Monday, August 3, 2020

Providers May be Due Refunds from Physicians for Some Services Excluded from SNF Consolidated Billing

On July 31, the Centers for Medicare and Medicaid Services (CMS) issued a notice that three new telephone evaluation and management codes were added to the list of physician services excluded from SNF Part A consolidated billing (CB) and therefore payable to the physician by the Medicare Administrative Contractor (MAC). In some cases, the Medicare claims processing edits inaccurately denied the services citing CB, and the physician subsequently billed the SNF instead. This problem edit has been corrected. Provider business offices should review the following details to determine if a refund is due from any physician offices. 

Specifically, the current COVID-19 Public Health Emergency (PHE) does not waive any requirements related to SNF CB; however, CMS added CPT codes 99441, 99442, and 99443, to the list of telehealth codes coverable under the waiver during the PHE. These codes designate three different time increments of telephone evaluation and management service provided by a physician. The physician can bill for these physician services separately under Part B when furnished to a SNF’s Part A resident.

The MACs have been instructed to reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were denied due to SNF CB edits. Physicians will have their Medicare claims automatically adjusted. If the physician office instead billed the SNF for these services citing CB, they are required to refund the payment to the SNF.

For more information, please visit www.ahcancal.org/coronavirus or email COVID19@ahca.org

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