0142-ASC Services During a Covered Part A SNF Stay

Submitted by Matthew.Gregor… on Mon, 11/04/2019 - 07:47
Issue Number - Name
0142-ASC Services During a Covered Part A SNF Stay
Review Type
Automated
Claim Type
Ambulatory Surgical Center (ASC), Skilled Nursing Facility (SNF)
Region and State
RAC 1-4 <br/> All States
Date Approved
2019-02-05

Description

Facility Services provided by a freestanding non-hospital ASC (Ambulatory Surgery Center) are included under the SNF Consolidated Billing Provisions.  Certain services are not payable because they are included in SNF Consolidated Billing

Affected Codes

Codes are identified found in SNF Consolidated Billing–Part A MAC Updates for years 2015, 2016, 2017 and 2018–Major Category 1  Appendix D tables for 2015, 2016, 2017 and 2018

Applicable Policy References

Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1833(e)-Payment of Benefits
Social Security Act (SSA), Title XVIII-Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)-Exclusions from Coverage and Medicare as a Secondary Payer
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 6-SNF Inpatient Part A Billing and SNF Consolidated Billing, Section 20.1.2-Other Excluded Services Beyond the Scope of a SNF Part A Benefit
CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 6-SNF Inpatient Part A Billing and SNF Consolidated Billing, Section  110.2.7-Edit to Prevent Payment of Facility Fees for Services Billed by an Ambulatory Surgical Center (ASC) when Rendered to a Beneficiary in a Part A Stay
OIG Report, Payments for Ambulatory Surgical Center Services Provided to Beneficiaries in Skilled Nursing Facility Stays Covered Under Medicare Part A in Calendar Years 2006 through 2008 (A-01-0900521) December 2010 
SNF Consolidated Billing–Annual Updates for Part A MAC–2015, 2016, 2017 and 2018
SNF Consolidated Billing–General Explanation of the Major Categories for Skilled Nursing Facility