Consolidating medical bills

In an effort to reduce potential fraud and abuse due to double billing by healthcare providers, SNFs currently bill Medicare under a Prospective Payment System (PPS) similar to the way inpatient facilities are reimbursed for medically necessary care to patients.

The PPS that governs SNF reimbursement is a set amount based on a Resource Utilization Group (RUG) rate.

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Medical billing and coding for skilled nursing facilities (SNFs) seems complicated at first.

Reimbursement for services received in an SNF are subject to an increasing number of regulatory restrictions, beginning with the Balanced Budget Act of 1997.

Some medical services are exempt from consolidated billing, and these services are billed by individual providers.

Prior to 1998, when the Balanced Budget Act of 1997 went into effect, SNFs were allowed to unbundle services that were provided by contracted healthcare entities.

Since 1998, most services provided to a Medicare beneficiary are required to be bundled together and billed by the SNF under the PPS in one consolidated healthcare claim.


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