Cost Benefit Analysis & Billing Protocol for Medicare Patients in a SNF

Cost Benefit Analysis & Billing Protocol for Medicare Patients in a SNF

Part B Patients – We at MassTex Imaging, LLC bill Medicare Part B services for all the professional and technical charges of the mobile x-ray service we provide. However, under the Balanced Budget Act of 1997, CMS determined that procedural code 92611 is subject to consolidating billing. According to the legislation, we cannot submit the speech therapy charge to Part B if a SNF bills Part B Medicare for therapy services. To be in compliance for reimbursement, the SNF is to file a claim without any modifiers to Medicare Part B because they are responsible for the submission of therapy services even when the services are provided by an “outside entity.”*

In this situation the SNF will receive our invoice for the Medicare allowable amount of the service which depends upon the county within which the SNF is located. This transaction can be classified as a Pass through charge as the SNF is entitled to the same reimbursement that we invoice, bearing no out-of-pocket cost.

2009 Medicare Allowable for CPT code 92611: motion fluoroscopy swallow function evaluation

Middlesex, Norfolk, Suffolk Counties . . .$ 107.90

All Other Counties...... $ 92.75

Part A Patients – Under the Part A consolidated billing act we must seek compensation for the technical component of our service from the SNF. MassTex Imaging, LLC is able to offer a discounted rate to you of $300.00 rather than the $450-500 (depending on the county) that Medicare would typically allow for these components. Furthermore, the SNF will forego the cost** of EMT transport to and from your facility as well as the possible accompaniment of a staff member. These costs alone can be upwards of $500. More importantly, you will reduce patient stress caused by long wait times at a hospital. We also give immediate results and recommendations for improved patient care.

Billable Medicare A technical codes and allowable reimbursement for patients in a part A stay receiving a dysphagia consultation including the MBSS from MassTex Imaging, LLC:

70360TC $22.90

70371TC $69.42

70373TC $73.81

70240TC $24.30

74240TC $90.21

70100TC $26.63

92611 $107.90

Allowable total reimbursement for Part A technical component: ...... $415.17

MassTex Imaging, LLC Discounted Rate to Facility for patient in Part A stay: ...... $300.00

Savings of $115.17

* Medicare Part B Newsletter No. 05-050, March 1, 2005, pp. 19

http://www.cms.hhs.gov/snfconsolidatedbilling/

** Medicare Part B Newsletter No. 05-050, March 1, 2005, pp. 16