Skilled Nursing Facility Consolidated Billing

Published 6/1/2016

Payment for most beneficiary services in a Medicare-covered Part A Skilled Nursing Facility (SNF) stay, including most services provided by entities other than the SNF, are included in a bundled prospective payment. The SNF must bill these bundled services to the MAC in a consolidated bill.

Medicare Part B may pay for:

  • Outpatient services furnished to beneficiaries who are not inpatients of a SNF
  • Services excluded from SNF Prospective Payment System (PPS) and SNF Consolidated Billing (CB)
  • Certain “medical and other health services” furnished to beneficiaries residing in a SNF whose Part A benefits are exhausted or who are not otherwise entitled to payment under Part A

For more information on how SNF Consolidated Billing impacts your Part B claims, see the following resources.