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.

Full GAO Report

Medicare Update: CMS Announces 2010 Medicare Premiums and Deductibles

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On October 16, 2009, the Centers for Medicare & Medicaid Services (CMS) released display copies of Notices announcing Medicare Part A and Part B premiums and deductibles for calendar year 2010.

Medicare Part A

The deductible for a beneficiary admitted as a hospital inpatient will be $1,100 in 2010, which is an increase of $32 from 2009. The Notices also indicate that a beneficiary will have to pay an additional $275 per day for days 61-90 in 2010, and $550 for lifetime reserve days. Further, the Notices indicate that the daily coinsurance for days 21-100 in a skilled nursing facility will increase to $137.50 in 2010.

According to CMS, 99 percent of Medicare beneficiaries do not have to pay a premium for Part A services. However, some seniors and certain other individuals under age 65 with disabilities, who have fewer than 30 quarters of coverage, may obtain Part A coverage by paying a monthly premium. That premium will be $461 per month in 2010. However, a reduced premium applies for individuals with 30-39 quarters of coverage, which will be $254 in 2010.

Medicare Part B

The Medicare Part B deductible for 2010 will be $155.

The 2010 Part B monthly premium rates for beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or who file a joint tax return are:
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