SNF Consolidated Billing: Who Really Has to Pay All These Invoices? - On-Demand
February 24, 2015
This is a rebroadcast of the September 17, 2014 webcast.
Janet Potter, CPA, MAS
Knowing whether a service invoice for a Part A resident needs to be paid under consolidated billing is often a difficult task. In this 90-minute webcast, expert Janet Potter, CPA, MAS, discusses the five major categories of skilled nursing facility consolidated billing and the inclusions and exclusions that apply to each. Through each of these details, Potter outlines what steps to take when a vendor invoice is received and how to investigate whether it should be paid.
At the conclusion of this program, participants will be able to:
- Determine if a service or procedure is included in or excluded from SNF consolidated billing
- Determine the Medicare allowable payment amount and be confident negotiating with vendors
- Improve communications between residents and family, facility staff, and outside vendors to avoid costly consolidated billing issues
1) What are the five major categories of SNF consolidated billing? What is included and excluded in each of the categories?
- Category 1: Services that have to be done in hospital
- Category 2: Hospice
- Category 3: Chemotherapy drugs (change quarterly)
- Category 4: Preventative services (flu shots)
- Category 5: Therapy services
- Educating people on prevention
2) Exclusion versus inclusion: Getting the terminology straight
- SNF Healthfiles (updated by CMS)
- Exclusions vs. inclusions
3) Why location matters—the same service can be paid very differently if provided in a different setting
4) Steps to take when a vendor invoice is received for a Part A resident
Who Should Attend
SNF billers, SNF business office managers, administrators, floor nurses, DONs
CMS’ major categories of exclusions
Meet the Speaker
As a manager in the healthcare research team at FR&R Healthcare Consulting, Inc., Janet Potter, CPA, MAS, delves into numerous aspects of the healthcare industry, including HIPAA, the Medicare Prescription Drug Program (Part D), and research into ongoing regulations and various healthcare topics pertaining to Medicare and Illinois Medicaid. Potter is instrumental in the writing and preparation of client bulletins, speaker presentations, and seminar materials. She is responsible for monitoring industry websites for regulatory and compliance changes, informing clients and colleagues of the changes, and assisting in interpretation of new regulations and guidance. She researches client reimbursement and regulatory questions in many long-term care settings, including skilled nursing facilities, home health agencies, hospices, rehab agencies, and physician practices.
Potter received her Bachelor of Science in Community Health Education and a master’s degree in accounting science at Northern Illinois University; she is also a certified public accountant. A frequent speaker on healthcare topics, she has presented seminars for the Illinois Health Care Association, Leading Age Michigan, the Illinois Home Care Council, and the Illinois Nursing Home Administrators Association. Potter is a member of the editorial advisory board for Billing Alert for Long-Term Care, published by HCPro, and is a frequent contributor to PPS Alert for Long-Term Care and other HCPro publications. She is the coauthor of “Recovery Audit Contractors: How to Stay Ahead of the Game,” a white paper published by Leading Age. She is a member of the Illinois CPA Society and AICPA.
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