Reminder for Skilled Nursing Facility (SNF) for Laboratory Services This is a reminder that when a beneficiary in an SNF is taken to a laboratory off of the premises, or a specimen from the beneficiary is sent to a laboratory, the SNF needs to make sure the laboratory is given a valid Health Insurance Claim (HIC) number for the beneficiary. SNFs must make arrangements under Part A and may make arrangements under Part B under which the SNF bills the intermediary and receives payment and payment is given to the laboratory. Laboratory tests performed for the SNFs Medicare inpatient covered under Part A are included in the SNF prospective payment system (PPS) rate and laboratories cannot bill separately. In the absence of such an arrangement under Part B, the laboratory may bill Medicare for laboratory services furnished to beneficiaries for whom Part A cannot be paid and for SNF outpatients and the SNF may not bill the program for these services. Hospital laboratories and laboratories in other SNFs would bill the intermediary. Independent laboratories would bill the carrier. There have been instances where an invalid HIC number or no HIC number information has been provided to the laboratory. Providing a valid HIC number will ensure that the laboratory claims are processed correctly by Medicare. All claims that are processed by Medicare require that a valid HIC number be entered on the claim. Providers should have a copy of the beneficiary’s Medicare card and verify that the information is correct using either the Interactive Voice Response (IVR) for Part A (1-877-567-7205 or for Part B (1-877-869-6504), or by checking the beneficiary eligibility in the Medicare claims processing system. Together we can work together to be sure that all claims submitted to Medicare are in total compliance with the regulations. © All current procedural terminology (CPT) codes and descriptors copyrighted by the American Medical Association. |
