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Recently at RCM360®, we became aware of an issue that was affecting one of our clients and could affect many others as well. The situation goes like this…

A patient is seen by a doctor in their office. During the visit, the patient has an x-ray performed with the understanding that the cost would be covered by Medicare Part B; however, it went unknown to the doctor’s office and Medicare that the patient was in a skilled nursing facility (SNF). Under the facility’s per diem payment, x-rays and other expenses for services and equipment provided within the SNF are already covered.

While Medicare originally covers the cost of the x-ray, after performing an internal audit, they become aware of the status of the SNF patient. They request the full amount of the x-ray back from the healthcare practice, despite it being performed at their office with their own equipment. In many cases, the doctor’s office will issue a refund to Medicare because they believe there is no other choice, or they perceive the cost to be an insignificant expense.

However, if a physician’s office writes off every relatively “small” expense, it could certainly add up over time. The experts here at RCM360® see this and want to educate medical professionals of their options.

What a Physician’s Office Can do if Medicare Requests Money Back for a Skilled Nursing Facility Patient’s X-Ray

To start, it is important to note the two components of an x-ray: the technical component, which is the use of the equipment; and the professional component, which is the interpretation of the x-ray. Both come into play when a physician’s office attempts to get some or all of that money back.

If Medicare requests money back, the physician’s office can…

  • Re-bill the SNF for the cost of the x-ray. The office can reach out to the patient’s nursing facility and make them aware of the situation. This method is not always ideal because it leaves the payment in the hands of the SNF, which can often fall through the cracks; however, if the doctor’s office fails to reach out, they’re losing out on the technical component of the x-ray.
  • Bill the professional component back to Medicare. The physician’s office has the ability to re-file the x-ray charge with a 26 modifier that specifies that the professional component—the interpretation or reading of that x-ray— is still billable and should be paid to the doctor’s office. Once again, the physician still cannot bill the technical piece to Medicare Part B or to the patient.

The best way to handle this in the first place is to find out if the patient is in a SNF unit before ever turning it over to Medicare. That way, the office can bill the SNF directly and avoid any confusion.

RCM360® Looks Out for Our Clients

At RCM360®, we ensure our clients are paid properly and promptly for their services. Despite it being a relatively smaller expense, the technical and professional components of an x-ray still equate to time and resources for which you deserve compensation.

We care about your financial well-being. We believe in giving you the information you need to avoid losing money to loopholes in Medicare billing regulations.

Learn more about other excluded services under consolidated billing or contact us if you have any questions or need assistance!