Hospital and Skilled Nursing Facility (SNF) Stays Impacting Part B Claims

Each month providers receive over $100,000.00 in part B denials or recoupments because a service was inappropriately billed to Part B when a patient was in a Part A stay. This is in accordance with CMS Internet Only Manual (IOM), Publication 100-04, Claims Processing Manual, Chapter 26, Section 10.5, "physician/practitioner/supplier furnishing services to a patient who is a registered inpatient, shall, at a minimum, report the inpatient hospital POS code 21 irrespective of the setting where the patient actually receives the face-to-face encounter."

If a patient is in a SNF or inpatient hospital stay, the claim will deny with the following remark codes:

  • CO-109: Claim/service not covered by this payer/contractor.
  • N193-Alert: Specific federal/state/local program may cover this service.

To avoid delays in payment, Noridian has the following tips:

  1. Verify all patient eligibility status on the Noridian Medicare Portal (NMP)
  2. Ensure there is open communication between ordering providers
    • If ordering a service for a patient, ensure your order includes the patient's status (e.g., under hospital care)
    • When receiving an order or referral from another provider, confirm the ordering or referring provider has provided patient's status
  3. Bill only the professional component of global services to Medicare Part B
  4. Confirm the place of service (POS) code is appropriate based on patient status

Resources

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