Most covered services and supplies billed by the SNF, including those furnished under arrangement with an outside provider, for a resident of a SNF in a covered Part A stay are included in the SNF's bill to the Fiscal Intermediary (FI).
It is the supplier's responsibility to check with the facility to see if their beneficiary is a resident in a covered Part A stay.
(See 42 CFR 424.73.) As a result, the outside supplier of the service or supplies must look to the SNF, rather than to the beneficiary or Medicare, for payment.
The SNF may collect any applicable deductible or coinsurance from the beneficiary.
This is a medical assistance program approved by the Centers for Medicare and Medicaid Services (formerly the federal HCFA).
ACT Assertive Community Treatment-Intensive, 24/7 services for people with serious mental illness provided mostly in community settings by multidisciplinary treatment teams.
The SNF, rather than the provider of the service or supplies, bills Medicare.
Medicare does not pay amounts that are due to a provider of the services or supplies to any other entity under assignment, power of attorney, or any other direct payment arrangement.
Reimbursement for services received in an SNF are subject to an increasing number of regulatory restrictions, beginning with the Balanced Budget Act of 1997.Conceptually, SNF CB resembles the bundling requirement for inpatient hospital services that's been in effect since the early 1980s—assigning to the facility itself the Medicare billing responsibility for virtually the entire package of services that a facility resident receives, except for certain services that are specifically excluded.CB eliminates the potential for duplicative billings for the same service to the Part A fiscal intermediary by the SNF and the Part B carrier by an outside supplier.This simple question could save you hundreds of reimbursement dollars.Without this information, the services you perform might not be reimbursable.