AOPA Works to Resolve SNF Billing Issues

AOPA knows that the process for getting paid for devices provided while patients are in a skilled nursing facility (SNF) or hospital can be frustrating and time-consuming. AOPA staff has been persistently requesting clarification on these issues from CMS, and met with CMS officials in October to clarify various billing scenarios.

As a result of some recent changes, there are numerous confusing scenarios related to who should pay for O&P devices provided to patients in a hospital or Part A SNF stay. AOPA initially requested clarification in April 2006, after CMS stated that any devices prescribed for patients while they were at home but delivered to patients while they were in a hospital or SNF facility would fall under medical necessity rules. Prior to this, date of delivery was considered date of service and medical necessity rules did not apply.

Repeated follow-up with CMS officials brought about a meeting to discuss SNF billing issues. During this meeting, AOPA staff made it clear that the information distributed by CMS was not complete and was causing confusion and reimbursement problems for O&P practitioners.

CMS agreed that the information related to SNF billing was incomplete and committed to addressing all concerns in writing. It agreed to provide program memos to the DMACs outlining how to process such claims, but did not provide a time frame for completion. AOPA staff will continue to follow up, and once this information is complete, AOPA will share it with you.

Keep on top of this and other coding, billing and reimbursement changes from Medicare by reading the members-only e-newsletter AOPA In Advance. Send the e-mail addresses you wish to receive this newsletter, along with your AOPA member ID and street address, to mobrist@AOPAnet.org.

Not an AOPA member and want to receive AOPA In Advance? Contact Kelly O’Neill at koneill@AOPAnet.org or (571) 431-0852.