Payments for Ambulatory Surgical Center Services Provided to Beneficiaries in Skilled Nursing Facility Stays Covered Under Medicare Part A

Ambulatory surgical center (ASC) facility services, such as nursing, recovery care, anesthetics, drugs, and other supplies, provided to SNF residents are subject to consolidated billing and must be billed to the SNF rather than Medicare Part B. Physicians’ professional services are statutorily excluded from consolidated billing and may be billed to Medicare Part B.

The nationwide audit covered 20,906 Medicare Part B ASC facility services valued at $7,113,542 with dates of service in calendar years (CY) 2006 through 2008 that matched 14,192 Part A SNF stays and that thus represented potential overpayments. GAO sampled 100 services provided by 88 ASCs.

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