Provider Billing for SNF patient

If a provider sees a SNF patient in his office for arthrocentesis. How do you bill Medicare for that service? Modifier?

re: Provider Billing for SNF patient

modifier GV

re: Provider Billing for SNF patient

GV is for hospice patient. If it was just the procedure, bill it as usual, place of service SNF. If an E&M also then -25. There is no issue with doctor's professional charges in a SNF. Bill like you do in the office.

re: Provider Billing for SNF patient

MY GOSH! My old cheat sheet is clearly inaccurate. I won't be posting anything until confirming it. My apologies.

re: Provider Billing for SNF patient

no apologies needed. Read Wikipedia- you'll find lots of errors if you look close enough. A community-driven resource can never be 100% accurate. Thanks for contributing!

re: Provider Billing for SNF patient

You are right. GV is for Hospice only. The procedure was performed IN THE PROVIDER's office, not the SNF. So, cannot bill the SNF as the place of service. That's my delimma. I originally billed the procedure with the POS as 11, office, & Medicare denied b/c the pt is in a SNF.

re: Provider Billing for SNF patient

My understanding is you cannot get paid for any services provided by a physician in a doctor's office if the patient is in a skilled nursing facility and Medicare is their primary. Medicare pays a per diem rate to the skilled nursing facility. I had a patient that got chemo in the office and the family did not tell us the patient no longer lived independently. Medicare denied the bill. I billed the nursing facility and got paid a year later, only after a lawsuit ensued.

re: Provider Billing for SNF patient

I believe that the rule does allow payment to physician for professional services provided in the office. This would be any claims reported with E&M codes or any code that has a professional component. Any other fees to the physician would be due from the SNF since those fees are included in their per diem. Unless the physician has prior arrangements with the SNF, it is very difficult for the physician to be paid the technical fees by the SNF.