tci Medicare Compliance & Reimbursement - 2012 Issue 10

Reader Question: Ensure That Physician Performs Initial Nursing Facility Visit

Question: I am receiving denial C0-170 (Payment is denied when preformed/billed by this type of provider) from Medicare when I bill for an initial nursing facility visit our physician assistant (PA) did. I am using place of service code 31 (Skilled Nursing Facility) and provider type 38 (Physician assistant). Why am I getting this denial? Answer: You cannot bill an initial visit in a skilled nursing facility (SNF) or nursing facility (NF) using 99304-99306 (Initial nursing facility care, per day, for the evaluation and management of a patient ...) under a physician assistant (PA), per Medicare rules. Medicare says...

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