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FEES Billing & Reimbursement FAQs

Billing and reimbursement for swallow studies in the SNF setting can be quite confusing! Here, we tackle some of the most common questions about FEES billing and reimbursement in SNFs. We’re always here to answer your questions and help you navigate these complex issues!

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Why can't Marigold Speech bill Medicare directly?

In the 1990s, Medicare updated the billing requirements for SNFs, mandating that all therapy services, including SLP codes for swallow studies, be billed directly to the SNF. The SNF receives daily funding from Medicare to cover swallow studies for Part A residents, while they bill Medicare directly for FEES reimbursement for Part B residents.

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How does a SNF bill Medicare directly for reimbursement for Part B when the facility is not providing the FEES services directly?

Medicare permits the facility SLP to bill “on behalf of Marigold Speech.” The facility SLP enters the CPT code for FEES (92612) and documents that “Marigold Speech completed a FEES, entering code on behalf of Marigold Speech per Consolidated Billing guidelines.” Medicare requires that the facility handle billing for the service, which can be managed by a facility SLP with clear documentation indicating they are billing on behalf of the vendor. Marigold Speech will invoice your facility as required by Medicare. If your facility does not bill the service to Medicare, then the facility will not be reimbursed for the exam. 

Therefore, we suggest your facility can add the CPT code for FEES (92612) to the resident’s monthly bill.​

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What are “Consolidated Billing guidelines”? I thought outside vendors could bill Medicare directly for residents receiving services under Part B? Why aren’t you doing that?

Consolidated Billing is the requirement that the SNF must bill Medicare for the entire package of care, including therapy evaluations conducted by outside vendors, such as FEES. Consolidated Billing continues to apply to any therapy service provided to residents under Part B. Although other vendors, like mobile x-ray companies, can bill Part B directly, Marigold Speech, as a therapy service provider, must bill the facility directly, regardless of the payer source. Medicare Advantage Plans also operate under Consolidated Billing guidelines, so the process is the same for residents covered under these plans. 

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What if the resident is Private Pay?

Marigold Speech will bill the facility directly. If the facility is invoicing a Private Pay resident for services provided during their SNF stay, FEES can be added to that invoice. 

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What if I have questions not addressed in this blog?

Reach out to us any time! We look forward to collaborating with you to help your residents access the services they need!

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