NEWS & REFERENCE - CONSOLIDATED BILLING

Several of our staff joined many other long term health care representatives at the May 27 and 28 conference entitled "Shifting Payment Gears: A Strategic Look at PPS and Consolidated Billing." It was sponsored by the American Health Care Association (AHCA) and held in Baltimore. Speakers included representatives from HCFA, AHCA and other industry leaders.

As a service to our customers who were not able to attend the conference, CARE is providing the following outline.

Consolidated Billing
SNF Consolidated Billing is a comprehensive billing requirement under which the SNF itself is responsible for billing Medicare for virtually all of the services that its residents receive.

Payment amount for Part B services furnished to an SNF resident shall be the amount prescribed in applicable fee schedules and requires SNF's Part B bills to identify all items and services through a uniform coding system, (HCFA Common Procedure Coding System [HCPCS]).

Consolidated Billing applies to all beds in any nursing home where any portion of the home has Medicare SNF certification.

Dates
The effective date for consolidated billing is July 1, 1998 or January 1, 1999, depending on facility and Fiscal Intermediary (FI) ability to participate.

Initially the extension to January 1, 1999 excluded therapy and ambulance services. They are now included in the option to delay to January 1, 1999.

Due to technical difficulties, Fiscal Intermediaries (FI) may not be prepared to begin Consolidated Billing effective July 1, 1998. Facilities must contact their FI to determine their preparedness and wait until January 1, 1999 if their FI is not ready.

Consolidated Billing effective dates do not coincide with PPS dates. In general, if a facility starts into the PPS prior to January 1, 1999, it must also begin Consolidated Billing at that time for its Part A residents.

Exception
PEN claims may not move to Consolidated Billing until January 1, 1999.

How it Works
All claims will go to the Fiscal Intermediary.

Certificates of Medical Necessity will be required.

HCFA to use HCPCS effective July 1, 1998.

Modifiers will be used on the therapy HCPCS code to distinguish between the therapies.