Edit to Prevent Payment of Facility Fees for Services Billed by

110.2.7 - Edit to Prevent Payment of Facility Fees for Services Billed by an Ambulatory Surgical Center (ASC) when Rendered to a Beneficiary in a Part A Stay (Rev. 1911; Issued: 02-05-10; Effective Date: 01-01-08; Implementation Date: 07- 06-10) The Balanced Budget Act (BBA) of 1997 required the implementation of a SNF prospective payment system and the consolidated billing of services provided to residents of the SNF. Facility services provided by a freestanding non-hospital ASC are included under the SNF CB provisions. This edit will prevent payment of those facility services when provided in an ASC to a beneficiary in a Part A SNF CB stay. Effective for claims with dates of service on or after January 1, 2008 that are processed on or after July 6, 2010, when CWF receives a claim for a facility service from an ASC that is enrolled as a provider specialty type 49, and the service has a Type of Service F, and the patient is in a Part A SNF stay, it shall notify the A/B MACs (B) that they shall reject the claim line for the service(s). It shall send the same trailer that is currently sent for services subject to SNF consolidated billing. (The services subject to this editing will also appear on the ASC Fee schedule.) Also, when CWF receives a Part A SNF claim, it shall also notify A/B MACs (A), (B), or (HHH), and DME MACs through an unsolicited response of any facility services as described above that were incorrectly paid. MACs shall follow current processes to recoup any overpayments. A/B MACs (A), (B), (HHH), or DME MACs shall return the same messages found in Section 110.2.1C.