Nursing home patients -who do you bill?

Recently we've had an influx of nursing home patients come in. Because I am unused to this how do I know the following?

1. Who do I bill, Medicare or the nursing home?

2. Should the nursing home (if they're responsible) pay the whole approved amount?

3. The nursing homes half the time don't even know who I should bill (unless they're just being shrewd) so how do I find out?

4. Can I find out by using the Medicare IVR? I have heard it say before the patient is a nursing home patient, does that mean I bill the nursing home?

Thank you for your answers.

Nursing home patients: what services are you providing?

Physician services for nursing home patients are billed to Part B Medicare.

However, certain diagnostic tests, the technical component of other tests, drugs, etc are billed to he SNF.

Look up "consolidated" in the search box and also nursing and you'll find some articles.

Thanks

Thank you for your answer. I have 2 patients who I have now found out get their office visits billed to the nursing home. It's a little confusing for me.

In answer to your question

We provide office visits, sometimes EMGs and sometimes EEGs.

I don't get it...

Why would the facility pay the doctor bill (unless they have some special arrangement)? If your doc sees the patient and does an EMG, you would bill the visit and the professional fee for the EMG to Medicare and the technical component to the nursing home. Billing the EMG as a single code with both prof and technical risks denial

why would nursing homes pay?

Signaturedoc - I think nursing homes pay the bill when the patient signs everything over to them (life insurance policy/pension, etc.). Sometimes my Medicare denials say, this is a nursing home patient. Not sure what separates the Medicare payors from the nursing home payors. In fact, one nursing home administrator told us to bill the nursing home for visits. It's confusing especially for long-term nursing home patients versus short-term nursing home patients. I am losing hair over this (:))

I am still confused

If the patient still has Medicare Part B then the doctor bill should be paid by Medicare. If there is some special program like a Medicare Advantage plan where the patient relinquishes their A and B then arrangements could be different. I assume these visits are medically necessary and not just done because the facility requires the visit.
Did you review your HCFA? Correct site of service, correct CPT code, correct diagnosis?

Snf

http://www.cms.hhs.gov/transmittals/downloads/R1757CP.pdf

medically necessary physician visits should be paid by Part B Medicare. There are diagnostic and therapeutic services that are included in the SNF, PPS. If provided the SNF is billed because they receive payment under consolidated billing.

Thanks

Thank you nmaguire! I have been getting code MA101 which the website you gave me refers to SNF is responsible for payment of outside providers who furnish these services/supplies .... This is just what I'm looking for. Thanks for your expertise.