Frequently Asked Questions: FAQs

1. I believe to be getting my Modified Barium Swallow Studies (MBSS) for “free”, how is that?
Recognize if you are in fact receiving the MBSS at no soct. It may arrive at your facility billed as many different services, such as Radiology time, fluoroscopy suite rental, speech therapy services, etc. Or the bill may come less frequently than once per swallow study. The hospital may bill monthly, quarterly, or annually. The rules clearly state therapy services fall under Consolidated Billing regardless of the site of care. Also recall the other costs associated with sending patients out: transportation costs, loss of rehab productivity time for all therapy services, the cost in the delay of getting the report back, cost of extended scheduling time, etc.

2. But Consolidated Billing rules only refer to Part A patients, correct?
No. The rules are clearly stated. All therapy services (both Part A and B) fall under the Consolidated Billing rules.

3. What about if I’m getting the MBSS done by a portable truck and not by the hospital?
Again, the Consolidated Billing legislation is very clearly stated that PT, OT, and SLP serviced provided to SNF residents are always subject to consolidated billing. A Modified Barium Swallow Study is a therapy service, too.

4. What is “unbundling” a therapy service?
Prior to the Balanced Budget Act of 1997, it was common for the SNF to permit an outside supplier to provide the service directly to the resident and the outside supplier would bill directly to Medicare Part B, without involving the SNF. However, this practice was problematic and thus was the whole reason the Consolidated Billing rules were enforced. The new rules eliminate the potential for duplicative billings for the same service and also enhances the SNF’s capacity to meet its existing responsibility to oversee and coordinate the total package of care that each of its residents receives. See website: http://www.cms.gov/SNFPPS/05_ConsolidatedBilling.asp

5. Are there some services that don’t fall under Consolidated Billing?
Yes. There is a listing of such services, such as physician services, cardiac catheterizations, MRIs and emergency services, etc. However, not PT, OT or ST therapy services. You can find those listed at the website: http://www.cms.gov/SNFPPS/05_ConsolidatedBilling.asp