Providing a Prosthesis in an SNF under Med A
Karl Entenmann
Description
Collection
Title:
Providing a Prosthesis in an SNF under Med A
Creator:
Karl Entenmann
Date:
4/16/2021
Text:
I am amazed that so many in our profession do not know the rules here. The following was found simply by asking Google Can a prosthesis be provided to a Medicare patient in an SNF during the Med A stay. Thank you Linda Collins from Ossur.
Orthotic braces are not exempt and are billed to the SNF. Casts and post op protectors and socks and shrinkers are not part of the finished prosthesis, so they are not exempt, and must be billed to the SNF. Prostheses generally are billed to Medicare, even during the part A stay, with a few exeptions. This does NOT apply to a hospital, just an SNF. Anything provided to a Medicare patient in a hospital gets billed to the hospital, but the 2 day rule generally applies.
We, as O and P professionals, have a responsibility to read and understand the rules. We should know the LCDs inside and out. Do your homework.
Karl Entenmann CPOTacoma WA
Can I Deliver a Prosthesis to a Patient in the SNF?
LINDA COLLINS,Ossur 10-31-2019Blog
When a patient is in a skilled nursing facility (SNF), most services are included in the payment to the facility. This includes all orthotic devices used by the patient during the stay.
When a patient is in a skilled nursing facility (SNF), most services are included in the payment to the facility. This includes all orthotic devices used by the patient during the stay. However, most prosthetic devices are exempt from the payment to the SNF. In other words, prosthetic devices delivered to the patient in a SNF can usually be billed under the patient's Part B Medicare benefit. Submitting the claim to Medicare is the responsibility of the prosthetic supplier. Payment is made, by the appropriate MAC, directly to the prosthetic supplier.
CMS provides a comprehensive list of items, defined by HCPCS codes, which are excluded from the SNF payment.
What Does this Mean for You?
Check the HCPCS list here.
Click on 2019 Part A MAC Update and then 2019 Annual SNF Consolidated Billing HCPCS.
If an item is not listed, then it is considered to be a part of the SNF daily rate and is the financial responsibility of the SNF. You may submit an invoice to the SNF and request payment directly from the facility in this situation. The HCPCS codes listed on the spreadsheet are excluded from the SNF payment. In this situation, you may provide the product, document the medical necessity, and submit a claim directly to the MAC for your region.
The DME MAC websites each provide a DMEPOS Consolidated Billing tool which allows you to determine if a particular HCPCS code is billable to Medicare separately.
Noridian Medicare Consolidated Billing/SNF Lookup
CGS Medicare Consolidated Billing/SNF Look up
Orthotic braces are not exempt and are billed to the SNF. Casts and post op protectors and socks and shrinkers are not part of the finished prosthesis, so they are not exempt, and must be billed to the SNF. Prostheses generally are billed to Medicare, even during the part A stay, with a few exeptions. This does NOT apply to a hospital, just an SNF. Anything provided to a Medicare patient in a hospital gets billed to the hospital, but the 2 day rule generally applies.
We, as O and P professionals, have a responsibility to read and understand the rules. We should know the LCDs inside and out. Do your homework.
Karl Entenmann CPOTacoma WA
Can I Deliver a Prosthesis to a Patient in the SNF?
LINDA COLLINS,Ossur 10-31-2019Blog
When a patient is in a skilled nursing facility (SNF), most services are included in the payment to the facility. This includes all orthotic devices used by the patient during the stay.
When a patient is in a skilled nursing facility (SNF), most services are included in the payment to the facility. This includes all orthotic devices used by the patient during the stay. However, most prosthetic devices are exempt from the payment to the SNF. In other words, prosthetic devices delivered to the patient in a SNF can usually be billed under the patient's Part B Medicare benefit. Submitting the claim to Medicare is the responsibility of the prosthetic supplier. Payment is made, by the appropriate MAC, directly to the prosthetic supplier.
CMS provides a comprehensive list of items, defined by HCPCS codes, which are excluded from the SNF payment.
What Does this Mean for You?
Check the HCPCS list here.
Click on 2019 Part A MAC Update and then 2019 Annual SNF Consolidated Billing HCPCS.
If an item is not listed, then it is considered to be a part of the SNF daily rate and is the financial responsibility of the SNF. You may submit an invoice to the SNF and request payment directly from the facility in this situation. The HCPCS codes listed on the spreadsheet are excluded from the SNF payment. In this situation, you may provide the product, document the medical necessity, and submit a claim directly to the MAC for your region.
The DME MAC websites each provide a DMEPOS Consolidated Billing tool which allows you to determine if a particular HCPCS code is billable to Medicare separately.
Noridian Medicare Consolidated Billing/SNF Lookup
CGS Medicare Consolidated Billing/SNF Look up
Citation
Karl Entenmann, “Providing a Prosthesis in an SNF under Med A,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/255511.
