Swallow study billing and reimbursement in the SNF setting is confusing! Here we address some of the most frequently asked questions about FEES billing and reimbursement in SNFs. We are always available to answer questions and to help navigate these tricky waters with you!
Why can’t Carolina Speech Pathology bill Medicare directly?
- In the 90s, Medicare changed the billing requirements for SNFs and mandated that all therapy services, including the SLP codes for swallow studies, must be billed directly to the SNF. The SNF receives daily money from Medicare to pay for swallow studies for Part A residents. The SNF bills Medicare directly for FEES reimbursement for Part B residents.
How does a SNF bill Medicare directly for reimbursement for Part B when the facility is not providing the FEES services directly?
- There are a couple of different options:
- The business office can add the CPT code for FEES (92612) to the resident’s monthly bill using TOB22x.
- The facility SLP can enter the CPT code for FEES (92612) into the documentation software.
- Carolina Speech Pathology can acquire a log-in username for our staff to bill directly in your software (additional charges may apply with this option).
Wait wait wait. How can a facility SLP bill for an exam that they themselves did not complete?
- Medicare allows the facility SLP to bill “on behalf of Carolina Speech Pathology.” The facility SLP enters the CPT code for FEES (92612) and documents “Carolina Speech Pathology completed a FEES, entering code on behalf of Carolina Speech Pathology per Consolidated Billing guidelines.” Medicare mandates that the facility must bill out for the service, so this can be facilitated by a facility SLP with clear documentation that they are billing on behalf of the vendor.
What are “Consolidated Billing guidelines”?
- Consolidated Billing is the mandate that states that the SNF is responsible for billing the entire package of care to Medicare, including therapy exams completed by outside vendors, such as FEES.
I thought outside vendors could bill Medicare directly for residents receiving services under Part B? Why aren’t you doing that?
- Consolidated Billing still applies for any therapy service provided to residents receiving services under Part B. Although other types of vendors are allowed to bill Part B directly (for example, mobile x-ray companies), Carolina Speech Pathology is providing a therapy service and therefore is required to bill the facility directly regardless of the payor source.
What happens if my facility does not bill Medicare for FEES completed by Carolina Speech Pathology?
- Carolina Speech Pathology will invoice your facility as required by Medicare. If your facility does not bill the service to Medicare, then the facility will not be reimbursed for the exam.
Can you bill Medicare Advantage Plans directly?
- No. Medicare Advantage Plans also operate under Consolidated Billing guidelines, so the process is the same for residents covered under these plans.
What if the resident is Private Pay?
- Per the service agreement put in place with your facility, Carolina Speech Pathology will bill the facility directly. If the facility is invoicing a Private Pay resident for services provided during their SNF stay, FEES can be added to that invoice.
What if I have questions not addressed in this blog?
- Reach out to us any time: firstname.lastname@example.org. We look forward to collaborating with you to help your residents access the services they need!