Understanding Consolidated Billing

Understanding  Consolidated Billing 

This course is designed to provide a better understanding of SNF PPS consolidated billing rules and regulations. A thorough understanding of how consolidated billing works is an important safeguard to the financial stability of the skilled nursing facility (SNF). This module covers terminology, definition of consolidated billing, the definition of “resident” for purposes of consolidated billing, major category I-IV exclusions, the HCPC file, professional versus technical component, principles to limit financial liability, best practice guidelines for reviewing provider invoices, and Medicare and physician fee schedules.
The content in this course is applicable to administrators, business office staff, and nurse managers/leaders, in the SNF setting.


Hours: 1.75


Certificates provided by accrediting body (0 Match)

Course Details

Course Code: REL-PAC-0-UCB
Hours: 1.75
Type: Online Course
Content Expiration Date: 12/31/2022
Learning Objectives:
Define who identifies as a "resident" for consolidated billing purposes.
Describe the five Major Categories of items or services under consolidated billing.
Identify ambulance services excluded under consolidated billing.
Discuss the use of CMS HCPC files to identify items or services included or excluded from SNF consolidated billing.
List key steps in minimizing liability under SNF consolidated billing.

Section 1: Introduction

About This Course

Learning Objectives

Section 2: Key Terminology


Section 3: Introduction to Consolidated Billing

Defining Consolidated Billing

Definition of “Resident” for Purposes of Consolidated Billing



Section 4: Consolidated Billing Major Category Exclusions

Major Categories

Major Category I: Exclusion of Services Beyond the Scope of a SNF

Major Category II: Additional Services Excluded When Rendered to Specific Beneficiaries

Major Category III: Additional Excluded Services Rendered by Certified Providers

Major Category IV: Preventative and Screening Services

Major Category V: Part B Services Included in SNF Consolidated Billing



Section 5: Additional Excluded Services

Professional Services

Ambulance Services

Medicare Non-Covered Services



Section 6: HCPC Files

Introduction to the HCPC File

Section 7: Limiting Financial Liability

Limiting Financial Liability under Consolidated Billing

Best Practice Guidelines for Reviewing Provider Invoices

“Under Arrangement”

Medicare and Physician Fee Schedules



Section 8: Conclusion


Course Contributor



Instructor: Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM Trainer
Ronald Orth, RN, CMAC, CHC  obtained a nursing degree from Milwaukee Area Technical College in 1985 and a B. A. in Health Care Administration from Concordia University in 1996. Mr. Orth possesses over 30 years of nursing experience with over 20 of those in the Skilled Nursing industry. Mr. Orth has extensive experience in teaching Medicare regulations to healthcare providers both in the US and internationally. Mr. Orth is currently the Post-acute Care Curriculum Designer and is certified in Healthcare Compliance through the Compliance Certification Board (CCB). Ron has also successfully completed the Infection Control Officer training through the AHCA and is an AHIMA approved ICD-10-CM trainer. Disclosure: Ron Orth RN, CHC, CMAC, AHIMA-Approved ICD-10-CM Trainer has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Target Audience:
The target audience for this course is: Nurses; in the following settings: Post-Acute Care.
Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
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