Consolidated Billing and PPS for SNF***

[Anthony Bui]

Hello All

I have a question regarding consolidated billing (CB) and reimburse rate in skill nursing facility (SNF). From my understanding, patient that admitted to a Medicare part A certified SNF is required to be assessed using MDS 3.0 to determine there Resource Utilization Group (RUG) which in turn is used to determine the per diem rate that Center Medicare Service (CMS) will reimburse the SNF. If my understanding is right, after a rate is determined, SNF will receive that reimbursed rate for that patient for the entire stay. If that is the case then why do SNF still have to bill the CB? SNF will receive that fixed rate regardless so why spending time billing knowing if the bill is more the SNF won't get any more money?

I am dying for the answer (:

Thank you

[roser13, ASN, RN]

Are you sure that a nursing forum is the right place to ask your question? Sounds more like a Billing Department issue. Maybe some nurses do go that deeply into payment issues, but thankfully not me.