Cutting Losses with Consolidated Billing in Rehab Facilities

If you’re finding that Medicare is kicking back a lot of your claims for being non-excluded services, there is something you can do to help your reimbursements – consolidated billing.

Use heavy documentation and case manage all physician visits. Follow up and use detailed documentation for each service the patient received. A good example of this is if a patient is in a rehab facility for a hip fracture and needs to see an orthopedist for follow-up, call the doctor to schedule the appointment and ask what the surgeon will need, such as imaging or lab work. Tell the managing physician to order those services and have the results sent to the office prior to the patient’s visit. This will keep the physician from ordering expensive MRI or CAT scans and your rehab facility will wind up footing the bill for those services as Medicare will only pay for expensive imaging services when they are provided by a bona fide hospital outpatient department that bills under the hospital’s provider number.

If the physician is adamant that their office do the lab work or imaging, make arrangements for that physicians office to receive the bill. You should also verify HCPCS codes before a rehab resident receives treatment. Check to see if the item is an excluded service.

By keeping a lid on services that are performed outside your rehab facility that you will wind up footing the bill for, you can use consolidated methods and close case management to get the best reimbursements while providing high quality treatment to your residents.

View all Articles by: Melissa Clark, CCS-P