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About SNF Consolidated Billing...

The Balanced Budget Act of 1997 requires that all Medicare covered services provided to an inpatient of Skilled Nursing Facility (SNF) be bundled to the SNF unless they have specifically been excluded. Essentially, this means that the SNF, along with each entity that provides services for SNF Part A inpatients must know what services are bundled to the SNF and under what circumstances each service is bundled. Additionally, the SNF and the supplier, clinic, physician or hospital must make arrangements for services and agree on how much is paid by the SNF.

The Medicare program provides for payment to the SNF under one of sixty-four Resource Utilization Groups (RUGS) for the entire bundle of services. It is the responsibility of the SNF to make arrangements for all services its patients may require. A critical part of the arrangement is the determination of the amount charged by the supplier and paid by the SNF. It is important to note that neither the Center for Medicare and Medicaid Services (CMS) nor the Office of the Inspector General (OIG) require any specific level of payment. The SNF and the supplier are free to negotiate price. In almost every case, the applicable fee schedule is the baseline for calculating payment. Our web page at specializes in knowing what services are bundled, why they are bundled and provides the applicable Medicare fee schedule.