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The “Consolidated billing made simple” series delves into the ins and outs of consolidated billing (CB) to help untangle CMS CB regulations and give billers' a solid understanding of the rules so that they can apply them appropriately.

As SNFs prepare for the implementation of the Patient-Driven Payment Model (PDPM) on October 1, they may be assessing their ability to take on more clinically acute residents. “Under PDPM, caring for residents with higher acuities may result in greater revenue,” says Stefanie Corbett, DHA, postacute regulatory specialist for HCPro. The new payment model incentivizes SNFs to care for more clinically complex patients however, these patients also bring higher costs because they require more expensive drugs, equipment, supplies, and staff time.

“The expenses are so extreme. The cost of some drugs can sometimes exceed the revenue that you’re getting for that resident,” says Pam Duchene, PhD, APRN-BC, NEA, FACHE, vice president of education and training for Harmony Healthcare International. With the high cost of the drugs, SNFs will have more money on the line under PDPM. The challenge for billers' is that the CB rules outline several exclusions that must be billed by the provider to Medicare. Billers' must know how to identify these exclusions so that they do not bear the cost of these services or include them on the CB.

This series also covers:

Inclusions vs exclusions
Chemotherapy and CB Major Category III
Ambulance trips for Major Category III services
Drugs not explicitly addressed by a major category and experimental drugs
Helpful consolidated billing resources
Preadmission screening tips

To read the full article, click here.

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