Consolidated Billing

CB Letter #7 Notice to a Hospital Treating a Beneficiary in a Medicare Part A Stay on an Outpatient Basis 2017

HH Click Here-jpg

SNF’s Notice to a Hospital Treating a Beneficiary in a Medicare Part A Stay on an

Outpatient Basis

(Sample Notification #7)

To: Hospital

From: Bill’s Care Center

Re: Resident Name

HIC #: 123-45-6789A

 

The Medicare beneficiary as referenced above is a Medicare Part A covered patient and

Medicare covered services provided may be subject to CMS rules on skilled nursing

facility (SNF) consolidated billing. In accordance with our “under arrangement”

agreement, we are hereby authorizing the following services:

 

The hospital shall bill Medicare Part B directly for services marked below that are

excluded from the SNF consolidated billing provisions. The hospital or physician shall

bill Medicare Part B directly for the services of physicians and certain other medical

practitioners. Certain diagnostic tests include both a professional component

(representing the physician’s interpretation of the test) and a technical component

(representing the test itself). The hospital or physician shall bill Medicare Part B directly

for the professional component of diagnostic services.

  • Ambulance transportation from: ____[place]____ to ____[place]____
  • Angiography, lymphatic, venous, and related procedures
  • Computerized axial tomography imaging (CT) scans (and related services)
  • Cardiac catherization (and related services)
  • Chemotherapy codes ________, ________, ________
  • Emergency Room Care (and related services)
  • ESRD Services
  • Magnetic resonance imaging (MRI) services (and related services)
  • _ Outpatient surgery (and related services) for the following codes ________,

________, ________

  • _ Prosthetic device codes ________, ________, ________
  • _ Radiation therapy (and related services)
  • _ Other ________, ________, ________

 

The SNF shall be responsible for routine or other non-emergency procedures including

the technical components of diagnostic services, provided that the supplier submits

necessary documentation to and obtains prior authorization from the SNF. For those

services that are the responsibility of the SNF, the SNF will pay [the negotiated payment

amount (for example, the Medicare Fee Schedule)] related to the technical component for

services. Please note that under our agreement, the SNF is responsible to provide

professional oversight for all services rendered. Please provide to our nursing department

a copy of:

  • Physician orders
  • Diagnosis
  • Medical history
  • Progress notes
  • Other ______________________________

 

In order to ensure appropriate payment, the supplier must obtain a written authorization

from the SNF as indicated above and provide the necessary documentation to allow the

SNF to maintain professional responsibility over the services provided.

SNF Authorization by: __________________________ Date:______________