Split Billing in SNFs: When to Bill Medicare Part A vs. Part B

 

Navigating Medicare billing in Skilled Nursing Facilities (SNFs) can be overwhelming—even for seasoned healthcare professionals. One of the biggest challenges? Knowing whether a service should be billed under Medicare Part A or Part B. This process, called split billing, plays a crucial role in maximizing reimbursement and avoiding claim denials.

For SNFs, getting this right isn’t just about money—it’s about compliance, documentation, and protecting the facility’s long-term financial health. In this article, we’ll break down how split billing works, when each Medicare part applies, and how outsourcing SNF billing can help simplify the process.

What Is Split Billing in Skilled Nursing Facilities?

Split billing refers to dividing medical charges between Medicare Part A and Part B based on patient eligibility and the type of services delivered. SNFs are responsible for identifying which services fall under each category—and billing accordingly.

Mistakes in split billing can result in:

• Denied claims
• Compliance audits
• Delayed reimbursements
• Lost revenue

In short, it’s a high-stakes part of your billing process that deserves extra attention.

Understanding the Difference: Medicare Part A vs. Part B in SNFs

Before you decide how to bill, it’s essential to understand what each Medicare part covers—and when they apply.

Medicare Part A: For Inpatient SNF Care

Medicare Part A covers skilled inpatient care after a qualifying hospital stay. To be eligible:

• The patient must have a 3-day hospital stay
• They must be admitted to the SNF within 30 days of discharge
• Care must be skilled and medically necessary

Coverage includes:

• Room and board
• Nursing care
• Meals
• In-house therapy
• Medical supplies and routine diagnostics

Part A offers coverage for up to 100 days per benefit period, with the first 20 days fully covered and coinsurance applying after that.

Medicare Part B: For Outpatient or Non-Bundled Services

Medicare Part B kicks in when:

• The patient is not eligible for Part A
• Part A coverage has expired
• The service is outpatient or excluded from Part A bundled billing

Coverage includes:

• Physician visits
• Diagnostic tests (e.g., labs, X-rays)
• Outpatient therapies
• Durable Medical Equipment (DME)
• Mental health services
• Ambulance transport (when medically necessary)

Each Part B service must be coded individually using CPT/HCPCS codes and must meet medical necessity documentation standards.

The Role of Consolidated Billing in SNFs

If a patient is covered under Medicare Part A, SNFs are required to follow consolidated billing rules. That means the SNF must bill Medicare for nearly all services—even those performed by outside providers.

Services Typically Included Under Part A Consolidated Billing:

• Nursing services
• Therapy provided in-house
• Medications during stay
• Routine labs and imaging
• Enteral/parenteral nutrition
• Medical equipment used inside the SNF

Services Excluded from Consolidated Billing (Bill Separately Under Part B):

• Physician services
• Advanced imaging (MRI, CT scans)
• Chemotherapy and specific high-cost drugs
• Dialysis
• Certain ambulance services
• Prosthetics/orthotics not commonly supplied by SNFs

When a patient is no longer covered by Part A, or the service is excluded from bundled billing, Part B becomes the appropriate billing route.

Why Split Billing Knowledge Matters

Incorrectly billing Part A instead of Part B (or vice versa) can result in:

• Claim rejections
• Repayment demands from CMS
• Costly delays in reimbursement
• Medicare audits

Every SNF must have solid internal processes or partners in place to ensure proper eligibility checks, documentation, and code accuracy. Knowing when coverage begins, ends, and transitions is the key to smooth billing workflows.

How Outsourcing Can Help Your SNF

Split billing requires attention to detail, knowledge of evolving Medicare policies, and constant tracking of benefit days. For many SNFs, managing this in-house is resource-intensive.

That’s why facilities are turning to offshore medical billing and coding providers with SNF expertise.

With the right billing partner, you get:

• Accurate eligibility checks
• Timely claims submission
• Clean claim rates
• Fewer denials
• End-to-end revenue cycle management

Conclusion

Split billing in SNFs goes beyond simply choosing between Medicare Part A or Part B. It requires careful eligibility verification, accurate coding, and a thorough understanding of consolidated billing rules. Any mistake during the process can result in financial losses, compliance issues, and even audits. To manage these complexities, the best approach includes proper training, accurate documentation, and reliable billing support.

Many SNFs now trust offshore medical billing and coding service providers in India to manage their Medicare billing more efficiently and cost-effectively.

Info Hub Consultancy Services is your trusted partner, as it is for many SNFs. We offer end-to-end solutions to ensure timely and accurate Medicare billing for your facility. Outsource medical billing and coding with Info Hub Consultancy Services and experience seamless, compliant, and profitable operations.

FAQs

1. Can SNFs bill both Medicare Part A and B on the same day?
No, only one part can be billed per service per day.

2. When does Part B apply in SNFs?
Part B applies when Part A benefits are exhausted or when services fall outside bundled billing.

3. Is a private room covered under Medicare?
Only if it’s medically necessary and properly documented.

4. Does Medicare cover telehealth in SNFs?
Yes, under Part B and specific conditions.

5. What if a patient switches to Original Medicare mid-stay?
SNFs must adjust billing based on the new plan immediately.

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