Tip: Part B Billing FAQs

Oct 18, 2019
The Bottom Line

The following are some frequently asked questions on Part B billing for SNFs:

Q: How should multiple units of the same HCPCS code given on the same day be listed on the UB-04 (e.g., four units of 97530 in OT)?
A: Units of the same HCPCS code provided by the same discipline on the same day should be listed on the same line item. In the previous example, it would be one line with four units of 97530, and the individual unit charge would be multiplied by four.


Q: Is it acceptable to take the ICD-10 codes from the face sheet or the hospital discharge paperwork?
A: No. The ICD-10 codes should always be reviewed by the clinician, therapist, or certified coder to ensure that they are the most accurate reflection of the reason the individual is receiving Part B services.


Q: Is an admission date required on a Part B claim?
A: Generally, no, you do not need an admission date for Part B. However, follow your MAC’s instructions if they differ.


Q: Can Medicare as secondary payer affect Part B claims?
A: Yes. Another insurance, such as an auto liability policy, can certainly be primary to traditional Medicare. Always screen for other payers.


Q: Why is the statement period for Medicare Part B a crucial issue?
A: Unlike Medicare Part A, most facilities do not keep a Medicare Part B census. If the resident was in the hospital for three days during the month, this may cause an overlap issue upon submission. SNFs should pay close attention to the therapy logs for discharge notations.


Q: Are therapy evaluations billed as one unit of service, regardless of therapist time spent completing the evaluation?
A: Yes, regardless of the amount of time spent on evaluations, providers can only bill for one unit.


Q: How often is the Physician Fee Schedule updated?
A: The Physician Fee Schedule is updated on January 1 of every year.

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