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Q. Are services for a Skilled Nursing Facility (SNF) Part A resident, received by a physician from a Rural Health Clinic (RHC) or a Federally Qualified Health Center (FQHC) subject to consolidated billing?

Patient Financial Services Weekly Advisor, November 16, 2007

Q. Are services for a Skilled Nursing Facility (SNF) Part A resident, received by a physician from a Rural Health Clinic (RHC) or a Federally Qualified Health Center (FQHC) subject to consolidated billing?

A. No. Effective with services furnished on or after January 1, 2005, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Section 410, amended the law to specify that when an SNF Part A resident receives the services of a physician from an RHC or FQHC, then those services are not subject to consolidated billing merely by virtue of being furnished under the auspices of the RHC or FQHC.

This exclusion also applies to any other type of practitioner that the law identifies as being excluded from SNF consolidated billing. Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Section 410, services otherwise included within the scope of RHC and FQHC services that are also described in the Social Security Act (Section 1888(e)(2)(A)(ii) are excluded from consolidated billing, effective with services furnished on or after January 1, 2005. Only this subset of RHC/FQHC services may be covered and paid separately when furnished to SNF residents during a covered Part A stay. Source: Centers for Medicare & Medicaid Services

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