Part B SNF Billing Q&A

When a Medicare beneficiary is not entitled to Part A benefits, limited benefits may be provided under Part B.

The following three situations qualify a SNF to submit a claim for Part B services:

• Part B inpatient stay (Part B residents). A Part B inpatient stay includes services furnished to inpatients whose benefit days are exhausted, or to inpatients who are not entitled to have payment made for services under Part A because they’ve dropped below a skilled level of care.

• Receiving outpatient services. Covered Part B services rendered to beneficiaries who are not inpatients of a SNF are considered SNF outpatient services. See “Important note” below.

• Part A covered stay. SNFs are required to consolidate billing to their intermediary for their covered Medicare inpatient services. However, certain services rendered to SNF inpatients are excluded from the SNF prospective payment system (PPS) reimbursement and are also excluded from consolidated billing by the SNF. Those services must be billed to Part B by the rendering provider and not by the SNF (with the exception of screening and preventive services, which the SNF bills for Part A residents).

   

  Frequently asked questions about Part B:

  Q: How should multiple units of the same HCPCS code given on the same day be listed on the UB-04 (e.g., four units of 97530 in occupational therapy)?

  A: Units of the same HCPCS code provided by the same discipline on the same day should be listed on the same line item. In the above example, it would be one line with four units of 97530, and the individual unit charge would be multiplied by four.

   

  Q: Is it acceptable to take the ICD-10 codes from the face sheet or the hospital discharge paperwork? 

  A: No. The ICD-10 codes should always be reviewed by the clinician, therapist, or certified coder to ensure that they are the most accurate reflection of the reason the individual is receiving Part B services.

   

  Q: Is an admission date required on a Part B claim?

  A: Generally, no, you do not need an admission date for Part B. However, follow your MAC’s instructions if they differ.

   

  Q: Can Medicare as Secondary Payer affect Part B claims?

  A: Yes! Another insurance, such as an auto liability policy, can certainly be primary to traditional Medicare. Always screen for other payers.