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
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
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.