Medicare and Billing: Things You Should Know


1.    CMS strongly recommends that the SNF have a written agreement in place with all patient service suppliers.

2.    Suppliers are not obligated to accept the Medicare fee schedule. Charges are to be a negotiation between the SNF and the supplier.

3.    All MBS suppliers are subject to the same PPS/Consolidated Billing rules.

4.    All therapy services are subject to PPS (Part A) and CB (Part B).

5.    The therapy portion of the MBS exam (Part B) can be billed on the UB-92 using CPT 92611.

6.    PPS/CB compliance requires that the supplier bill the SNF for the therapy portion of the exam for all Medicare patients and the technical component of the radiology portion of the exam for all skilled patients.

7.    It is the SNF's responsibility to make the supplier aware of the accurate billing status of the resident.

8.    The cost of ambulance transportation of a skilled resident to the hospital for the MBS study is the responsibility of the SNF.

9.    In most cases it is beneficial for the resident and the SNF for service to be provided within the SNF.

10.  A Proactive Dysphagia Program, including an in-house MBS service, is financially beneficial to the SNF for the following reasons:

  • Addresses major issues of dehydration, malnutrition, and aspiration pneumonia, resulting in healthier residents
  • Reduces the SNF's liability
  • Billable treatment recommendations are immediately available.
  • Will increase the Part B caseload: improved productivity
  • May justify continuation of the skilled stay
  • Reduces peg tube utilization
  • Reduces thickened liquids utilization
  • Improves communication among all concerned
  • Produces revenue and saves money