Split Billing in SNFs When to Bill Medicare Part A vs. Part B

2. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B Medicare billing in Skilled Nursing Facilities (SNFs) can be complex, particularly when it comes to determining whether services should be billed under Medicare Part A or Part B. This process, also known as split billing, ensures providers receive proper reimbursements while reducing the risk of errors, denials, or compliance issues. Read detailed blog - https://infohubconsultancy.com/blog/split-billing-in-snfs- when-to-bill-medicare-part-a-vs-part-b/ Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

3. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B Failure to follow Medicare’s strict billing rules can result in claim rejections, delayed payments, audits, or even penalties for non-compliance. In this guide, we’ll break down the essentials of SNF split billing, outline key differences between Medicare Part A and Part B, and explain how Outsource SNF billing and coding services providers helps facilities improve accuracy and compliance. What is Split Billing in SNFs? Split billing refers to the process of dividing Medicare billing between Part A and Part Bdepending on the service provided and the patient’s eligibility. SNFs must carefully determine which part applies, as billing errors may cause denials or duplicate payments, both of which harm revenue. split billing compliance for skilled nursing becomes especially important when a patient exhausts their Part A benefits or requires outpatient services while staying in an SNF. Following CMS guidelines ensures compliance, timely reimbursements, and fewer claim rejections. Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

4. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B Medicare Part A vs. Part B: Key Differences in SNFs Understanding the distinctions between Part A and Part B billing is crucial for SNFs: 1. Services Covered & Billing Approach Medicare Part A: Provides bundled coverage for inpatient SNF stays, including lodging, meals, skilled nursing, and in-facility therapy. Medicare Part B: Covers outpatient services such as physician visits, diagnostic tests, and therapies after Part A coverage ends. Each service must be billed separately using CPT/HCPCS codes. Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

5. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B 2. Eligibility and Coverage Periods Part A: Requires a three-day hospital stay (not counting the discharge date), admission to an SNF within 30 days, and daily skilled care. Coverage lasts up to 100 days per benefit period, with full coverage for the first 20 days. Part B: Does not require hospitalization. It provides ongoing coverage for medically necessary outpatient services. Patients are responsible for deductibles and coinsurance. 3. Claim Submission Rules Part A: Claims are filed by the SNF using the UB-04 form for bundled services. Part B: Claims are filed using the CMS-1500 form, either by the SNF or external providers, for separately billed services. Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

6. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B When Does Medicare Part A Apply in SNFs? Part A applies when a patient is admitted to an SNF after a qualifying three-day hospital stay and within 30 days of discharge. Services must be medically necessary and fall under skilled care. Coverage is limited to 100 days per benefit period, with the first 20 days fully covered and partial coverage thereafter. Reimbursements under Part A are bundled, covering nursing care, therapy, room, board, and some diagnostics. However, eligibility must be monitored closely to prevent billing mistakes or claim denials. Proper documentation and verification of benefit days are critical for compliance. Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

7. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B When Does Medicare Part B Apply in SNFs? Part B becomes active if the patient: No longer qualifies for Part A Exceeds the 100-day Part A limit Receives outpatient services not covered under consolidated billing Services billed under Part B include physician visits, therapy, diagnostics, durable medical equipment (DME), ambulance services, preventive screenings, and mental health treatments. Each service must be coded correctly with CPT/HCPCS codes and supported by medical necessity documentation. Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

8. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B SNF Consolidated Billing and Its Role in Split Billing The consolidated billing rule requires SNFs to submit one bundled claim to Medicare for most services provided during a Part A stay. However, not all services are included. Knowing which are bundled and which can be billed separately under Part B is essential. Included under Part A consolidated billing: Nursing care In-house therapy services Medications and supplies during stay Routine labs and X-rays Enteral and parenteral nutrition Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

9. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B Excluded from consolidated billing (billed under Part B): Physician services Advanced diagnostics (CT, MRI) Chemotherapy, radioisotope therapy, and high-cost drugs Dialysis for ESRD Ambulance transportation under specific conditions Certain prosthetics and orthotics Part B services if Part A does not apply: Outpatient therapy (PT, OT, SLP) Diagnostic imaging and lab tests not bundled under Part A Physician office visits Preventive care (vaccinations, screenings) Durable Medical Equipment (DME) for home use Mental health evaluations and counseling Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

10. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B Conclusion Split billing in SNFs requires more than just selecting Medicare Part A or Part B. It demands precise eligibility verification, proper coding, and strict compliance with consolidated billing regulations. Even small mistakes can lead to denials, audits, or revenue loss. For many facilities, the most effective way to manage these challenges is by partnering with experienced offshore medical billing and coding services provider in India Info Hub Consultancy Services is a trusted partner for SNFs, offering complete billing solutions that ensure compliance, accuracy, and maximized reimbursements. Outsource your SNF billing to Info Hub Consultancy Services and streamline your operations with confidence. Contact us at +1 (888) 694-8634 / 0422 4212 455 or email inquiry@infohubconsultancy.com to learn how we can support your Medicare billing needs. . Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

11. Split Billing in SNFs: When to Bill Medicare Part A vs. Part B FAQs 1. Can SNFs bill both Part A and Part B for the same patient on the same day? No, SNFs cannot bill both for the same service date. Only one applies, depending on eligibility. 2. Does Medicare cover telehealth services in SNFs? Yes, certain telehealth services are covered under Part B if requirements are met. 3. What happens if a patient changes from Medicare Advantage to Original Medicare mid- stay? Billing must be updated accordingly, and eligibility verified before claims submission. 4. Are there therapy caps under Part B in SNFs? Therapy caps have been removed, but documentation and medical necessity are still required. 5. Can Medicare cover private room charges in SNFs? Private rooms are generally not covered unless medically necessary and documented. Read full blog- https://infohubconsultancy.com/blog/split-billing-in-snfs-when-to-bill-medicare-part-a-vs- part-b/ Call us +1 (888) 694-8634 sales@infohubconsultancy.com https://infohubconsultancy.com/

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