialysis services and supplies;
Part B coverage of epoetin alfa (Epogen) for certain dialysis patients;
Hospice care, an ambulance trip that conveys a beneficiary to the SNF for the initial admission, and physician "Incident To" services.
Some specific outpatient hospital services also are excluded: Some hospital services are so intensive and costly that CMS has excluded them from SNF CB.
Also, durable medical equipment is excluded from CB.