American Urological Association - Skilled Nursing Facilities

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Home Practice Resources Coding and Reimbursement Coding Resources and Information Skilled Nursing Facilities

Skilled Nursing Facilities


Q.   What is skilled nursing facility (SNF) care?

A.   SNF care is health care that is given when a patient needs skilled health care staff to manage, observe and manage a patient's care. Care that is given by non-professional health care providers is not considered skilled care.


Q.   Where are SNFs located?

A.   A SNF can be part of a nursing home or hospital. Medicare certifies facilities if they have the necessary staff and equipment to care for certain needs of a patient.


Q.   Does Medicare pay for SNF care services?

A.   Medicare will only cover certain SNF care services that are needed on a daily short-term basis up to 100 days. Services will be covered under the patient's Medicare Part A.


Q.   What is Consolidated Billing?

A.   In 1998, Medicare implemented a specific payment system specifically for SNFs. Under this form of billing the SNF is the generally the only entity that can bill Medicare for services rendered to its residents.


Q.   A patient came to our office that resides in a skilled nursing facility recovering from an illness, how can our physicians be reimbursed for their services?

A.   If a patient presents to a physician's office that resides in a SNF, there are certain services that are excluded from the consolidated billing requirement. These services are considered to be separately billed by the physician's office and are reimbursable by Medicare. There are certain services that have been excluded and they are:

  • Physician's professional services;
  • Certain chemotherapy drugs and
  • Certain chemotherapy administration services

For the entire listing of excluded services, please visit the CMS website.

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