Billing Alert

X-Ray Charges


Program Memorandum A-00-88, which delayed Part B consolidated billing until further notice, also changed the way some services will be reimbursed effective April 1, 2001. The memorandum requires that the payment amount for Part B services furnished to SNF Part B inpatients and outpatients shall be the amount prescribed in the otherwise applicable fee schedule.

This change will affect a SNF's reimbursement on radiology services because these services are currently reimbursed under a reasonable cost basis. Services on or after April 1, 2001 will be reimbursed at 80% of the lower of your facility charge or the fee schedule amount. If your charge is less than the fee schedule amount, you will be paid 80% of your charge.

The resident is liable for 20% of the approved amount. Remember that unpaid coinsurance on any services reimbursed under a fee schedule cannot be claimed as a coinsurance bad debt on the Medicare cost report. It is advisable to review your current contracts. Depending on your payment arrangements, billing for radiology services may no longer be profitable.

This memorandum could also affect blood glucose tests for patients in the certified unit, which are currently being reimbursed under the reasonable cost basis. However HCFA has not put it in writing that the tests will be paid under the fee schedule.

For assistance in Medicaid and Medicare billing issues, contact Health Care Resources.

    Updated 01/26/2001